Rural Hospital Protection Act

Medicare payment reductions via the Federal Budget Hospital Payment Propective Payment System for Acute Care Hospitals and Long Term Care Hospital Propective Payment System and Fiscal Year 2012 Rates Medicare and Medicaid programs electronic recoerd (EHR) incentive final rule. July 28, 2010 Federal Register: multi campus provis HR 1398 Rural Hospital Protectin Act, reimbursment for Critical Access Hospitals. HR 452, Medicare Decisions Accountibility Act of 2011, Independent Payment Advisory Board, Sections 6407 of the Affordable Care Act of 2010, CMR Regulatiosn on home health physiciansface to face encounter requirement. HR 1216. to amend the Public Health Service Act to convert funding for graduate medical educaoitns in qualifed teaching healht care centers from dierct appropriation to an authorziation of appropriations (GME).

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

FDA Model Food Care; H.R.1398 and S.558, Menu Labeling Meal Act; H.R.759, Food and Drug Administration Globalization Act of 2009; H.R.999, Keeping Americans food Safe Act of 2009; H.R.875 and S.510, FDA Food Safety Modernization Act; H.R.2749, The food Safety Enchancement Act.

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

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS)

H.R. 2674: 340B Improvement Act of 2011 H.R. 1217: To Repeal the Prevention and Public Health Fund H.R. 1398: Rural Hospital Protection Act S. 668: Health Care Bureaucrats Elimination Act

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), 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

Medicare payment reductions via the Federal Budget Hospital Payment Propective Payment System for Acute Care Hospitals and Long Term Care Hospital Propective Payment System and Fiscal Year 2012 Rates Medicare and Medicaid programs electronic recoerd (EHR) incentive final rule. July 28, 2010 Federal Register: multi campus provis HR 1398 Rural Hospital Protectin Act, reimbursment for Critical Access Hospitals. HR 452, Medicare Decisions Accountibility Act of 2011, Independent Payment Advisory Board, Sections 6407 of the Affordable Care Act of 2010, CMR Regulatiosn on home health physiciansface to face encounter requirement. HR 1216. to amend the Public Health Service Act to convert funding for graduate medical educaoitns in qualifed teaching healht care centers from dierct appropriation to an authorziation of appropriations (GME).

Client expense: $6,656 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

FDA Model Food Care; H.R.1398 and S.558, Menu Labeling Meal Act; H.R.759, Food and Drug Administration Globalization Act of 2009; H.R.999, Keeping Americans food Safe Act of 2009; H.R.875 and S.510, FDA Food Safety Modernization Act; H.R.2749, The food Safety Enchancement Act.

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

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS)

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.

Client expense: $3,970,000 · 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), Internal Revenue Service (IRS), SENATE, White House Office

Medicare payment reductions via the Federal Budget Hospital Payment Propective Payment System for Acute Care Hospitals and Long Term Care Hospital Propective Payment System and Fiscal Year 2012 Rates Medicare and Medicaid programs electronic recoerd (EHR) incentive final rule. July 28, 2010 Federal Register: multi campus provis HR 1398 Rural Hospital Protectin Act, reimbursment for Critical Access Hospitals. HR 452, Medicare Decisions Accountibility Act of 2011, Independent Payment Advisory Board, Sections 6407 of the Affordable Care Act of 2010, CMR Regulatiosn on home health physiciansface to face encounter requirement. HR 1216. to amend the Public Health Service Act to convert funding for graduate medical educaoitns in qualifed teaching healht care centers from dierct appropriation to an authorziation of appropriations (GME).

Client expense: $6,867 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

FDA Model Food Care; H.R.1398 and S.558, Menu Labeling Meal Act; H.R.759, Food and Drug Administration Globalization Act of 2009; H.R.999, Keeping Americans food Safe Act of 2009; H.R.875 and S.510, FDA Food Safety Modernization Act; H.R.2749, The food Safety Enchancement Act.

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

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS)

H.R. 2674: 340B Improvement Act of 2011 H.R. 1217: To Repeal the Prevention and Public Health Fund H.R. 1398: Rural Hospital Protection Act S. 668: Health Care Bureaucrats Elimination Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.778 - Protecting Access to Rural Therapy Services (PARTS) Act S.1301 - Medicaid Improvement and State Empowerment Act H.R. 1 - Full-Year Continuing Appropriations Act of 2011 H.R. 452 - Medicare Decisions Accountability Act of 2011 H.R.1216 - Would make the Public Health Services Act's graduate medical education money no longer a direct appropriation. H.R.1398 - To amend Title XVIII of the Social Security Act to treat certain provider taxes as allowable costs for purposes of Medicare reimbursements to critical access hospitals. H.R.1546/S.829 - The Medicare Access to Rehabilitation Services Act. H.R.1852/S.958 - Children's Hospital GME Support Reauthorization Act of 2011. H.R.2267/S.227 - Home Health Care Planning Improvement Act of 2011. Inpatient Prospective Payment System Proposed Rule, 76 FR 25788, May 5, 2011, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Propective Payment Systen and Fiscal Year 2012 Rates.

Client expense: $202,000 · Firm income: Not reported

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

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 overstate 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; Sessions Crowley and Stabenow-Murkowski IPPS letter requesting fixes to the coding offset circulated for signature; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expires in September, 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.

Client expense: $5,370,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE, White House Office

Medicare payment reductions via the Federal Budget Hospital Payment Propective Payment System for Acute Care Hospitals and Long Term Care Hospital Propective Payment System and Fiscal Year 2012 Rates Medicare and Medicaid programs electronic recoerd (EHR) incentive final rule. July 28, 2010 Federal Register: multi campus provis HR 1398 Rural Hospital Protectin Act, reimbursment for Critical Access Hospitals. HR 452, Medicare Decisions Accountibility Act of 2011, Independent Payment Advisory Board, Sections 6407 of the Affordable Care Act of 2010, CMR Regulatiosn on home health physiciansface to face encounter requirement. HR 1216. to amend the Public Health Service Act to convert funding for graduate medical educaoitns in qualifed teaching healht care centers from dierct appropriation to an authorziation of appropriations (GME).

Client expense: $5,845 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid Tunding in the Federal Budget, Medicare Funding in the Federal Budget, Cost reporting treatment of provider taxes, The Rural Hospital Protection Act , H.R. 1398, Urban Medicare Dependent Hospital (UMDH), H.R. 1656, S. 1900, Permanent medicare doctor payment fix (SGR), Direct physician supervision of hospital outpatient services, Demonstration projects - Center for Medicare and Medicaid Innovation, H. R. 3630, Middle Class Tax Relief and Job Creation Act of 2011

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

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

FDA Model Food Care; H.R.1398 and S.558, Menu Labeling Meal Act; H.R.759, Food and Drug Administration Globalization Act of 2009; H.R.999, Keeping Americans food Safe Act of 2009; H.R.875 and S.510, FDA Food Safety Modernization Act; H.R.2749, The food Safety Enchancement Act.

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

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS)

H.R. 2674: 340B Improvement Act of 2011 H.R. 1217: To Repeal the Prevention and Public Health Fund H.R. 1398: Rural Hospital Protection Act S. 668: Health Care Bureaucrats Elimination Act

Client expense: Not reported · Firm income: Not reported

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

Medicare payment reductions via the Federal Budget Hospital Payment Propective Payment System for Acute Care Hospitals and Long Term Care Hospital Propective Payment System and Fiscal Year 2012 Rates Medicare and Medicaid programs electronic recoerd (EHR) incentive final rule. July 28, 2010 Federal Register: multi campus provis HR 1398 Rural Hospital Protectin Act, reimbursment for Critical Access Hospitals. HR 452, Medicare Decisions Accountibility Act of 2011, Independent Payment Advisory Board, Sections 6407 of the Affordable Care Act of 2010, CMR Regulatiosn on home health physiciansface to face encounter requirement. HR 1216. to amend the Public Health Service Act to convert funding for graduate medical educaoitns in qualifed teaching healht care centers from dierct appropriation to an authorziation of appropriations (GME).

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid Funding in the Federal budget, Medicare funding in the Federal budget, Cost reporting treatment of provider taxes, The Rural Hospital Protection Act, H.R. 1398, Urban Medicare Dependent Hospital (UMDH), H.R. 1656, Permanent Medicare doctor payment fix (SGR), Direct physician supervision of hospital outpatient services, Demonstration projects - Center for Medicare and Medicaid Innovation.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), 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 overstate 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; Sessions Crowley and Stabenow-Murkowski IPPS letter requesting fixes to the coding offset circulated for signature; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expires in September, 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.

Client expense: $4,760,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE, White House Office

FDA Model Food Care; H.R.1398 and S.558, Menu Labeling Meal Act; H.R.759, Food and Drug Administration Globalization Act of 2009; H.R.999, Keeping Americans food Safe Act of 2009; H.R.875 and S.510, FDA Food Safety Modernization Act; H.R.2749, The food Safety Enchancement Act.

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

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS)

Medicaid Funding in the Federal budget, Medicare funding in the Federal budget, Cost reporting treatment of provider taxes, Urban Medicare Dependent Hospital (UMDH), H.R. 1656, Pemanent medicare doctor payment fix (SGR), Direct physician supervision of hospital outpatient services, The Rural Hospital Protection Act, H.R 1398, Demonstration projects - Center for Medicare and Medicaid Innovation

Client expense: $140,000 · Firm income: Not reported

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

P.L. 112-8, Further Additional Continuing Appropriations Amendments, 2011 (hospital preparedness) P.L. 112-10, Department of Defense and Full-Year Continuing Appropriations Act, 2011 H.Con.Res 34, Establishing the budget for the United States Government for fiscal year 2012 and setting forth appropriate budgetary levels for fiscal years 2013 through 2021 (Ryan budget) S.218/H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (Medical liability reform) Inpatient Prospective Payment System Proposed Rule, 76 FR 25788, May 5, 2011, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates (Coding offset) Medicare and Medicaid programs' electronic health record (EHR) incentive final rule, July 28, 2010 Federal Register (multi-campus provisions) H.R. 452, Medicare Decisions Accountability Act of 2011 (IPAB repeal) S. 668, Health Care Bureaucrats Elimination Act (IPAB repeal) H.R. 1398, Rural Hospital Protection Act (CAH provider tax bill) H.R. 1216, To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations., Graduate Medical Education H.R. 2224, Improving Physician Access to Teaching Hospitals Act (Medicare residency slots) H.R. 2500 The Equal Access and Parity for Multi-Campus Hospitals Act (Electronic Health Record multi-campus incentive bill) Medicare payment reductions via the federal budget Medicaid payment reductions via the federal budget Center for Medicare and Medicaid Innovation (CMMI) ONC meaningful use certification regulation

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES

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 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, lgislation 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; Urging congress to establish patient and facility criteria to distinguish LTACHs from other care settings; Raising concerns about CMS flawed methodology that overstate 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; Sessions Crowley and Stabenow Murkowski IPPS letter requesting fixes to the coding offset circulated for signature; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expires in September, 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; Worked on legislation related to HIT payments for hospitals in multi-campus systems.

Client expense: $4,220,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE, White House Office

"P.L. 112-8, Further Additional Continuing Appropriations Amendments, 2011 (hospital preparedness) "P.L. 112-10, Department of Defense and Full-Year Continuing Appropriations Act, 2011 "H.Con.Res 34, Establishing the budget for the United States Government for fiscal year 2012 and setting forth appropriate budgetary levels for fiscal years 2013 through 2021 (Ryan budget) S. 296/H.R. 2245, Preserving Access to Life-Saving Medications Act (drug shortages in hospitals) S.218/H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (Medical liability reform) Inpatient Prospective Payment System Proposed Rule, 76 FR 25788, May 5, 2011, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates (Coding offset) Medicare and Medicaid programs' electronic health record (EHR) incentive final rule, July 28, 2010 Federal Register (multi-campus provisions) H.R. 452, Medicare Decisions Accountability Act of 2011 (IPAB repeal) S. 668, Health Care Bureaucrats Elimination Act (IPAB repeal) H.R. 1398, Rural Hospital Protection Act (CAH provider tax bill) H.R. 1216, To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations., Graduate Medical Education H.R. 1852 / S.958, Children's Hospital GME Support Reauthorization Act of 2011, (To amend the Public Health Service Act to reauthorize support for graduate medical education programs in children's hospitals) H.R. 2224, Improving Physician Access to Teaching Hospitals Act (Medicare residency slots) H.R. 2500 The Equal Access and Parity for Multi-Campus Hospitals Act (Electronic Health Record multi-campus incentive bill) Medicare payment reductions via the federal budget Medicaid payment reductions via the federal budget Center for Medicare and Medicaid Innovation (CMMI) ONC meaningful use certification regulation

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

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

S. 778: Protecting Access to Rural Therapy Services (PARTS) Act S. 1301: Medicaid Improvement and State Empowerment Act H.R. 1: Full-Year Continuing Appropriations Act of 2011 H.R. 452: Medicare Decisions Accountability Act of 2011 H.R. 1216: Would make the Public Health Service Act's graduate medical education money no longer a direct appropriation. H.R. 1398: To amend title XVIII of the Social Security Act to treat certain provider taxes as allowable costs for purposes of Medicare reimbursements to critical access hospitals. H.R. 1546/S. 829: The Medicare Access to Rehabilitation Services Act. H.R. 1852/S. 958: Children's Hospital GME Support Reauthorization Act of 2011. H.R. 2267/S. 227: Home Health Care Planning Improvement Act of 2011. Inpatient Prospective Payment System Proposed Rule, 76 FR 25788, May 5, 2011, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates.

Client expense: $400,000 · Firm income: Not reported

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

Medicare Payment reductions via the Federal Budget Medicare Payment reductions via the Federal Budget Hospital Inpatient Propective Payment System for Acute Care Hospitals and the Long Term Care Hosptial Propsecitve Payment System and Fiscal Year 2012 Rates Medicare and Medicaid programs electronic record (EHR) incentive final rule, July 28, 2010 Federald Register: mulit-campus provisions H.R. 1398, Rural Hospital Protection Act, reimbursemtn for Critical Access Hospital HR 452, Medicare Decisions Acccountiblity Act of 2011, Independent Payment Advisory Baord, Sections 6407 of the Affordable Care Act of 2010, CMR Regulations on home health physician face-to-face encounter requirement HR 1216, To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health care centers from direct appropriations to an authorization of appropriations, Graduate Medical Education HR

Client expense: $6,754 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Grant funding by the Agency for Healthcare Research and Quality of a Health Research and Education Trust on "Development and Demonstrations of a Surgical United-based Safety Program (SUSP) to Reduce Surgical Site Infections and Other Surgical Complications." Review implications of the Commitment to American Prosperity Act of 2011" for Missouri. CMS' certification and survey process. H.R. 1398 as it relates to the calculation of provider taxes in Medicare cost reports. Proposed funding reductions in H.R. 1363 for hospital disaster preparedness programs. Review/snalyze CMS actions taken against a member hospital for alleged violation of Medicare Conditions of Participation. Profile of Missouri's hospitals; financial projections of Medicare margins through 2019; reductions in the use of state provider tax as proposed in the President's first budget proposal of 2011; CMS standards for disproportionate share hospital payments; CMS treatment of provider taxes in Medicare cost reports and the benefits of H.R. 1398; preservation of Medicare critical access hospital, Medicare-dependent hospital and sole community hospital payments; federal funding of poison control centers; and the implications of the FY 2012 budget proposal advanced by Rep. Paul Ryan. Advocated Health Resources and Services Administration to implement funding reductions of the final continuing resolution for FY 2011 by avoiding disproportionate cuts to children's graduate medical education payments and funding for poison control centers

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), Health Resources & Services Administration (HRSA), SENATE

FDA Model Food Care; H.R.1398 and S.558, Menu Labeling Meal Act; H.R.759, Food and Drug Administration Globalization Act of 2009; H.R.999, Keeping Americans food Safe Act of 2009; H.R.875 and S.510, FDA Food Safety Modernization Act; H.R.2749, The food Safety Enchancement Act.

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

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS)

Medicare payment reductions via the federal budget Medicaid payment reductions via the federal budget H.R. 1852, Children's Hospital GME Support Reauthorization Act of 2011, To amend the Public Health Service Act to reauthorize support for graduate medical education programs in children's hospitals. S. 958, Children's Hospital GME Support Reauthorization Act of 2011,To amend the Public Health Service Act to reauthorize support for graduate medical education programs in children's hospitals. Inpatient Prospective Payment System Proposed Rule, 76 FR 25788, May 5, 2011, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates Medicare and Medicaid programs' electronic health record (EHR) incentive final rule, July 28, 2010 Federal Register; multi-campus provisions H.R. 1398, Rural Hospital Protection Act, reimbursement for Critical Access Hospital H.R. 452, Medicare Decisions Accountability Act of 2011, Independent Payment Advisory Board Section 6407 of the Affordable Care Act of 2010,, CMS Regulation on home health physician face-to-face encounter requirement H.R. 1216, To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations., Graduate Medical Education H.R. 1546, Medicare Access to Rehabilitation Services Act of 2011, therapy caps S. 829, Medicare Access to Rehabilitation Services Act of 2011, therapy caps

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4: Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act H.R. 1217: To Repeal the Prevention and Public Health Fund H.R. 1398: Rural Hospital Protection Act S. 668: Health Care Bureaucrats Elimination Act

Client expense: Not reported · Firm income: Not reported

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

-Discussed the implications of the Commitment to American Prosperity Act of 2011" for Missouri. -Supported grant funding by the Agency for Healthcare Research and Quality of a Health Research and Education Trust on "Development and Demonstrations of a Surgical United-based Safety Program (SUSP) to Reduce Surgical Site Infections and Other Surgical Complications." -Met with CMS staff to discuss concerns with CMS' certification and survey process. -Expressed support to the congressional delegation for H.R. 1398 as it relates to the calculation of provider taxes in Medicare cost reports. -Expressed concern to the Missouri congressional delegation about proposed funding reductions in H.R. 1363 for hospital disaster preparedness programs. -Discussed with CMS its actions taken against a member hospital for alleged violation of Medicare Conditions of Participation. -Met with the Missouri congressional delegation to discuss the following topics: 1) a profile of Missouri's hospitals; 2) financial projections of Medicare margins through 2019; 3) reductions in the use of state provider tax as proposed in the President's first budget proposal of 2011; 4) CMS standards for disproportionate share hospital payments 5); CMS treatment of provider taxes in Medicare cost reports and the benefits of H.R. 1398; 6) preservation of Medicare critical access hospitals, Medicare-dependent hospital and sole community hospital payments; 7) federal funding of poison control centers; and 8) the implications of the FY 2012 budget proposal advanced by Rep. Paul Ryan. -Encouraged the Health Resources and Services Administration to implement funding reductions of the final continuing resolution for FY 2011 by avoiding disproportionate cuts to children's graduate medical education payments and funding for poison control centers.

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

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

H.R.2, Repealing the Job-Killing Health Care Law Act (ACA repeal) S.668, Health Care Bureaucrats Elimination Act (IPAB Repeal) H.R.452, Medicare Decisions Accountability Act (IPAB Repeal) S.218/H.R.5, Help Efficient, Accessible, Low Cost, Timely Health (HEALTH) Care Act (Medical Malpractice) H.R.992, Building American Jobs Act (Build America Bonds extension) S.296, Preserving Access to Lifesaving Medications Act (Rx drug shortage) P.L.112-4, Further Continuing Appropriations Amendments, 2011 P.L.112-6, Additional Continuing Appropriations Amendments, 2011 ONC meaningful use certification regulation CMS Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Final Regulations Disproportionate Share Hospital (DSH) payments Medicare Inpatient Coding Offset New York State Medicaid Federal-State Health Reform Partnership (FSHRP) Waiver Graduate Medical Education (GME) Residency Slot Augmentation Accountable Care Organizations (ACO) Proposed Rule Medicare Hospital Value-Based Purchasing Program H.R.1398, Rural Hospital Protection Act (CAH provider tax bill) Center for Medicare and Medicaid Innovation (CMMI) H.R.1, Full Year Continuing Appropriations Act, sections relating to repeal of funding for P.L.111-148 (Patient Protection and Affordable Care Act) and P.L.111-152 (Health Care and Education Reconciliation Act)

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

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

-H.R. 2, Repealing the Job-Killing Health Care Law Act (ACA repeal) -S. 668, Health Care Bureaucrats Elimination Act (IPAB Repeal) -H.R. 452, Medicare Decisions Accountability Act (IPAB Repeal) -S. 218/H.R. 5, Help Efficient, Accessible, Low Cost, Timely Health (HEALTH) Care Act (Med Mal) H.R. 992, Building American Jobs Act (Build America Bonds extension) S. 296, Preserving Access to Lifesaving Medications Act (Rx drug shortage) H.R. 1, Full Year Continuing Appropriations Act, sections relating to repeal of funding for P.L. 111-148 (Patient Protection and Affordable Care Act) and P.L. 111-152 (Health Care and Education Reconciliation Act) P.L. 112-4, Further Continuing Appropriations Amendments, 2011 P.L. 112-6, Additional Continuing Appropriations Amendments, 2011 ONC meaningful use certification regulation CMS Medicare and Medicaid Electronic Health Record (EHR) Incentive program final regulations Disproportionate Share Hospital (DSH) payments Medicare inpatient coding offset New York State Medicaid Federal-State Health Reform Partnership (FSHRP) waiver Graduate Medical Education (GME) residency slot augmentation Accountable Care Organizations (ACO) proposed rule Medicare hospital value-based purchasing program H.R. 1398, Rural Hospital Protection Act (CAH provider tax bill) Center for Medicare and Medicaid Innovation (CMMI)

Client expense: Not reported · Firm income: Not reported

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

FDA Model Food Care; H.R.1398 and S.558, Menu Labeling Meal Act; H.R.759, Food and Drug Administration Globalization Act of 2009; H.R.999, Keeping Americans food Safe Act of 2009; H.R.875 and S.510, FDA Food Safety Modernization Act; H.R.2749, The food Safety Enchancement Act.

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

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS), Treasury, Dept of

H.R. 4: Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act H.R. 1217: To Repeal the Prevention and Public Health Fund H.R. 1398: Rural Hospital Protection Act S. 668: Health Care Bureaucrats Elimination Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE