To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests.

HR 1159 - To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests H.R.1186 - To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. Bad Debt Payments to Hospitals Lawmakers have proposed lowering the amount of Medicare Bad Debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. Oppose changes to current law impacting Medicare Documentation and Coding. Direct and Indirect Graduate Medical Education Payments Lawmakers have proposed changes to the way that hospitals are reimbursed for the costs of training physicians and other medical professionals. S. 2620 - Rural Hospital Access Act of 2012- A bill that would extend the Medicare Dependent Hospital (MDH) and current Low-Volume Hospital (LVH) programs and would prevent the pending expiration of both programs on October, 1 2012. Oppose the lowering of Medicare outpatients rates for Evaluation and Management visits in a hospital S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act of 2011 - A bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program, and for other purposes. Oppose the reduction of allowed Medicaid provider taxes in states Oppose any cuts to the Medicaid DSH funds above and beyond what was legislated in the Affordable Care Act CMS Coverage Determination Policy Support a long-term patch or full repeal of the Sustainable Growth Rate for Physician payments in Medicare Oppose the proposal of lowering Medicare reimbursements to Inpatient Rehabilitation Facilities. Support a reasonable one-time budget neutrality adjustment for long-term care hospitals. Medicaid and Medicare dual-eligibles- limit the size, scope and envisioned savings from the dual-eligibles demonstrations per the Affordable Care Act (ACA). Inpatient Prospective Payment System- CMS proposed rule for hospitals paid under the Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System that would increase Medicare's operating payments to acute-care hospitals for fiscal year 2013. Sequestration - work to mitigate impact of Medicare sequestration on hospitals per the Budget Control Act. S. 3391- the Taking Essential Steps for Testing (TEST) Act of 2012- A bill that would provide CMS with flexibility to apply sanctions appropriate to the level of noncompliance and improve access to essential laboratory services. Advocate in support of reauthorization of funding for quality measure development, endorsement, pre-rulemaking review and recommendations, and collection of data analyzing measure implementation under MIPPA (P.L. 110-275, Section 1980 ) and ACA (P.L. 111-148, Section 3014) for the consensus-based entity (National Quality Forum). H.R. 6575, "Medicare Audit Improvement Act of 2012" -- supports legislation to improve Medicare audits.

Client expense: $580,000 · Firm income: Not reported

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

H.R. 1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals. H.R. 1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. Physician owned hospital issues

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

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

Following medicare/medicaid, reimbursement and self referral issues. H.R. 1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition of certain physician referrals for hospitals. H.R. 1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Following medicare/medicaid, reimbursement and self referral issues.H.R. 1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition of certain physician referrals for hospitals. H.R. 1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. H.R. 5651, Food and Drug Reform Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support the speedy implementation of the National Alzheimer's Project Act (NAPA) by HHS, and support Leaders Engaged on Alzheimer's Disease (LEAD) recommendations as to how to proceed. Support repeal of Section 6001 of the PPACA and remove all restrictions on physician-owned hospitals. (Support H.R. 1159 and H.R. 1186) Support extensive clinical trials, manufacturing inspections and post-market surveillance for all biosimilar drugs. Support higher PDUFA fees for biosimilar drugs to pay for the additional safeguards needed. Oppose federal budget cuts that would increase co-payments for home health care services under Medicare and/or Medicaid. Support all legislative and regulatory action to modernize the FDA and to speed new cures and therapies to patients. Support the Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (S. 1096, H.R. 2020) Support Leaders Engaged on Alzheimer's Disease (LEAD) FY 2012 funding proposals in the amount of for $35 billion for the National Institutes of Health (NIH), $1.4 billion for the National Institute on Aging (NIA), $100 million for the Cures Acceleration Network (CAN), $11.46 million for the Alzheimer's Disease Supportive Services Program (ADSSP), $192 million for the National Family Caregiver Support Program (NFCSP), $50 million for the Lifespan Respite Care Program (LRCP), and$2.744 billion for the Food and Drug Administration (FDA), as well as $2 million for the Missing Alzheimer's Disease Patient Alert Program and $750,000 to organize and host a high-level meeting to focus on the global Alzheimer's disease crisis. Oppose proposals that would reduce Medicare payments for providers of drugs and biologics under Medicare Part B. Support the proposed Prescription Drug User Fee Act Reauthorization Agreement (PDUFA-V) now under consideration by the Congress for reauthorization. Support an extension of the Therapeutic Discovery Project Tax Credit (I.R.C. 48D). Oppose the proposed merger between pharmacy benefit managers (PBM) Medco Health Solutions (Medco) and Express Scripts, Inc. (ESI), including comments to the Federal Trade Commission on the merger's obvious danger to older Americans. Support the development of clearly-defined, comprehensive, patient-centric Essential Health Benefits rules under the Affordable Care Act. Support the Counterfeit Drug Penalty Enhancement Act of 2011. Joined other patient advocate organizations to urge the National Government Services to reconsider its policy regarding blanket denials under the Current Procedural Terminology (CPT) health and behavioral assessment and intervention codes (96150-96155) which restrict those medically appropriate services to Medicare beneficiaries with Alzheimer's disease. Joined other patient advocate organizations January 2012 to urge HHS to ensure that ACA "Essential Health Benefits" guidelines provide comprehensive, quality and affordable health care. This was in response to the HHS December 16, 2011 bulletin on Essential Health Benefits because the HHS bulletin did not provide adequate patient protections as intended under the ACA. Joined other patient advocate groups to support the Spending Reductions through Innovations in Therapies (SPRINT) Act (H.R. 3891 and S. 2064) Support H.R.5998, the USPSTF Transparency and Accountability Act of 2012. Support the creation of the National Center for AdvancingTranslations Sciences' (NCATS) "Discovering New Therapeutic Uses for Existing Molecules Initiative." Support the new Centers for Disease Control recommendations regarding the identification of chronic Hepatitis C infections. Urge all providers and payers to follow those same CDC recommendations. Oppose the substitution and use of unapproved and off-label drugs to treat age-related macular degeneration (AMD). Urge the Department of HHS to adopt the Advisory Council on Alzheimer's Research recommendations and ensure that the final National Alzheimer's Plan includes measures: Providing high-level, overall accountability for National Plan implementation. Recognizing and proposing a path forward to secure the public and private resources needed to achieve all of the goals. Forming robust public-private partnerships between government and industry to inform the research agenda, shorten the time and cost of developing therapies, and accelerate delivery of safe and effective treatments to individuals with Alzheimers. Fostering greater collaboration on research and other issues with international counterparts to achieve global coordination and progress toward a Global Alzheimers Action Plan. Expanding attention on early detection and diagnosis of Alzheimers disease. Ensuring access to the full array of long-term support services for special and emerging populations of people with Alzheimers disease, including younger people and those with developmental disabilities. Addressing caregivers physical and behavioral health. Expanding access to high quality, cost-effective and evidence based care and redoubling efforts to test and validate innovative care interventions. Support extensive clinical trials, manufacturing inspections and post-market surveillance for all biosimilar drugs. Support higher PDUFA fees for biosimilar drugs to pay for the additional safeguards needed. Support stiff restrictions on biosimilar "flexibility" (intentionally introducing differences to the molecule or the finished product) that adds high risk. Support distinctive labeling for safety, and install a strong track and trace system before the first biosimilar is allowed on the market. Support Congressional review and oversight to examine the National Alzheimer's Plan implementation progress. Support "unique naming" requirements for all biologic drugs, especially biosimilar drugs, as a matter of patient safety. Support full Medicare funding for dual energy x-ray absorptiometry (DXA) test reimbursement to fight osteoporosis. Support new extended funding (as under the expired Medicare Improvements for Patients and Providers Act or MIPPA) for Medicare low-income outreach and enrollment activities. Support the Medicare Part D prescription drug benefit program and the needed improvements to correct its limitations; including gaps in coverage, onerous cost-shifting created by specialty tiers, and restrictive utilization management tools. Robust formularies, coverage of the six protected drug classes, strong oversight, and transparency for consumers are also critical, as is a process for notice of non-coverage, and an appeals and exceptions process that is patient and provider friendly. Support all measures making Alzheimer's disease a continued top priority at the U.S. Food and Drug Administration (FDA).

Client expense: Not reported · Firm income: $6,710

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Support American Society of Consultant Pharmacists and "Short Cycle Dispensing Coalition" recommendations regarding the delay and study of new long-term care pharmacy dispensing rules and the impact of those rules on Medicare and Medicaid patients. Support H.R. 1055, the Part D Off-Label Prescription Drug Parity Act. Continue to oppose cuts to Medicare benefits, and continue to oppose the Independent Payment Advisory Board (IPAB). Support Medicare Access for Patients Rx (MAPRx) recommendations to Centers for Medicare and Medicaid Services (CMS) all regarding Medicare Part D. Those MAPRx recommendations are in regard to: Improved beneficiary protections; Better, more transparent Specialty Tier guidance including the threshold for inclusion on this tier and the inclusion of data for newly approved drugs; New, more realistic co-pay thresholds; Automatic disenrollment from Special Needs Plans; Proposed plan rating criteria; and Approval of six-tier formularies. These are in addition to MAPRx concerns regarding: The Part D Medicare appeals process and the handling of enrollee complaints; Drug dispensing rules for Part D beneficiaries in long-term care facilities; the Authority to deny bids and potential additional restrictions; and Compound Drug Policy. Support repeal of IPAB (H.R. 452). Support changes to the Medicare Shared Savings Program: Accountable Care Organization (ACO) proposed regulations, to provide additional safeguards to guarantee patient access to needed care, and to ensure that ACO's support the adoption of new treatments and cures for patients. Also support the addition of new Alzheimer's disease focused ACO quality measures, new ACO measures of provider evidence of competency in Geriatrics and Dementia, as well as a guarantee that Alzheimer's and Dementia patients under ACO care will have access to the newest pharmaceutical and biological treatments. Support repeal of Section 6001 of the PPACA and remove all restrictions on physician-owned hospitals. (Support H.R. 1159 and H.R. 1186) Oppose federal budget cuts that would increase co-payments for home health care services under Medicare and/or Medicaid Support the Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (S. 1096 and H.R. 2020) Support MAPRx suggestions to CMS on Medicare Part D Prescription Drug Program regarding new beneficiary-friendly point-of-sale notices that address problems in filling prescriptions and clear, instructive remedies for beneficiaries. Oppose proposals that would reduce payments to providers of drugs and biologics under Medicare Part B. Oppose proposals to increase Medicare Part D cost-sharing, raise Part D coinsurance, and/or freeze income thresholds. Oppose efforts to require Medicaid-type drug rebates from any Medicare Part D providers and all other kinds of mandated or negotiated Part D price controls that will harm beneficiaries and increase costs in other areas of Medicare. Support efforts to focus Medicare cost-saving efforts on eliminating improper payments, waste, fraud, and abuse first -- before cutting benefits, cutting payments to providers, or raising premium and coinsurance costs for beneficiaries. Support H.R. 3613 - Medicare Part D Beneficiary Appeals Fairness Act. Urged the "Super Committee" to resist proposals to erode beneficiary protections in Part D that ensure broad and accessible prescription drug formularies. Supported an extension of legislation to preserve access to osteoporosis testing for Medicare beneficiaries in the the final conference report on the Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3630). Joined other patient advocate organizations to urge the National Government Services to to reconsider its policy regarding blanket denials under the Current Procedural Terminology (CPT) health and behavioral assessment and intervention codes (96150-96155) which restrict those medically appropriate services to Medicare beneficiaries with Alzheimer's disease. Support the MAPRx comments regarding the Draft 2013 Medicare Call Letter regarding proposed actions related to the Part D Prescription Drug Program. These included improved comments on beneficiary protections; Specialty Tiers; Co-pay Thresholds; Tier Labeling; Plan Rating Criteria; Medicare Therapy Management; and Drug Utilization Review Controls in Part D. Oppose Centers for Medicare and Medicaid Services (CMS) regulation that subjects dual-eligible Medicare/Medicaid beneficiaries to new state programs that may well diminish their Medicare protections and lessen their access to quality health care services. This includes passive enrollment into a managed care plan and disruptions to the continuity of care. Support "unique naming" requirements for all biologic drugs, especially biosimilar drugs, as a matter of patient safety. Support full Medicare funding for dual energy x-ray absorptiometry (DXA) test reimbursement to fight osteoporosis. Support new extended funding (as under the expired Medicare Improvements for Patients and Providers Act or MIPPA) for Medicare low-income outreach and enrollment activities. Support the Medicare Part D prescription drug benefit program and the needed improvements to correct its limitations; including gaps in coverage, onerous cost-shifting created by specialty tiers, and restrictive utilization management tools. Robust formularies, coverage of the six protected drug classes, strong oversight, and transparency for consumers are also critical, as is a process for notice of non-coverage, and an appeals and exceptions process that is patient and provider friendly. Support all measures making Alzheimer's disease a continued top priority at the U.S. Food and Drug Administration (FDA).

Client expense: Not reported · Firm income: $6,710

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

suppport HR 1159 and HR 1186 to reverse restrictions on physician owned hospitals support legislation on increased reimbursement for ambulatory surgical centers (HR 2108 and S. 1173) oppose cuts to reimbursement for advanced medical imaging

Client expense: Not reported · Firm income: $24,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

suppport HR 1159 and HR 1186 to reverse restrictions on physician owned hospitals support legislation on increased reimbursement for ambulatory surgical centers (HR 2108 and S. 1173) oppose cuts to reimbursement for advanced medical imaging

Client expense: Not reported · Firm income: $24,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

support HR1159 and HR 1186 to reverse restrictive language on physician owned hospitals

Client expense: Not reported · Firm income: $12,600

Government targets: HOUSE OF REPRESENTATIVES, SENATE

support HR1159 and HR 1186 to reverse restrictive language on physician owned hospitals

Client expense: Not reported · Firm income: $12,600

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 1159 and HR 1186 ending ban on physician owned hospitals;oppose CMS cuts to medical imaging; support appropriateness model for diagnostic imaging;support IPAB repeal

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 1159 and HR 1186 ending ban on physician owned hospitals;oppose CMS cuts to medical imaging; support appropriateness model for diagnostic imaging; support IPAB repeal

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

monitor revisions to 75% Inpatient Rehabilitation Rule monitor legislation regarding Hospital in Hospital regulations support HR 1159 and HR 1186 ending ban on physician owned hospitals; support legislation reforming ASC reimbursement (HR 1173 and S 2108); monitor legislation affecting hospital not-for-profit status; monitor GME legislation

Client expense: Not reported · Firm income: $33,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 and HR 2783 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 1398 Rural Hospital Protection Act, legislation which would amend the Social Security Act to ensure that the full cost of certain provider taxes are considered allowable costs for purposes of Medicare reimbursements to CAHs; S 1486 Long-Term Care Hospital Improvement Act of 201, a bill to amend title XVIII of the Social Security Act to clarify and expand on criteria applicable to patient admission to and care furnished in long-term care hospitals participating in the Medicare program; Raising concerns about CMS flawed methodology that overstates the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to improve the regulation to implement ACOs; Urging CMS to update, streamline, and modernize the Medicare conditions of participation; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expired in September 2011, and the bills would reauthorize the CHGME program for an additional five years, through fiscal year (FY) 2016, at the current authorization level of up to $330 million a year; HR 1683/ S 868 Medicaid MOE, strikes provisions of ACA related to maintaining Medicaid eligibility levels; HR 1543 Improving Access to Medicare Coverage Act of 2011, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare; S 1251Medicare and Medicaid FAST Act, a bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs; HR 2500 Equal Access and Parity for Multi-Campus Hospitals Act, a bill 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 2674 340B Program Improvement Act, a bill to amend section 340B of the Public Health Service Act to improve the provision of discounts on drug purchases for certain safety net providers; HR 3630 Temporary Payroll Tax Cut Continuation Act of 2011 or Middle Class Tax Relief and Job Creation Act of 2011, a bill that cuts hospitals to pay for the doc fix, it contains the Social Security payroll tax cut and the Unemployment Insurance extension; HR 3519 a bill to amend and exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011; S. 1680 Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act of 2011, a bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program; Letter to Rehberg and DeLauro in support of the CHGME program that was circulated by Reps. Capps and Bilbray; Wyden/Crapo letter to CMS to actively oppose a Senate Dear Colleague letter to CMS in support of updating Medicare payments to ambulatory surgery centers (ASCs). The letter did not request a payment update for ASCs. Rather, the letter advocated against the Medicare payment rate for services provided in hospital outpatient department settings; HR 2954 and S 2474 Health Equity and Accountability Act of 2011, Comprehensive bill focused on eliminating racial and ethnic disparities in health care through improved data collection and reporting, culturally and linguistically-appropriate health care, workforce diversity, health information technology, and other actions; Discussions with the Administration (CMS) on applying the therapy cap to hospital outpatient departments; Worked to change CMS definition of allowed EHR costs for CAH Meaningful Use incentive payments to include capital lease purchases of EHRs; HR 3859 Rural Hospital and Provider Equity (R-HOPE) Act of 2012, to amend title XVIII of the SSA to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program; HR 4245 Veterans Co-Pay Fairness Act, to amend title 38, United States Code, to require the Secretary of Veterans Affairs to reimburse eligible veterans who are entitled to Medicare benefits for Medicare deductibles and other expenses that are owed by the veterans for emergency medical treatment provided in non-Department of Veterans affairs facilities; S 2620 and HR 5943 Rural Hospital Access Act of 2012, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; S 3187 and HR 5651Prescription Drug User Fee Amendments of 2012, a bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs and medical devices, to establish user-fee programs for generic drugs and biosimilars.

Client expense: $3,550,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Office of Management & Budget (OMB), SENATE, White House Office

Support the speedy implementation of the National Alzheimer's Project Act (NAPA) by HHS, and support Leaders Engaged on Alzheimer's Disease (LEAD) recommendations as to how to proceed. Support repeal of Section 6001 of the PPACA and remove all restrictions on physician-owned hospitals. (Support H.R. 1159 and H.R. 1186) Support extensive clinical trials, manufacturing inspections and post-market surveillance for all biosimilar drugs. Support higher PDUFA fees for biosimilar drugs to pay for the additional safeguards needed. Oppose federal budget cuts that would increase co-payments for home health care services under Medicare and/or Medicaid. Support all legislative and regulatory action to modernize the FDA and to speed new cures and therapies to patients. Support the Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (S. 1096, H.R. 2020) Support Leaders Engaged on Alzheimer's Disease (LEAD) FY 2012 funding proposals in the amount of for $35 billion for the National Institutes of Health (NIH), $1.4 billion for the National Institute on Aging (NIA), $100 million for the Cures Acceleration Network (CAN), $11.46 million for the Alzheimer's Disease Supportive Services Program (ADSSP), $192 million for the National Family Caregiver Support Program (NFCSP), $50 million for the Lifespan Respite Care Program (LRCP), and$2.744 billion for the Food and Drug Administration (FDA), as well as $2 million for the Missing Alzheimer's Disease Patient Alert Program and $750,000 to organize and host a high-level meeting to focus on the global Alzheimer's disease crisis. Oppose proposals that would reduce Medicare payments for providers of drugs and biologics under Medicare Part B. Support the proposed Prescription Drug User Fee Act Reauthorization Agreement (PDUFA-V) now under consideration by the Congress for reauthorization. Support an extension of the Therapeutic Discovery Project Tax Credit (I.R.C. 48D). Oppose the proposed merger between pharmacy benefit managers (PBM) Medco Health Solutions (Medco) and Express Scripts, Inc. (ESI), including comments to the Federal Trade Commission on the merger's obvious danger to older Americans. Support the development of clearly-defined, comprehensive, patient-centric Essential Health Benefits rules under the Affordable Care Act. Support the Counterfeit Drug Penalty Enhancement Act of 2011. Joined other patient advocate organizations to urge the National Government Services to reconsider its policy regarding blanket denials under the Current Procedural Terminology (CPT) health and behavioral assessment and intervention codes (96150-96155) which restrict those medically appropriate services to Medicare beneficiaries with Alzheimer's disease. Joined other patient advocate organizations January 2012 to urge HHS to ensure that ACA "Essential Health Benefits" guidelines provide comprehensive, quality and affordable health care. This was in response to the HHS December 16, 2011 bulletin on Essential Health Benefits because the HHS bulletin did not provide adequate patient protections as intended under the ACA. Joined other patient advocate groups to support the Spending Reductions through Innovations in Therapies (SPRINT) Act (H.R. 3891 and S. 2064) Support H.R.5998, the USPSTF Transparency and Accountability Act of 2012. Support the creation of the National Center for AdvancingTranslations Sciences' (NCATS) "Discovering New Therapeutic Uses for Existing Molecules Initiative." Support the new Centers for Disease Control recommendations regarding the identification of chronic Hepatitis C infections. Urge all providers and payers to follow those same CDC recommendations. Oppose the substitution and use of unapproved and off-label drugs to treat age-related macular degeneration (AMD). Urge the Department of HHS to adopt the Advisory Council on Alzheimer's Research recommendations and ensure that the final National Alzheimer's Plan includes measures: Providing high-level, overall accountability for National Plan implementation. Recognizing and proposing a path forward to secure the public and private resources needed to achieve all of the goals. Forming robust public-private partnerships between government and industry to inform the research agenda, shorten the time and cost of developing therapies, and accelerate delivery of safe and effective treatments to individuals with Alzheimers. Fostering greater collaboration on research and other issues with international counterparts to achieve global coordination and progress toward a Global Alzheimers Action Plan. Expanding attention on early detection and diagnosis of Alzheimers disease. Ensuring access to the full array of long-term support services for special and emerging populations of people with Alzheimers disease, including younger people and those with developmental disabilities. Addressing caregivers physical and behavioral health. Expanding access to high quality, cost-effective and evidence based care and redoubling efforts to test and validate innovative care interventions. Support extensive clinical trials, manufacturing inspections and post-market surveillance for all biosimilar drugs. Support higher PDUFA fees for biosimilar drugs to pay for the additional safeguards needed. Support stiff restrictions on biosimilar "flexibility" (intentionally introducing differences to the molecule or the finished product) that adds high risk. Support distinctive labeling for safety, and install a strong track and trace system before the first biosimilar is allowed on the market. Support Congressional review and oversight to examine the National Alzheimer's Plan implementation progress.

Client expense: $75,187 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Support American Society of Consultant Pharmacists and "Short Cycle Dispensing Coalition" recommendations regarding the delay and study of new long-term care pharmacy dispensing rules and the impact of those rules on Medicare and Medicaid patients. Support H.R. 1055, the Part D Off-Label Prescription Drug Parity Act. Continue to oppose cuts to Medicare benefits, and continue to oppose the Independent Payment Advisory Board (IPAB). Support Medicare Access for Patients Rx (MAPRx) recommendations to Centers for Medicare and Medicaid Services (CMS) all regarding Medicare Part D. Those MAPRx recommendations are in regard to: Improved beneficiary protections; Better, more transparent Specialty Tier guidance including the threshold for inclusion on this tier and the inclusion of data for newly approved drugs; New, more realistic co-pay thresholds; Automatic disenrollment from Special Needs Plans; Proposed plan rating criteria; and Approval of six-tier formularies. These are in addition to MAPRx concerns regarding: The Part D Medicare appeals process and the handling of enrollee complaints; Drug dispensing rules for Part D beneficiaries in long-term care facilities; the Authority to deny bids and potential additional restrictions; and Compound Drug Policy. Support repeal of IPAB (H.R. 452). Support changes to the Medicare Shared Savings Program: Accountable Care Organization (ACO) proposed regulations, to provide additional safeguards to guarantee patient access to needed care, and to ensure that ACO's support the adoption of new treatments and cures for patients. Also support the addition of new Alzheimer's disease focused ACO quality measures, new ACO measures of provider evidence of competency in Geriatrics and Dementia, as well as a guarantee that Alzheimer's and Dementia patients under ACO care will have access to the newest pharmaceutical and biological treatments. Support repeal of Section 6001 of the PPACA and remove all restrictions on physician-owned hospitals. (Support H.R. 1159 and H.R. 1186) Oppose federal budget cuts that would increase co-payments for home health care services under Medicare and/or Medicaid Support the Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (S. 1096 and H.R. 2020) Support MAPRx suggestions to CMS on Medicare Part D Prescription Drug Program regarding new beneficiary-friendly point-of-sale notices that address problems in filling prescriptions and clear, instructive remedies for beneficiaries. Oppose proposals that would reduce payments to providers of drugs and biologics under Medicare Part B. Oppose proposals to increase Medicare Part D cost-sharing, raise Part D coinsurance, and/or freeze income thresholds. Oppose efforts to require Medicaid-type drug rebates from any Medicare Part D providers and all other kinds of mandated or negotiated Part D price controls that will harm beneficiaries and increase costs in other areas of Medicare. Support efforts to focus Medicare cost-saving efforts on eliminating improper payments, waste, fraud, and abuse first -- before cutting benefits, cutting payments to providers, or raising premium and coinsurance costs for beneficiaries. Support H.R. 3613 - Medicare Part D Beneficiary Appeals Fairness Act. Urged the "Super Committee" to resist proposals to erode beneficiary protections in Part D that ensure broad and accessible prescription drug formularies. Supported an extension of legislation to preserve access to osteoporosis testing for Medicare beneficiaries in the the final conference report on the Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3630). Joined other patient advocate organizations to urge the National Government Services to to reconsider its policy regarding blanket denials under the Current Procedural Terminology (CPT) health and behavioral assessment and intervention codes (96150-96155) which restrict those medically appropriate services to Medicare beneficiaries with Alzheimer's disease. Support the MAPRx comments regarding the Draft 2013 Medicare Call Letter regarding proposed actions related to the Part D Prescription Drug Program. These included improved comments on beneficiary protections; Specialty Tiers; Co-pay Thresholds; Tier Labeling; Plan Rating Criteria; Medicare Therapy Management; and Drug Utilization Review Controls in Part D. Oppose Centers for Medicare and Medicaid Services (CMS) regulation that subjects dual-eligible Medicare/Medicaid beneficiaries to new state programs that may well diminish their Medicare protections and lessen their access to quality health care services. This includes passive enrollment into a managed care plan and disruptions to the continuity of care.

Client expense: $75,187 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

HR 1159 - To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. H.R.1186 - To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. Bad Debt Payments to Hospitals Lawmakers have proposed lowering the amount of Medicare Bad Debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. Direct and Indirect Graduate Medical Education Payments Lawmakers have proposed changes to the way that hospitals are reimbursed for the costs of training physicians and other medical professionals. S. 2620 - Rural Hospital Access Act of 2012- A bill that would extend the Medicare Dependent Hospital (MDH) and current Low-Volume Hospital (LVH) programs and would prevent the pending expiration of both programs on October, 1 2012. Oppose the lowering of Medicare outpatients rates for Evaluation and Management visits in a hospital S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act of 2011 - A bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program, and for other purposes. Oppose the reduction of allowed Medicaid provider taxes in states Oppose any cuts to the Medicaid DSH funds above and beyond what was legislated in the Affordable Care Act CMS Coverage Determination Policy Support a long-term patch or full repeal of the Sustainable Growth Rate for Physician payments in Medicare Oppose the proposal of lowering reimbursements to Inpatient Rehabilitation Facilities through Medicare. Support a reasonable one-time budget neutrality adjustment for long-term care hospitals. Medicaid and Medicare dual-eligibles- limit the dual-eligibles demonstrations per the Affordable Care Act (ACA). Inpatient Propsective Payment System- CMS proposed rule for hospitals paid under the Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System that would increase Medicare's operating payments to acute-care hospitals for fiscal year 2013. Sequestration - work to mitigate impact of Medicare sequestration on hospitals per the Budget Control Act. S. 3391- the Taking Essential Steps for Testing (TEST) Act of 2012- A bill that would provide CMS with flexibility to apply sanctions appropriate to the level of noncompliance and improve access to essential laboratory services. Advocate in support of reauthorization of funding for quality measure development, endorsement, pre-rulemaking review and recommendations, and collection of data analyzing measure implementation under MIPPA (P.L. 110-275, Section 1980 ) and ACA (P.L. 111-148, Section 3014) for the consensus-based entity (National Quality Forum).

Client expense: $570,000 · Firm income: Not reported

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

Counsel and gudiance on repealing Section 6001 of PPACA; HR1159; HR1186

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor H.R.1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. Monitor H.R.1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. "Middle Class Tax Relief and Job Creation Act of 2012" (H.R.3630). "Middle Class Tax Relief and Job Creation Act of 2011" (S.Amdt. 1465 to H.R.3630). "Temporary Payroll Tax Cut Continuation Act of 2011" (H.R.3765).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals. H.R. 1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. Physician owned hospital issues

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

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

HR 1159 To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests (All sections of full text) HR 1186 To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals (All sections full text) HR 436 Health Care Cost Reduction Act of 2012 (All sections of full text)

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

Government targets: SENATE

Support the speedy implementation of the National Alzheimer's Project Act (NAPA) by HHS, and support Leaders Engaged on Alzheimer's Disease (LEAD) recommendations as to how to proceed. Support repeal of Section 6001 of the PPACA and remove all restrictions on physician-owned hospitals. (Support H.R. 1159 and H.R. 1186) Support extensive clinical trials, manufacturing inspections and post-market surveillance for all biosimilar drugs. Support higher PDUFA fees for biosimilar drugs to pay for the additional safeguards needed. Oppose federal budget cuts that would increase co-payments for home health care services under Medicare and/or Medicaid. Support all legislative and regulatory action to modernize the FDA and to speed new cures and therapies to patients. Support the Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (S. 1096, H.R. 2020) Support Leaders Engaged on Alzheimer's Disease (LEAD) FY 2012 funding proposals in the amount of for $35 billion for the National Institutes of Health (NIH), $1.4 billion for the National Institute on Aging (NIA), $100 million for the Cures Acceleration Network (CAN), $11.46 million for the Alzheimer's Disease Supportive Services Program (ADSSP), $192 million for the National Family Caregiver Support Program (NFCSP), $50 million for the Lifespan Respite Care Program (LRCP), and$2.744 billion for the Food and Drug Administration (FDA), as well as $2 million for the Missing Alzheimer's Disease Patient Alert Program and $750,000 to organize and host a high-level meeting to focus on the global Alzheimer's disease crisis. Oppose proposals that would reduce Medicare payments for providers of drugs and biologics under Medicare Part B. Support the proposed Prescription Drug User Fee Act Reauthorization Agreement (PDUFA-V) now under consideration by the Congress for reauthorization. Support an extension of the Therapeutic Discovery Project Tax Credit (I.R.C. 48D). Oppose the proposed merger between pharmacy benefit managers (PBM) Medco Health Solutions (Medco) and Express Scripts, Inc. (ESI), including comments to the Federal Trade Commission on the merger's obvious danger to older Americans. Support the development of clearly-defined, comprehensive, patient-centric Essential Health Benefits rules under the Affordable Care Act. Support the Counterfeit Drug Penalty Enhancement Act of 2011. Joined other patient advocate organizations to urge the National Government Services to reconsider its policy regarding blanket denials under the Current Procedural Terminology (CPT) health and behavioral assessment and intervention codes (96150-96155) which restrict those medically appropriate services to Medicare beneficiaries with Alzheimer's disease. Joined other patient advocate organizations January 2012 to urge HHS to ensure that ACA "Essential Health Benefits" guidelines provide comprehensive, quality and affordable health care. This was in response to the HHS December 16, 2011 bulletin on Essential Health Benefits because the HHS bulletin did not provide adequate patient protections as intended under the ACA. Joined other patient advocate groups to support the Spending Reductions through Innovations in Therapies (SPRINT) Act (H.R. 3891 and S. 2064) Support H.R.5998, the USPSTF Transparency and Accountability Act of 2012. Support the creation of the National Center for AdvancingTranslations Sciences' (NCATS) "Discovering New Therapeutic Uses for Existing Molecules Initiative." Support the new Centers for Disease Control recommendations regarding the identification of chronic Hepatitis C infections. Urge all providers and payers to follow those same CDC recommendations. Oppose the substitution and use of unapproved and off-label drugs to treat age-related macular degeneration (AMD). Urge the Department of HHS to adopt the Advisory Council on Alzheimer's Research recommendations and ensure that the final National Alzheimer's Plan includes measures: Providing high-level, overall accountability for National Plan implementation. Recognizing and proposing a path forward to secure the public and private resources needed to achieve all of the goals. Forming robust public-private partnerships between government and industry to inform the research agenda, shorten the time and cost of developing therapies, and accelerate delivery of safe and effective treatments to individuals with Alzheimers. Fostering greater collaboration on research and other issues with international counterparts to achieve global coordination and progress toward a Global Alzheimers Action Plan. Expanding attention on early detection and diagnosis of Alzheimers disease. Ensuring access to the full array of long-term support services for special and emerging populations of people with Alzheimers disease, including younger people and those with developmental disabilities. Addressing caregivers physical and behavioral health. Expanding access to high quality, cost-effective and evidence based care and redoubling efforts to test and validate innovative care interventions. Support extensive clinical trials, manufacturing inspections and post-market surveillance for all biosimilar drugs. Support higher PDUFA fees for biosimilar drugs to pay for the additional safeguards needed. Support stiff restrictions on biosimilar "flexibility" (intentionally introducing differences to the molecule or the finished product) that adds high risk. Support distinctive labeling for safety, and install a strong track and trace system before the first biosimilar is allowed on the market. Support Congressional review and oversight to examine the National Alzheimer's Plan implementation progress.

Client expense: Not reported · Firm income: $9,625

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Support American Society of Consultant Pharmacists and "Short Cycle Dispensing Coalition" recommendations regarding the delay and study of new long-term care pharmacy dispensing rules and the impact of those rules on Medicare and Medicaid patients. Support H.R. 1055, the Part D Off-Label Prescription Drug Parity Act. Continue to oppose cuts to Medicare benefits, and continue to oppose the Independent Payment Advisory Board (IPAB). Support Medicare Access for Patients Rx (MAPRx) recommendations to Centers for Medicare and Medicaid Services (CMS) all regarding Medicare Part D. Those MAPRx recommendations are in regard to: Improved beneficiary protections; Better, more transparent Specialty Tier guidance including the threshold for inclusion on this tier and the inclusion of data for newly approved drugs; New, more realistic co-pay thresholds; Automatic disenrollment from Special Needs Plans; Proposed plan rating criteria; and Approval of six-tier formularies. These are in addition to MAPRx concerns regarding: The Part D Medicare appeals process and the handling of enrollee complaints; Drug dispensing rules for Part D beneficiaries in long-term care facilities; the Authority to deny bids and potential additional restrictions; and Compound Drug Policy. Support repeal of IPAB (H.R. 452). Support changes to the Medicare Shared Savings Program: Accountable Care Organization (ACO) proposed regulations, to provide additional safeguards to guarantee patient access to needed care, and to ensure that ACO's support the adoption of new treatments and cures for patients. Also support the addition of new Alzheimer's disease focused ACO quality measures, new ACO measures of provider evidence of competency in Geriatrics and Dementia, as well as a guarantee that Alzheimer's and Dementia patients under ACO care will have access to the newest pharmaceutical and biological treatments. Support repeal of Section 6001 of the PPACA and remove all restrictions on physician-owned hospitals. (Support H.R. 1159 and H.R. 1186) Oppose federal budget cuts that would increase co-payments for home health care services under Medicare and/or Medicaid Support the Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (S. 1096 and H.R. 2020) Support MAPRx suggestions to CMS on Medicare Part D Prescription Drug Program regarding new beneficiary-friendly point-of-sale notices that address problems in filling prescriptions and clear, instructive remedies for beneficiaries. Oppose proposals that would reduce payments to providers of drugs and biologics under Medicare Part B. Oppose proposals to increase Medicare Part D cost-sharing, raise Part D coinsurance, and/or freeze income thresholds. Oppose efforts to require Medicaid-type drug rebates from any Medicare Part D providers and all other kinds of mandated or negotiated Part D price controls that will harm beneficiaries and increase costs in other areas of Medicare. Support efforts to focus Medicare cost-saving efforts on eliminating improper payments, waste, fraud, and abuse first -- before cutting benefits, cutting payments to providers, or raising premium and coinsurance costs for beneficiaries. Support H.R. 3613 - Medicare Part D Beneficiary Appeals Fairness Act. Urged the "Super Committee" to resist proposals to erode beneficiary protections in Part D that ensure broad and accessible prescription drug formularies. Supported an extension of legislation to preserve access to osteoporosis testing for Medicare beneficiaries in the the final conference report on the Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3630). Joined other patient advocate organizations to urge the National Government Services to to reconsider its policy regarding blanket denials under the Current Procedural Terminology (CPT) health and behavioral assessment and intervention codes (96150-96155) which restrict those medically appropriate services to Medicare beneficiaries with Alzheimer's disease. Support the MAPRx comments regarding the Draft 2013 Medicare Call Letter regarding proposed actions related to the Part D Prescription Drug Program. These included improved comments on beneficiary protections; Specialty Tiers; Co-pay Thresholds; Tier Labeling; Plan Rating Criteria; Medicare Therapy Management; and Drug Utilization Review Controls in Part D. Oppose Centers for Medicare and Medicaid Services (CMS) regulation that subjects dual-eligible Medicare/Medicaid beneficiaries to new state programs that may well diminish their Medicare protections and lessen their access to quality health care services. This includes passive enrollment into a managed care plan and disruptions to the continuity of care.

Client expense: Not reported · Firm income: $9,625

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Following medicare/medicaid, reimbursement and self referral issues.H.R. 1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition of certain physician referrals for hospitals. H.R. 1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. H.R. 5651, Food and Drug Reform Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Following medicare/medicaid, reimbursement and self referral issues. H.R. 1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition of certain physician referrals for hospitals. H.R. 1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1159 To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests (All sections of full text) HR 1186 To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals (All sections of full text)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

suppport HR 1159 and HR 1186 to reverse restrictions on physician owned hospitals support legislation on increased reimbursement for ambulatory surgical centers (HR 2108 and S. 1173) oppose cuts to reimbursement for advanced medical imaging

Client expense: Not reported · Firm income: $24,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

suppport HR 1159 and HR 1186 to reverse restrictions on physician owned hospitals support legislation on increased reimbursement for ambulatory surgical centers (HR 2108 and S. 1173) oppose cuts to reimbursement for advanced medical imaging

Client expense: Not reported · Firm income: $24,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

support HR1159 and HR 1186 to reverse restrictive language on physician owned hospitals

Client expense: Not reported · Firm income: $12,600

Government targets: HOUSE OF REPRESENTATIVES, SENATE

support HR1159 and HR 1186 to reverse restrictive language on physician owned hospitals

Client expense: Not reported · Firm income: $12,600

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 1159 and HR 1186 ending ban on physician owned hospitals;oppose CMS cuts to medical imaging; support appropriateness model for diagnostic imaging; support IPAB repeal

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 1159 and HR 1186 ending ban on physician owned hospitals;oppose CMS cuts to medical imaging; support appropriateness model for diagnostic imaging;support IPAB repeal

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

monitor revisions to 75% Inpatient Rehabilitation Rule monitor legislation regarding Hospital in Hospital regulations support HR 1159 and HR 1186 ending ban on physician owned hospitals; support legislation reforming ASC reimbursement (HR 1173 and S 2108); monitor legislation affecting hospital not-for-profit status; monitor GME legislation

Client expense: Not reported · Firm income: $33,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Counsel and gudiance on repealing Section 6001 of PPACA; HR1159; HR1186

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Following medicare/medicaid, reimbursement and self referral issues. H.R. 1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition of certain physician referrals for hospitals. H.R. 1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Following medicare/medicaid, reimbursement and self referral issues.H.R. 1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition of certain physician referrals for hospitals. H.R. 1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. H.R. 5651, Food and Drug Reform Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 and HR 2783 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 1398 Rural Hospital Protection Act, legislation which would amend the Social Security Act to ensure that the full cost of certain provider taxes are considered allowable costs for purposes of Medicare reimbursements to CAHs; S 1486 Long-Term Care Hospital Improvement Act of 201, a bill to amend title XVIII of the Social Security Act to clarify and expand on criteria applicable to patient admission to and care furnished in long-term care hospitals participating in the Medicare program; Raising concerns about CMS flawed methodology that overstates the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to improve the regulation to implement ACOs; Urging CMS to update, streamline, and modernize the Medicare conditions of participation; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expired in September 2011, and the bills would reauthorize the CHGME program for an additional five years, through fiscal year (FY) 2016, at the current authorization level of up to $330 million a year; HR 1683/ S 868 Medicaid MOE, strikes provisions of ACA related to maintaining Medicaid eligibility levels; HR 1543 Improving Access to Medicare Coverage Act of 2011, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare; S 1251Medicare and Medicaid FAST Act, a bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs; HR 2500 Equal Access and Parity for Multi-Campus Hospitals Act, a bill 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 2674 340B Program Improvement Act, a bill to amend section 340B of the Public Health Service Act to improve the provision of discounts on drug purchases for certain safety net providers; HR 3630 Temporary Payroll Tax Cut Continuation Act of 2011 or Middle Class Tax Relief and Job Creation Act of 2011, a bill that cuts hospitals to pay for the doc fix, it contains the Social Security payroll tax cut and the Unemployment Insurance extension; HR 3519 a bill to amend and exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011; S. 1680 Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act of 2011, a bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program; Letter to Rehberg and DeLauro in support of the CHGME program that was circulated by Reps. Capps and Bilbray; Wyden/Crapo letter to CMS to actively oppose a Senate Dear Colleague letter to CMS in support of updating Medicare payments to ambulatory surgery centers (ASCs). The letter did not request a payment update for ASCs. Rather, the letter advocated against the Medicare payment rate for services provided in hospital outpatient department settings; HR 2954 Health Equity and Accountability Act of 2011, Comprehensive bill focused on eliminating racial and ethnic disparities in health care through improved data collection and reporting, culturally and linguistically-appropriate health care, workforce diversity, health information technology, and other actions; Discussions with the Administration (CMS) on applying the therapy cap to hospital outpatient departments; Worked to change CMS definition of allowed EHR costs for CAH Meaningful Use incentive payments to include capital lease purchases of EHRs; HR 3859 Rural Hospital and Provider Equity (R-HOPE) Act of 2012, to amend title XVIII of the SSA to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program. HR 4245 Veterans Co-Pay Fairness Act, to amend title 38, United States Code, to require the Secretary of Veterans Affairs to reimburse eligible veterans who are entitled to Medicare benefits for Medicare deductibles and other expenses that are owed by the veterans for emergency medical treatment provided in non-Department of Veterans Affairs facilities; S 2620 and HR 5943 Rural Hospital Access Act of 2012, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; S 3187 and HR 5651Prescription Drug User Fee Amendments of 2012, a bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs and medical devices, to establish user-fee programs for generic drugs and biosimilars.

Client expense: $4,150,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Office of Management & Budget (OMB), SENATE, White House Office

HR 1159 - To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. H.R.1186 - To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. Bad Debt Payments to Hospitals Lawmakers have proposed lowering the amount of Medicare Bad Debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. Direct and Indirect Graduate Medical Education Payments Lawmakers have proposed changes to the way that hospitals are reimbursed for the costs of training physicians and other medical professionals. S. 2620 - Rural Hospital Access Act of 2012- A bill that would extend the Medicare Dependent Hospital (MDH) and current Low-Volume Hospital (LVH) programs and would prevent the pending expiration of both programs on October, 1 2012. Oppose the lowering of Medicare outpatients rates for Evaluation and Management visits in a hospital S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act of 2011 - A bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program, and for other purposes. Oppose the reduction of allowed Medicaid provider taxes in states Oppose any cuts to the Medicaid DSH funds above and beyond what was legislated in the Affordable Care Act CMS Coverage Determination Policy Support a long-term patch or full repeal of the Sustainable Growth Rate for Physician payments in Medicare Oppose the proposal of lowering reimbursements to Inpatient Rehabilitation Facilities through Medicare. Support a reasonable one-time budget neutrality adjustment for long-term care hospitals. Medicaid and Medicare dual-eligibles- limit the dual-eligibles demonstrations per the Affordable Care Act (ACA). Inpatient Propsective Payment System- CMS proposed rule for hospitals paid under the Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System that would increase Medicare"s operating payments to acute-care hospitals for fiscal year 2013.

Client expense: $610,000 · Firm income: Not reported

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

Issues related to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests, H.R.1159.

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor H.R.1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. Monitor H.R.1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. "Middle Class Tax Relief and Job Creation Act of 2012" (H.R.3630). "Middle Class Tax Relief and Job Creation Act of 2011" (S.Amdt. 1465 to H.R.3630). "Temporary Payroll Tax Cut Continuation Act of 2011" (H.R.3765).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1159, To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals. H.R. 1186, To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. Physician owned hospital issues

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

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

H.R. 1159 To repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests (All sections of full text) (Oppose) HR 1186 To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals (All sections of full text) (oppose)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support American Society of Consultant Pharmacists and "Short Cycle Dispensing Coalition" recommendations regarding the delay and study of new long-term care pharmacy dispensing rules and the impact of those rules on Medicare and Medicaid patients. Support H.R. 1055, the Part D Off-Label Prescription Drug Parity Act. Continue to oppose cuts to Medicare benefits, and continue to oppose the Independent Payment Advisory Board (IPAB). Support Medicare Access for Patients Rx (MAPRx) recommendations to Centers for Medicare and Medicaid Services (CMS) all regarding Medicare Part D. Those MAPRx recommendations are in regard to: Improved beneficiary protections; Better, more transparent Specialty Tier guidance including the threshold for inclusion on this tier and the inclusion of data for newly approved drugs; New, more realistic co-pay thresholds; Automatic disenrollment from Special Needs Plans; Proposed plan rating criteria; and Approval of six-tier formularies. These are in addition to MAPRx concerns regarding: The Part D Medicare appeals process and the handling of enrollee complaints; Drug dispensing rules for Part D beneficiaries in long-term care facilities; the Authority to deny bids and potential additional restrictions; and Compound Drug Policy. Support repeal of IPAB (H.R. 452). Support changes to the Medicare Shared Savings Program: Accountable Care Organization (ACO) proposed regulations, to provide additional safeguards to guarantee patient access to needed care, and to ensure that ACO's support the adoption of new treatments and cures for patients. Also support the addition of new Alzheimer's disease focused ACO quality measures, new ACO measures of provider evidence of competency in Geriatrics and Dementia, as well as a guarantee that Alzheimer's and Dementia patients under ACO care will have access to the newest pharmaceutical and biological treatments. Support repeal of Section 6001 of the PPACA and remove all restrictions on physician-owned hospitals. (Support H.R. 1159 and H.R. 1186) Oppose federal budget cuts that would increase co-payments for home health care services under Medicare and/or Medicaid Support the Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (S. 1096 and H.R. 2020) Support MAPRx suggestions to CMS on Medicare Part D Prescription Drug Program regarding new beneficiary-friendly point-of-sale notices that address problems in filling prescriptions and clear, instructive remedies for beneficiaries. Oppose proposals that would reduce payments to providers of drugs and biologics under Medicare Part B. Oppose proposals to increase Medicare Part D cost-sharing, raise Part D coinsurance, and/or freeze income thresholds. Oppose efforts to require Medicaid-type drug rebates from any Medicare Part D providers and all other kinds of mandated or negotiated Part D price controls that will harm beneficiaries and increase costs in other areas of Medicare. Support efforts to focus Medicare cost-saving efforts on eliminating improper payments, waste, fraud, and abuse first -- before cutting benefits, cutting payments to providers, or raising premium and coinsurance costs for beneficiaries. Support H.R. 3613 - Medicare Part D Beneficiary Appeals Fairness Act. Urged the "Super Committee" to resist proposals to erode beneficiary protections in Part D that ensure broad and accessible prescription drug formularies. Supported an extension of legislation to preserve access to osteoporosis testing for Medicare beneficiaries in the the final conference report on the Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3630). Joined other patient advocate organizations to urge the National Government Services to to reconsider its policy regarding blanket denials under the Current Procedural Terminology (CPT) health and behavioral assessment and intervention codes (96150-96155) which restrict those medically appropriate services to Medicare beneficiaries with Alzheimer's disease. Support the MAPRx comments regarding the Draft 2013 Medicare Call Letter regarding proposed actions related to the Part D Prescription Drug Program. These included improved comments on beneficiary protections; Specialty Tiers; Co-pay Thresholds; Tier Labeling; Plan Rating Criteria; Medicare Therapy Management; and Drug Utilization Review Controls in Part D. Oppose Centers for Medicare and Medicaid Services (CMS) regulation that subjects dual-eligible Medicare/Medicaid beneficiaries to new state programs that may well diminish their Medicare protections and lessen their access to quality health care services. This includes passive enrollment into a managed care plan and disruptions to the continuity of care.

Client expense: Not reported · Firm income: $10,808

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Support the speedy implementation of the National Alzheimer's Project Act (NAPA) by HHS, and support Leaders Engaged on Alzheimer's Disease (LEAD) recommendations as to how to proceed. Support repeal of Section 6001 of the PPACA and remove all restrictions on physician-owned hospitals. (Support H.R. 1159 and H.R. 1186) Support extensive clinical trials, manufacturing inspections and post-market surveillance for all biosimilar drugs. Support higher PDUFA fees for biosimilar drugs to pay for the additional safeguards needed. Oppose federal budget cuts that would increase co-payments for home health care services under Medicare and/or Medicaid. Support all legislative and regulatory action to modernize the FDA and to speed new cures and therapies to patients. Support the Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (S. 1096, H.R. 2020) Support Leaders Engaged on Alzheimer's Disease (LEAD) FY 2012 funding proposals in the amount of for $35 billion for the National Institutes of Health (NIH), $1.4 billion for the National Institute on Aging (NIA), $100 million for the Cures Acceleration Network (CAN), $11.46 million for the Alzheimer's Disease Supportive Services Program (ADSSP), $192 million for the National Family Caregiver Support Program (NFCSP), $50 million for the Lifespan Respite Care Program (LRCP), and$2.744 billion for the Food and Drug Administration (FDA), as well as $2 million for the Missing Alzheimer's Disease Patient Alert Program and $750,000 to organize and host a high-level meeting to focus on the global Alzheimer's disease crisis. Oppose proposals that would reduce Medicare payments for providers of drugs and biologics under Medicare Part B. Support the proposed Prescription Drug User Fee Act Reauthorization Agreement (PDUFA-V) now under consideration by the Congress for reauthorization. Support an extension of the Therapeutic Discovery Project Tax Credit (I.R.C. 48D). Oppose the proposed merger between pharmacy benefit managers (PBM) Medco Health Solutions (Medco) and Express Scripts, Inc. (ESI), including comments to the Federal Trade Commission on the merger's obvious danger to older Americans. Support the development of clearly-defined, comprehensive, patient-centric Essential Health Benefits rules under the Affordable Care Act. Support the Counterfeit Drug Penalty Enhancement Act of 2011. Joined other patient advocate organizations to urge the National Government Services to reconsider its policy regarding blanket denials under the Current Procedural Terminology (CPT) health and behavioral assessment and intervention codes (96150-96155) which restrict those medically appropriate services to Medicare beneficiaries with Alzheimer's disease. Joined other patient advocate organizations January 2012 to urge HHS to ensure that ACA "Essential Health Benefits" guidelines provide comprehensive, quality and affordable health care. This was in response to the HHS December 16, 2011 bulletin on Essential Health Benefits because the HHS bulletin did not provide adequate patient protections as intended under the ACA. Joined other patient advocate groups to support the Spending Reductions through Innovations in Therapies (SPRINT) Act (H.R. 3891 and S. 2064) Support H.R.5998, the USPSTF Transparency and Accountability Act of 2012. Support the creation of the National Center for AdvancingTranslations Sciences' (NCATS) "Discovering New Therapeutic Uses for Existing Molecules Initiative." Support the new Centers for Disease Control recommendations regarding the identification of chronic Hepatitis C infections. Urge all providers and payers to follow those same CDC recommendations. Oppose the substitution and use of unapproved and off-label drugs to treat age-related macular degeneration (AMD). Urge the Department of HHS to adopt the Advisory Council on Alzheimer's Research recommendations and ensure that the final National Alzheimer's Plan includes measures: Providing high-level, overall accountability for National Plan implementation. Recognizing and proposing a path forward to secure the public and private resources needed to achieve all of the goals. Forming robust public-private partnerships between government and industry to inform the research agenda, shorten the time and cost of developing therapies, and accelerate delivery of safe and effective treatments to individuals with Alzheimers. Fostering greater collaboration on research and other issues with international counterparts to achieve global coordination and progress toward a Global Alzheimers Action Plan. Expanding attention on early detection and diagnosis of Alzheimers disease. Ensuring access to the full array of long-term support services for special and emerging populations of people with Alzheimers disease, including younger people and those with developmental disabilities. Addressing caregivers physical and behavioral health. Expanding access to high quality, cost-effective and evidence based care and redoubling efforts to test and validate innovative care interventions. Support extensive clinical trials, manufacturing inspections and post-market surveillance for all biosimilar drugs. Support higher PDUFA fees for biosimilar drugs to pay for the additional safeguards needed. Support stiff restrictions on biosimilar "flexibility" (intentionally introducing differences to the molecule or the finished product) that adds high risk. Support distinctive labeling for safety, and install a strong track and trace system before the first biosimilar is allowed on the market.

Client expense: Not reported · Firm income: $10,808

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE