Improving Access to Medicare Coverage Act of 2011

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; H.R.6575 Medicare Audit Improvement Act of 2012 to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Urging HHS and OIG to examine error rates of RAC as part of its Workplan for 2013 studies of RAC effectiveness.

Client expense: $5,350,000 · 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), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

PL 111-148 - The Patient Protection and Affordable Care Act; HR 452 - A bill to repeal IPAB; PL 112-96 - Middle Class Tax Relief and Job Creation Act of 2012; S. 818 - Improving Access to Medicare Coverage Act of 2011; HR 1543 - Improving Access to Medicare Coverage Act of 2011; S. 2037 - To reauthorize and improve the Older Americans Act of 1965, and for other purposes; Continued monitoring of Post Acute Care Payments and reform issues; monitoring the reduction of Hospital Readmission for Skilled Nursing Facilities; HR 5979 - Medicaid Accountability and Care Act; HR 6413 - the Medicare Transitional Care Act of 2012; S. 3604 - Improving Dementia Care Treatment for Older Adults act of 2012; HR 8 - American Taxpayer Relief Act of 2012; HR 6884 - Spending Reduction Act of 2012, Sec. 211; and PL 112-25 - Budget Control Act of 2011.

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

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

P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 452: A bill to repeal IPAB. H.R. 1543: Improving Access to Medicare Coverage Act of 2011. S. 818: Improving Access to Medicare Coverage Act of 2011. P.L. 112-96: Middle Class Tax Relief and Job Creation Act of 2012. S. 2037: To reauthorize and improve the Older Americans Act of 1965, and for other purposes. Continued monitoring Post Acute Care Payment and reform issues. Continued monitoring to reducing Hospital Readmission from Skilled Nursing Facility. H.R. 5979: Medicaid Accountability and Care Act. H.R. 6413: the Medicare Transitional Care Act of 2012. S. 3604: Improving Dementia Care Treatment for Older Adults Act of 2012. H.R. 8: American Taxpayer Relief Act of 2012. H.R. 6884: Spending Reduction Act of 2012, Sec. 211. P.L.112-25: Budget Control Act of 2011.

Client expense: $470,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE

H.R. 1543/S.818, Improving Access to Medicare Coverage Act 2011- Observation Stay Legislation Continued monitoring Post Acute Care Payments and reform issues Continued monitoring to reducing Hospital Readmission from Skilled Nursing Facility H.R.8, American Taxpayer Relief Act of 2012

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

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

H.R. 8, American Taxpayer Relief Act of 2012, entire bill with focus on Title VI and Title X. H.R. 6575, Medicare Audit Improvement Act, entire bill. H.R. 6611, Patient Access to Drugs in Shortage Act of 2012, entire bill. H.R. 1543 and S. 818, Improving Access to Medicare Coverage Act of 2011, entire bill. H.R. 6684, Spending Reduction Act of 2012, entire bill with focus on Title II and Title VII. H.R. 4872, Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 1106: physician-owned hospitals and self-referral; Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States; Section 1202: Payments to primary care physicians. H.R. 3590, Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 6001: physician-owned hospital and self-referral; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3401: Independent Payment Advisory Board; Section 3015: hospital readmissions program; Section 3124: Extension of Medicare Dependent Hospital program; Section 3137: Section 508 Reclassification; Section 9007: non-profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: Primary Care Provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: Expansion of Medicaid, CHIP; Sections 1311-1343: CO-OPs and Exchanges; Section 3022: Accountable Care Organizations; Section 3023: Hospital Bundling Provision; Section 6401-6402: Program Integrity Provisions; Section 6501-6503, 6505, 6508: Medicaid Program Integrity Provisions; Section 3141: Changes to the Rural Floor of the Hospital Wage Index. H.R. 2674, 340B Program Improvement Act, entire bill. S. 722 and H.R. 3506, Hospice Evaluation and Legitimate Payment Act, entire bills. S. 778, Protecting Access to Rural Therapy Services (PARTS) Act, entire bill. H.R. 3859 and S. 1680, Rural Hospital and Provider Equity (R-HOPE) Act of 2012, entire bills. H.R. 5943 and S. 2620, Rural Hospital Access Act of 2012, entire bills. H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2011, Title II, Subtitle C--Medicare Extensions; Other Health Provisions, Part 1--Medicare extensions, Section 2201, Physician payment update. Section 2202: Ambulance Add-ons; Section 2203: Medicare payment for outpatient therapy services; Section 2204: Work geographic Adjustment; Part 3--Offsets, Section 2223: Parity in Medicare payments for hospital outpatient department evaluation and management office visit services; Section 2224, Reduction of bad debt treated as an allowable cost; Section 2225, Rebasing of State DSH allotments for FY 2021. Part 2 of Subtitle C--Other Health Provisions, Section 2213: Modification to requirements for qualifying for exception to Medicare prohibition on certain physician referrals for hospitals. H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2012, entire bill. Other issues: 2013 Outpatient Prospective Payment System rule, entire rule. 2013 Inpatient Prospective Payment System rule, entire rule. 2013 Physician Fee Schedule rule, entire rule. Proposals surrounding the Sustainable Growth Rate (SGR) and deficit/debt reduction as related to hospitals and physicians. Accountable Care Organizations and the Innovation Center's demonstration programs. Medicare and Medicaid Recovery Audit Contractor programs. Geographic Variation in Medicare spending, IOM studies on high value and Medicare geographic adjusters. Medical Liability Reform. Medicare and Medicaid Electronic Health Record Payment Incentive Programs. Hospital wage index reform, including Section 3137(b) of the Affordable Care Act. Implementation of the state health insurance exchanges. 2013 Inpatient Rehab rule, entire rule. 2013 LTCH rule, entire rule Hospice Quality Reporting Program. 2013 Home Health rule, entire rule. Dual Eligible Demonstration Programs.

Client expense: $53,327 · Firm income: Not reported

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

Medicaid Funding in the Federal Budget, Medicare Funding in the Federal Budget, H.R. 1656 & S. 1900 Urban Medicare Dependent Hospital Act, Sustainable Growth Rate Formula - Permanent Medicare Doctor Payment Fix, H.R. 1543 & S.818 Improving Access to Medicare Coverage Act, MedPac Recommendations on Area Wage Index Adjustments, Demonstration Projects, H.R. 5943 Rural Hospital Access Act, H.R. 6532 Resident Physician Shortage Reduction and Graduate Medical Education

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

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

PL 111-148 - The Patient Protection and Affordable Care Act; HR 452 - A bill to repeal IPAB; PL 112-96 - Middle Class Tax Relief and Job Creation Act of 2012; S. 818 - Improving Access to Medicare Coverage Act of 2011; HR 1543 - Improving Access to Medicare Coverage Act of 2011; S. 2037 - To reauthorize and improve the Older Americans Act of 1965, and for other purposes; Continued monitoring of Post Acute Care Payments and reform issues; monitoring the reduction of Hospital Readmission for Skilled Nursing Facilities; HR 5979 - Medicaid Accountability and Care Act; HR 6413 - the Medicare Transitional Care Act of 2012; S. 3604 - Improving Dementia Care Treatment for Older Adults act of 2012; and Sequestration Repeal.

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

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

P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 452: A bill to repeal IPAB. H.R. 1543: Improving Access to Medicare Coverage Act of 2011. S. 818: Improving Access to Medicare Coverage Act of 2011. P.L. 112-96: Middle Class Tax Relief and Job Creation Act of 2012. S. 2037: To reauthorize and improve the Older Americans Act of 1965, and for other purposes. Continued monitoring Post Acute Care Payment and reform issues. Continued monitoring to reducing Hospital Readmission from Skilled Nursing Facility. H.R. 5979: Medicaid Accountability and Care Act. H.R. 6413: the Medicare Transitional Care Act of 2012. S. 3604: Improving Dementia Care Treatment for Older Adults Act of 2012. Sequestration Repeal.

Client expense: $440,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE

H.R. 1543/S.818, Improving Access to Medicare Coverage Act 2011- Observation Stay Legislation Continued monitoring Post Acute Care Payments and reform issues Continued monitoring to reducing Hospital Readmission from Skilled Nursing Facility H.J. Res 117, Continuing Appropriation Resolution 2013

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See addendum page Supported letter sent to CMS supporting moving existing services that have been paid on the Clinical Laboratory Fee Schedule to the Physician Fee Schedule. Stregthening Medicare and Repaying Taxpayers (SMART) Act, H.R. 1063: Neutral on this bill. Improving Access to Medicare Coverage Act of 2011 (H.R. 1543): Neutral on this bill. Lobbied on the Medicare Physician Reimbursement issue and the SGR Supported Association of Orthopedic Surgeons to oppose CMS management review program that requires a minimum of three months of documented physical therapy prior to surgery.

Client expense: $118,063 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Education, Dept of, HOUSE OF REPRESENTATIVES, Office of Science & Technology Policy (OSTP), Patent & Trademark Office (PTO), SENATE

H.R. 1543 and S. 818, Improving Access to Medicare Coverage Act of 2011, entire bill. H.R. 6365, the National Security and Job Protection Act of 2011, entire bill. H.R. 4872, the Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 1106: physician-owned hospitals and self-referral; Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States; Section 1202: Payments to primary care physicians. H.R. 3590, the Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 6001: physician-owned hospital and self-referral; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3401: Independent Payment Advisory Board; Section 3015: hospital readmissions program; Section 3124: Extension of Medicare Dependent Hospital program; Section 3137: Section 508 Reclassification; Section 9007: non-profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: Primary Care Provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: Expansion of Medicaid, CHIP; Sections 1311-1343: CO-OPs and Exchanges; Section 3022: Accountable Care Organizations; Section 3023: Hospital Bundling Provision; Section 6401-6402: Program Integrity Provisions; Section 6501-6503, 6505, 6508: Medicaid Program Integrity Provisions. H.R. 2674, 340B Program Improvement Act, entire bill. S. 722 and H.R. 3506, Hospice Evaluation and Legitimate Payment Act, entire bills. S. 778, Protecting Access to Rural Therapy Services (PARTS) Act, entire bill. H.R. 3285, Medicare Equity Extension Act, entire bill. H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2011, Title II, Subtitle C--Medicare Extensions; Other Health Provisions, Part 1--Medicare extensions, Section 2201, Physician payment update. Section 2202: Ambulance Add-ons; Section 2203: Medicare payment for outpatient therapy services; Section 2204: Work geographic Adjustment; Part 3--Offsets, Section 2223: Parity in Medicare payments for hospital outpatient department evaluation and management office visit services; Section 2224, Reduction of bad debt treated as an allowable cost; Section 2225, Rebasing of State DSH allotments for FY 2021. Part 2 of Subtitle C--Other Health Provisions, Section 2213: Modification to requirements for qualifying for exception to Medicare prohibition on certain physician referrals for hospitals. H.R. 3859 and S. 1680, The Rural Hospital and Provider Equity (R-HOPE) Act of 2012, entire bills. H.R. 3630, The Middle Class Tax Relief and Job Creation Act of 2012, entire bill. H.R. 5943 and S. 2620, the Rural Hospital Access Act of 2012, entire bills. H.R. 2461, Physician Pathology Services Continuity Act of 2011, entire bill. H.R. 2104, Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2011, entire bill. 2013 Outpatient Prospective Payment System proposed rule, entire rule. 2013 Inpatient Prospective Payment System final rule, entire rule. 2013 Physician Fee Schedule proposed rule, entire rule. Other issues: Proposals surrounding the Sustainable Growth Rate (SGR) and deficit/debt reduction as related to hospitals and physicians. Accountable Care Organizations and the Innovation Center's demonstration programs. Medicare and Medicaid Recovery Audit Contractor programs. Geographic Variation in Medicare spending, IOM studies on high value and Medicare geographic adjusters. Medical Liability Reform. Medicare and Medicaid Electronic Health Record Payment Incentive Programs. Hospital wage index reform, including Section 3137(b) of the Affordable Care Act. Implementation of the state health insurance exchanges. 2013 Inpatient Rehab rule, entire rule. 2013 LTCH rule, entire rule Hospice Quality Reporting Program. 2013 Home Health rule, entire rule. Dual Eligible Demonstration Programs.

Client expense: $50,463 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE

Benefit Redesign. (No Bill): proposals for providing a catastrophic cap on Medicare out-of-pocket spending to be paid for by a surcharge on private Medigap policies and employer-provided retiree health benefits. Independent Payment Advisory Board. H.R. 1: provisions to repeal or modify P.L. 111-148/P.L. 111-152 authorizing the creation of an independent commission to promulgate Medicare policies designed to reduce Medicare spending growth. Medicare Drug Savings. S. 1206, H.R. 2190: provisions extending the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Home Health Benefits. (No bill): proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Income-relating. (No bill): proposals to increase the cost of Medicare to higher-income beneficiaries. Medicare Part A Hospital Inpatient Status. S. 818, H.R. 1543: provisions ensuring beneficiaries receiving hospital services are designated as inpatients, thereby assuring coverage of prescription drugs and post-acute care under Part A following a three-day hospitalization. Medicare Parts C and D. P.L. 110-275, P.L. 108-173: implementation of regulations and issuance of guidance relating to beneficiary eligibility, enrollment, and effectiveness of exceptions and the appeals processes under Medicare Parts C and D. Medicare Part D Negotiation of Drug Prices. S. 31, S. 44, S. 560, H.R. 999, H.R. 6392: provisions creating a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Managed Care. H.R. 4254: provisions pertaining to revisions to the coding intensity adjustment factor in the formula for the demographic adjustment used in calculating payments to Medicare Advantage organizations for 2015 and subsequent years and setting the timing of prepayments to January 2013. Medicare Supplemental Health Insurance. (No bill): proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Physician Fees. (No bill): proposals to maintain current levels of physician fees under Part B. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: provisions related to reducing Medicare Advantage plan payments; reducing the Part D coverage gap; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); improving the process for reassigning LIS beneficiaries to new plans; expanding coverage of prevention services; establishing a Medicare Commission; providing expanded Medicaid coverage for home and community-based services; authorizing the collection of data regarding disparities in the provision of care; providing safeguards and subsidies to assure affordability of health coverage for seniors. Center for Medicare and Medicaid Innovation. (No bill): proposals related to the planning for the Center for Medicare and Medicaid Innovations, and the approach this office will take to test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care for Medicare, Medicaid and CHIP beneficiaries. Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill): proposals related to activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients who receive benefits from both Medicare and Medicaid, e.g, dual-eligibles. Long-term Services and Supports/Repeal of CLASS Act. S. 720, H.R. 1173: provisions repealing expanded support for long-term supports and services through the Community Living Assistance Services and Supports (CLASS) Act.

Client expense: $310,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Employment & Training Administration, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Vice President of the U.S.

Medicaid Funding in the Federal Budget, Medicare Funding in the Federal Budget, H.R. 1656 & S.1900 Urban Medicare Dependent Hospital Act, Sustainable Growth Rate Formula - Permanent Medicare Doctor Payment Fix , H.R.1543 & S.818 Improving Access to Medicare Coverage Act, MedPac Recommendations on Area Wage Index Adjustments, Demonstration Projects, H.R.5943 Rural Hospital Access Act, H.R.6532 Resident Physician Shortage Reduction and Graduate Medical Education

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

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

Support H.R. 6476, the Medicare Adult Day Services Act, to provide Medicare coverage for approved adult day services for Medicare beneficiaries. Support S. 501, the Fostering Independence Through Technology Act, to provide incentives for home health agencies to use home monitoring and communications technologies. S. 818/H.R. 1543, Improving Access to Medicare Coverage Act - support. Would specify that a Medicare beneficiary hospitalized under observation for more than 24 hours would be deemed to have been an inpatient and would be considered to have been discharged upon leaving the hospital. Under these circumstances, the beneficiary would be eligible for Medicare Part A coverage of post-acute care. Advocating for extension of Medicare therapy caps exceptions process under any Medicare legislation considered in the post-election session of Congress.

Client expense: $18,958 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid Funding in the Federal Budget, Medicare Funding in the Federal Budget, Middle Class Tax Relief and Job Creaton Act of 2012 (Medicare, Medicaid, Social Security Tax Reduction Extenders) H.R. 3630, Urban Medicare Dependent Hospital Act H.R. 1656 & S. 1900, Sustainable Growth Rate Formula - Permanent Medicare Doctor Payment Fix, Improving Access to Medicare Coverage Act H.R. 1543 & S. 818, MedPac Recommendations on Area Wage Index Adjustments, Demonstration Projects

Client expense: $90,000 · Firm income: Not reported

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

P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 452: A bill to repeal IPAB. H.R. 1543: Improving Access to Medicare Coverage Act of 2011. S. 818: Improving Access to Medicare Coverage Act of 2011. H.R. 3630: Middle Class Tax Relief and Job Creation Act of 2012. H.R. 2032: To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits by federally-funded entities involving such residents and in Department of Justice actions that could result in an agreement to move such a resident from that resident's facility. S. 2037: To reauthorize and improve the Older Americans Act of 1965, and for other purposes. Continued monitoring Post Acute Care Payment and reform issues. Continued monitoring to reducing Hospital Readmission from Skilled Nursing Facility. H.R. 5979: Medicaid Accountability and Care Act.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE

H.R. 1543/S.818, Improving Access to Medicare Coverage Act 2011- Observation Stay Legislation Continued monitoring Post Acute Care Payments and reform issues Continued monitoring to reducing Hospital Readmission from Skilled Nursing Facility

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

PL 111-148 - The Patient Protection and Affordable Care Act; HR 452 - A bill to repeal IPAB; HR 3630 Proposed reduction in SNF bad debt reimbursement rates; HR 2032 - To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits by federally-funded entities involving such residents and in Department of Justice actions that could result in an agreement to move such a resident from that resident's facility; S. 818 - Improving Access to Medicare Coverage Act of 2011; HR 1543 - Improving Access to Medicare Coverage Act of 2011; S. 2037 - To reauthorize and improve the Older Americans Act of 1965, and for other purposes; S. 2077 - Elder Protection and Abuse Prevention Act; continued monitoring Post Acute Care Payment and reform issues; reducing hospital readmission from Skilled Nursing Facility.

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

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

Medicare Dental Benefits. S. 3272, H.R. 5909: provisions creating a Medicare Part B dental benefit. Medigap Benefits. S. 3271: provisions expanding access to Medicare supplemental insurance. Benefit Redesign. (No Bill): proposal to provide a catastrophic cap on Medicare out-of-pocket spending funded by a surcharge on private Medigap policies and employer-provided retiree health benefits. Independent Payment Advisory Board. H.R. 452, S. 668, H.R. 1 (Sec. 4050): proposals to repeal or modify the provisions of P.L. 111-148 and P.L. 111-152 reducing Medicare spending growth through an independent commission. Medicare Drug Savings. S. 1206, H.R. 2190: provisions extending Medicaid drug rebates to prescription drugs paid for by Medicare on behalf of Medicare-Medicaid dual-eligibles, and by Medicare Part D Low-Income Subsidy beneficiaries. Home Health Benefits. (No bill): proposal to require copayments from people receiving the Medicare home health benefit. Medicare Income-relating. (No bill): proposals to increase the percent of Medicare beneficiaries paying higher income-related premiums. Medicare Part A Hospital Inpatient Status. S. 818, H.R. 1543: provisions ensuring beneficiaries receiving hospital services are designated as inpatients, thereby assuring coverage of prescription drugs and post-acute care under Part A following a three-day hospitalization. Medicare Parts C and D. P.L. 110-275, P.L. 108-173: implementation of regulations and the issuance of guidance relating to beneficiary eligibility, enrollment, and effectiveness of exceptions and the appeals processes under Medicare Parts C and D. Medicare Part D Negotiation of Drug Prices. S. 31, S. 44, S. 560, H.R. 999, H.R. 3638: provisions creating a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Managed Care. H.R. 4254: provisions pertaining to revising the coding intensity adjustment factor in the demographic adjustment formula (used in calculating payments to Medicare Advantage organizations) for 2015 and subsequent years and setting the timing of prepayments beginning with January 2013. Medicare Supplemental Health Insurance. (No bill): proposals to increase costs for Medicare supplemental insurance. Medicare Physician Fees. P.L. 112-96, (H.R. 3630): provisions maintaining current levels of physician fees under Part B; extending the therapy caps exceptions process; and extending the Qualified Individual program. Medicare Privatization/Premium Support. (H. Con. Res. 112 and S. Con. Res. 37): provisions to convert Medicare from a defined benefit plan to a premium support/voucher system. Raising Medicare Eligibility Age. (H. Con. Res. 112 and S. Con. Res. 37): provisions to raise the Medicare eligibility age from 65 to 67. Prescription Drug Safety. P.L.112-144 (S. 3187, H.R. 3988, H.R. 4087, H.R. 5334, S. 2236, S. 2289 and S. 2516): provisions facilitating the importation of prescription drugs; preventing pharmaceutical fraud by requiring good corporate behavior; facilitating the adoption of modern information technology; and prohibiting brand name drug companies from compensating generic drug companies to delay the entry of a generic drug into the market. Public Health Service Act Dental Care. S. 1878, H.R. 4091: provisions pertaining to offering grant support to national dental programs that provide pro-bono dental care to Medicare and Medicaid eligible low-income children and adults. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: provisions related to reducing Medicare Advantage plan payments; reducing the Part D coverage gap; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); improving the process for reassigning LIS beneficiaries to new plans; expanding coverage of prevention services; establishing a Medicare Commission; providing expanded Medicaid coverage for home and community-based services; authorizing the collection of data regarding disparities in the provision of care; providing safeguards and subsidies to assure affordability of health coverage for seniors. Center for Medicare and Medicaid Innovations. (No bill): proposals related to planning for the Center for Medicare and Medicaid Innovations, and the approach this entity will take to test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care for Medicare, Medicaid and CHIP beneficiaries. Federal Coordinated Health Care Office/Medicare-Medicaid Coordination Office. (No bill): proposals related to activities of the Federal Coordinated Health Care Office intended to improve the quality of care for Medicare and Medicaid dual-eligibles. Long-term Care Financing. (No bill): proposals to amend the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums; to permit the use of qualified long-term care insurance under cafeteria plans and flexible spending arrangements; and to provide a tax credit for individuals with long-term care needs. Long-term Services and Supports/Repeal of CLASS. S. 720, H.R. 1173: provisions repealing the Community Living Assistance Services and Supports (CLASS) Act.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Employment & Training Administration, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Vice President of the U.S.

Improving Access to Medicare Coverage Act of 2011, HR1543 and S818, supported. Rural Hospital Access Act of 2012, HR5943 and S2620, supported. Advocated for appropriate wage indexing and low-volume adjustment factors. Proposed Rulemaking on Preventive Services, CMS-9968-ANPRM, supported the repeal of the contraceptive mandateor to modify the definition of religious employer to include religious sponsored hospitals. Supported measures to ensure appropriate reimbursement for hospital and other health care services.

Client expense: $58,003 · Firm income: Not reported

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

HR 883/S 495, Adult Day Achievement Center Enhancement Act - support. Establishes grants and funds research on developing specialized adult day services programs for younger adults with neurological diseases or conditions. S. 501, Fostering Independence Through Technology - support. Creates a Medicare pilot program to provide incentives for home health agencies to use home monitoring and communications technologies to help beneficiaries remain at home. S 818/HR 1543, Improving Access to Medicare Coverage Act - support. Would specify that a Medicare beneficiary hospitalized under observation for more than 24 hours would be deemed to have been an inpatient and would be considered to have been discharged upon leaving the hospital. Under these circumstances, the beneficiary would be eligible for Medicare Part A coverage of post-acute care. Advocating for protection of the interests of beneficiaries dually eligible for Medicare and Medicaid coverage under managed care demonstration programs under development in the various states.

Client expense: $52,910 · Firm income: Not reported

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

Children's Hospital GME Support Reauthorization Act (H.R. 1852/S. 958) Improving Access to Medicare Coverage Act of 2011 (H.R. 1543)

Client expense: $12,500 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid Funding in the Federal Budget, Medicare Funding in the Federal Budget, Middle Class Tax Relief and Job Creation Act of 2012 (Medicare, Medicaid, Social Security Tax Reduction Extenders) H.R. 3630, Urban Medicare Dependent Hospital Act H.R. 1656 & S.1900, Sustainable Growth Rate formula - Permanent Medicare doctor payment fix, Improving Access to Medicare Coverage Act H.R.1543 & S. 818, MedPac recommendations on area wage index adjustments, Demonstration Projects

Client expense: $90,000 · Firm income: Not reported

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

H.R. 3630 - advocated for extension of Medicare therapy caps exceptions process and against cuts in Medicare reimbursement of nursing homes for bad debt. H.R. 883/S. 495, Adult Day Achievement Center Enhancement Act - support. Establishes grants and funds research on developing specialized adult day services programs for younger adults with neurological diseases or conditions. S. 501, Fostering Independence Through Technology - support. Creates a Medicare pilot program to provide incentives for home health agencies to use home monitoring and communications technologies to help beneficiaries remain at home. S. 818/H.R. 1543, Improving Access to Medicare Coverage Act - support. Would specify that a Medicare beneficiary hospitalized under observation for more than 24 hours would be deemed to have been an inpatient and would be considered to have been discharged upon leaving the hospital. Under these circumstances, the beneficiary would be eligible for Medicare Part A coverage of post-acute care.

Client expense: $46,643 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid Funding in the Federal Budget, Medicare Funding in the Federal Budget, Middle Class Tax Relief and Job Creation Act of 2012 (Medicare, Medicaid, Social Security Tax Reduction Extenders) H.R.3630, Urban Medicare Dependent Hospital Act H.R. 1656 & S.1900, Sustainable Growth Rate formula - Permanent Medicare doctor payment fix, Improving Access to Medicare Coverage Act H.R. 1543 & S.818, MedPAC recommendations on area wage index adjustments, Demonstration Projects

Client expense: $90,000 · Firm income: Not reported

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

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

PL 111-148 - The Patient Protection and Affordable Care Act; HR 452 - A bill to repeal IPAB; HR 3630 Proposed reduction in SNF bad debt reimbursement rates; HR 2032 - To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits by federally-funded entities involving such residents and in Department of Justice actions that could result in an agreement to move such a resident from that resident's facility; S. 818 - Improving Access to Medicare Coverage Act of 2011; HR 1543 - Improving Access to Medicare Coverage Act of 2011; S. 2037 - To reauthorize and improve the Older Americans Act of 1965, and for other purposes; S. 2077 - Elder Protection and Abuse Prevention Act; continued monitoring Post Acute Care Payment and reform issues; reducing hospital readmission from Skilled Nursing Facility.

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

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

P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 452: A bill to repeal IPAB. H.R. 3630: Middle Class Tax Relief and Job Creation Act of 2012. H.R. 2032: To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits by federally-funded entities involving such residents and in Department of Justice actions that could result in an agreement to move such a resident from that resident's facility. S. 818: Improving Access to Medicare Coverage Act of 2011. H.R. 1543: Improving Access to Medicare Coverage Act of 2011. S. 2037: To reauthorize and improve the Older Americans Act of 1965, and for other purposes. S. 2077: Elder Protection and Abuse Prevention Act. Continued monitoring Post Acute Care Payment and reform issues. Reducing Hospital Readmission from Skilled Nursing Facility.

Client expense: $460,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE

Medicare/Commission. P.L. 111-148, P.L. 111-152 (Sec. 4050): provisions pertaining to the repeal or modification of provisions creating an independent commission authorized to establish Medicare payment and policy designed to reduce Medicare spending growth. Medicare Drug Savings. S. 1206, H.R. 2190: provisions extending Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare/Home Health Benefits. (No bill): proposals regarding potential copayments for beneficiaries receiving the Medicare home health benefit. Medicare/Income-relating. (No bill): proposals to increase costs for higher-income Medicare beneficiaries. Medicare/Part A Hospital Inpatient Status. S. 818, H.R. 1543: provisions ensuring beneficiaries receiving hospital services are designated as inpatients, thereby assuring coverage of prescription drugs and post-acute care under Part A following a three-day hospitalization. Medicare Part B Drug Savings. S. 1699: provisions pertaining to provisions that reduce the cost of prescription drugs paid for under Medicare Part B. Medicare/Parts C and D. P.L. 110-275, P.L. 108-173: provisions pertaining to the implementation of regulations and issuance of guidance relating to beneficiary eligibility, enrollment, and effectiveness of exceptions and the appeals processes under Medicare Parts C and D. Medicare/Part D plan, Negotiation of Part D Drug Prices. S. 31, S. 44, S. 560, H.R. 999: provisions creating a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare/Managed Care. Medicare Advantage Program Integrity Act of 2012. H.R. 4254: provisions pertaining to revisions of the coding intensity adjustment factor in the formula for the demographic adjustment used in calculating payments to Medicare Advantage organizations for 2015 and subsequent years and sets the timing of prepayments to beginning with January 2013. Medicare/Medicare Supplemental Health Insurance. (No bill): proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare/Physician Fees. P.L. 112-96, (H.R. 3630): provisions pertaining to provisions that maintain current levels of physician fees under Medicare Part B; extending the therapy caps exceptions process; extending the Qualified Individual program. Medicare/Premium Support/Privatization. (No bill): proposals to convert Medicare from a defined benefit plan to a premium support/voucher system. Medicare/Raising Eligibility Age. (No bill): proposals to raise the Medicare eligibility age from 65 to 67. Medicare/Medicaid. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: provisions related to reducing Medicare Advantage plan payments; reducing the Part D coverage gap; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); improving the process for reassigning LIS beneficiaries to new plans; expanding coverage of prevention services; establishing a Medicare Commission; providing expanded Medicaid coverage for home and community-based services; authorizing the collection of data regarding disparities in the provision of care; providing safeguards and subsidies to assure affordability of health coverage for seniors. Medicare and Medicaid/Center for Medicare and Medicaid Innovations. (No bill): proposals related to the planning for the Center for Medicare and Medicaid Innovations, and the approach this office will take to test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care for Medicare, Medicaid and CHIP beneficiaries. Medicare and Medicaid/Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill): proposals related to activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients who receive benefits from both Medicare and Medicaid, i.e., dual-eligibles. Long-term Care Financing via Tax Deduction. (No bill): provisions amending the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long -term care needs. Long-term Services and Supports/Community Living Assistance Services and Supports (CLASS) Act. S. 720, H.R. 1173: provisions repealing previously enacted expanded support for long-term supports and services.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Employment & Training Administration, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Vice President of the U.S.

PL 111-148 - The Patient Protection and Affordable Care Act; S. 218 & HR 5 - Help Efficient, Accessible, Low Cost, timely Healthcare (health) Act of 2011; S. 668 - Health Care Bureaucrats Elimination Act; HR 1 - Full-Year continuing Appropriations Act of 2011; HR 314 - Medical Liability Procedural Reform Act of 2011; HJ Res. 44 - Further Continuing Appropriations Amendments of 2011; HJ Res. 48 - Additional Continuing Appropriations Amendments of 2011; S. 818 & HR 1543 - Improving Access to Medicare Coverage Act of 2011; S. 868 - State Flexibility Act; HR 1683 - State Flexibility Act, introduced on May 3, 2011 by Rep. Phil Gingrey. A bill to restore the longstanding partnership between States and the Federal Government in managing the Medicaid program; HR 2031 - To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits by federally-funded entities involving such residents and in Department of Justice actions that could result in an agreement to move such a resident from that resident's facility; HR 1546 & S. 829 - Medicare Access to Rehabilitation Services Act of 2011; S. 1486 - Long-Term Care Hospital Improvement Act of 2011; and continued monitoring of Post Acute Care Payment and Reform issues (site neutrality) House side.

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

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

Children's Hospital GME Support Reauthorization Act (H.R. 1852/S. 958) Improving Access to Medicare Coverage Act (H.R. 1543) Middle Class Tax Relief and Job Creation Act (H.R. 3630)

Client expense: $12,500 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

P.L. 111-148: The Patient Protection and Affordable Care Act. S: 218: Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011. H.R. 5: Help Efficient, Accessible, Low Cost, Timely Healthcare (Health) Act of 2011. . S. 668: Health Care Bureaucrats Elimination Act. H.R. 1: Full-Year Continuing Appropriations Act, 2011. H.R. 314: Medical Liability Procedural Reform Act of 2011. H.J. Res. 44: Further Continuing Appropriations Amendments, 2011. H.J. Res. 48: Additional Continuing Appropriations Amendments, 2011. S. 818: Improving Access to Medicare Coverage Act of 2011. H.R. 1543: Improving Access to Medicare Coverage Act of 2011. S. 868: State Flexibility Act. H.R. 1683: State Flexibility Act, introduced on May 3, 2011 by Rep. Phil Gingrey. A bill to restore the longstanding partnership between States and the Federal Government in managing the Medicaid program. H.R. 2032: To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits by federally-funded entities involving such residents and in Department of Justice actions that could result in an agreement to move such a resident from that resident's facility. H.R. 1546: Medicare Access to Rehabilitation Services Act of 2011. S. 829: Medicare Access to Rehabilitation Services Act of 2011.

Client expense: $440,000 · Firm income: Not reported

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

H.R. 3630 - advocated for extension of Medicare therapy caps exceptions process and against cuts in Medicare reimbursement of nursing homes for bad debt. H.R. 883/S 495, Adult Day Achievement Center Enhancement Act - support. Establishes grants and funds research on developing specialized adult day services programs for younger adults with neurological diseases or conditions. S. 501, Fostering Independence Through Technology - support. Creates a Medicare pilot program to provide incentives for home health agencies to use home monitoring and communications technologies to help beneficiaries remain at home. Advocated against the inclusion of cuts in Medicare and Medicaid in any deficit reduction plan developed by the Joint Select Committee on Deficit Reduction. S. 818/H.R. 1543, Improving Access to Medicare Coverage Act - support. Would specify that a Medicare beneficiary hospitalized under observation for more than 24 hours would be deemed to have been an inpatient and would be considered to have been discharged upon leaving the hospital. Under these circumstances, the beneficiary would be eligible for Medicare Part A coverage of post-acute care.

Client expense: $74,242 · Firm income: Not reported

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 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

P.L. 111-148: The Patient Protection and Affordable Care Act. S: 218: Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011. H.R. 5: Help Efficient, Accessible, Low Cost, Timely Healthcare (Health) Act of 2011. . S. 668: Health Care Bureaucrats Elimination Act. H.R. 1: Full-Year Continuing Appropriations Act, 2011. H.J. Res. 44: Further Continuing Appropriations Amendments, 2011. H.J. Res. 48: Additional Continuing Appropriations Amendments, 2011. S. 818: Improving Access to Medicare Coverage Act of 2011. H.R. 1543: Improving Access to Medicare Coverage Act of 2011. S. 868: State Flexibility Act. H.R. 1683: State Flexibility Act, introduced on May 3, 2011 by Rep. Phil Gingrey. A bill to restore the longstanding partnership between States and the Federal Government in managing the Medicaid program. H.R. 2032: To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits by federally-funded entities involving such residents and in Department of Justice actions that could result in an agreement to move such a resident from that resident's facility. H.R. 1546: Medicare Access to Rehabilitation Services Act of 2011. S. 829: Medicare Access to Rehabilitation Services Act of 2011. __ Continued monitoring Post Acute Care Payment and Reform issues (site neutrality) house side. S. 1486: Long-Term Care Hospital Improvement Act of 2011. H.R. 3587: Fair Pay to Medicaid Providers Act of 2011. .

Client expense: $480,000 · Firm income: Not reported

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

PL 111-148 - The Patient Protection and Affordable Care Act; S. 218 & HR 5 - Help Efficient, Accessible, Low Cost, timely Healthcare (health) Act of 2011; S. 668 - Health Care Bureaucrats Elimination Act; HR 1 - Full-Year continuing Appropriations Act of 2011; HR 314 - Medical Liability Procedural Reform Act of 2011; HJ Res. 44 - Further Continuing Appropriations Amendments of 2011; HJ Res. 48 - Additional Continuing Appropriations Amendments of 2011; S. 818 & HR 1543 - Improving Access to Medicare Coverage Act of 2011; S. 868 - State Flexibility Act; HR 1683 - State Flexibility Act, introduced on May 3, 2011 by Rep. Phil Gingrey. A bill to restore the longstanding partnership between States and the Federal Government in managing the Medicaid program; HR 2031 - To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits by federally-funded entities involving such residents and in Department of Justice actions that could result in an agreement to move such a resident from that resident's facility; HR 1546 & S. 829 - Medicare Access to Rehabilitation Services Act of 2011; S. 1486 - Long-Term Care Hospital Improvement Act of 2011; and continued monitoring of Post Acute Care Payment and Reform issues (site neutrality) House side.

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

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

Medicare/Home Health Benefits (No bill). Pertaining to potential regulation regarding the face-to-face physician encounter requirement to qualify for the Medicare home health benefit. Medicare/Home Health Benefits (No bill). Pertaining to potential copayments for beneficiaries receiving the Medicare home health benefit. Medicare/Clinical Laboratory Services (No bill). Pertaining to potential copayments for beneficiaries Medicare clinical laboratory services. Medicare/Part A Hospital Inpatient Status. S. 818, H.R. 1543: provisions ensuring beneficiaries receiving hospital services are designated as inpatients, thereby assuring coverage of prescription drugs and post-acute care under Part A. Medicare/Physician Fees. P.L. 111-309 (H.R. 4994), H.R. 3630, H.R. 3743, H.R. 3765: provisions maintaining current levels of physician fees under Part B; extending the therapy caps exceptions process; extending the Qualified Individual program. Comprehensive Health Care Reform. P.L. 111-148 (H.R. 3590), P.L. 111-152 (H.R. 4872): implementation of provisions reducing Medicare Advantage plan payments; reducing the Part D coverage gap; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); improving the process for reassigning LIS beneficiaries to new plans; expanding coverage of prevention services; establishing a Medicare Commission; providing expanded Medicaid coverage for home and community-based services; authorizing the collection of data regarding disparities in the provision of care; providing safeguards and subsidies to assure affordability of health coverage for seniors. Medicare/Commission. P.L. 111-148 (H.R. 3590), P.L. 111-152 (H.R. 452, S. 668): pertaining to the repeal or modification of provisions creating an independent commission authorized to establish Medicare payment and policy designed to reduce Medicare spending growth. Medicare/Parts C and D. P.L. 110-275, P.L. 108-173: implementation of regulations and issuance of guidance relating to beneficiary eligibility, enrollment, and effectiveness of exceptions and the appeals processes under Medicare Parts C and D. Medicare/Medicare-operated Part D plan, Negotiation of Part D Drug Prices. S. 31, S. 44, S.560, H.R. 999: creating a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Drug Savings. S. 1206, H.R. 2190: extending Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Part B Drug Savings. S. 1699: provisions reducing the cost of prescription drugs paid for under Medicare Part B. Medicare and Medicaid/Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office) (No bill). Proposals for the activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients who receive benefits from both Medicare and Medicaid, i.e., dual-eligibles. Medicare and Medicaid/Center for Medicare and Medicaid Innovations (No bill). Proposals related to the planning for the Center for Medicare and Medicaid Innovations, and the approach this office will take to test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care for Medicare, Medicaid and CHIP beneficiaries. Medicare/Raising Eligibility Age (No bill). Proposals to raise the Medicare eligibility age from 65 to 67. Medicare/Medicare Supplemental Health Insurance (No bill). Proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare/Income-relating (No bill). Proposals to increase costs for higher-income Medicare beneficiaries. Medicare Privatization (No Bill): Provisions to convert Medicare from a defined benefit plan to a premium support/voucher system. Long-term Care Financing. S. 227, H.R. 2267: provisions permitting advance practice registered nurses (APRNs) and physician assistants (PAs) to sign home health plans of care. Long-term Care Financing via Tax Deduction (no bill): Provisions amending the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long -term care needs. Repeal of expanded support for long-term supports and services, S. 720, H.R. 1173: Legislation would repeal the Community Living Assistance Services and Supports (CLASS) Act, a voluntary national insurance program for purchasing community living assistance will help many people remain in the community and avoid institutional care, which will improve their quality of life.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Employment & Training Administration, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Social Security Administration (SSA)

S.1486: Long-Term Care Hospital Improvement Act of 2011, All Sections H.R.3516: To amend title XVIII of the Social Security Act with respect to Medicare payment for long-term care hospital services, All Sections H.R.1543 -- Improving Access to Medicare Coverage Act of 2011 (Observation stays) S.818: Improving Access to Medicare Coverage Act of 2011 (Observation stays) H.R.1546: Medicare Access to Rehabilitation Services Act of 2011 (Therapy Cap repeal) S.829: Medicare Access to Rehabilitation Services Act of 2011 (Therapy Cap repeal) H.R.3765 (PL 112-78) Temporary Payroll Tax Cut Continuation Act of 2011 SEC. 301. MEDICARE PHYSICIAN PAYMENT UPDATE. SEC. 304. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE THERAPY CAPS H.R.3630 -- Temporary Payroll Tax Cut Continuation Act of 2011 TITLE III--TEMPORARY EXTENSION OF HEALTH PROVISIONS SEC. 301. MEDICARE PHYSICIAN PAYMENT UPDATE. SEC. 304. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE THERAPY CAPS H.R.3743 -- Temporary Payroll Tax Cut Continuation Act of 2011 TITLE III--TEMPORARY EXTENSION OF HEALTH PROVISIONS SEC. 301. MEDICARE PHYSICIAN PAYMENT UPDATE. SEC. 304. EXTENSION OF EXCEPTIONS PROCESS FOR MEDICARE THERAPY CAPS

Client expense: $430,000 · Firm income: Not reported

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

Children's Hospital GME Support Reauthorization Act of 2011 (H.R. 1852/S. 958) Improving Access to Medicare Coverage Act (H.R. 1543) Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3630)

Client expense: $12,500 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1486, Long-Term Care Hospital Improvement Act of 2011, all sections. H.R. 1546, Medicare Access to Rehabilitation Services Act of 2011 (Therapy Cap Repeal). S. 829, Medicare Access to Rehabilitation Services Act of 2011 (Therapy Cap Repeal). S. 818, Improving Access to Medicare Coverage Act of 2011 (Observation Stays). H.R. 1543, Improving Access to Medicare Coverage Act of 2011 (Observation Stays).

Client expense: $1,600,000 · Firm income: Not reported

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

PL 111-148 - The Patient Protection and Affordable Care Act; S. 218 & HR 5 - Help Efficient, Accessible, Low Cost, timely Healthcare (health) Act of 2011; S. 668 - Health Care Bureaucrats Elimination Act; HR 1 - Full-Year continuing Appropriations Act of 2011; HR 314 - Medical Liability Procedural Reform Act of 2011; HJ Res. 44 - Further Continuing Appropriations Amendments of 2011; HJ Res. 48 - Additional Continuing Appropriations Amendments of 2011; S. 818 & HR 1543 - Improving Access to Medicare Coverage Act of 2011; S. 868 - State Flexibility Act; HR 1683 - State Flexibility Act, introduced on May 3, 2011 by Rep. Phil Gingrey. A bill to restore the longstanding partnership between States and the Federal Government in managing the Medicaid program; HR 2031 - To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits by federally-funded entities involving such residents and in Department of Justice actions that could result in an agreement to move such a resident from that resident's facility; HR 1546 & S. 829 - Medicare Access to Rehabilitation Services Act of 2011; S. 1486 - Long-Term Care Hospital Improvement Act of 2011; and continued monitoring of Post Acute Care Payment and Reform issues (site neutrality) House side.

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

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

HR 883/S 495, Adult Day Achievement Center Enhancement Act - support. Establishes grants and funds research on developing specialized adult day services programs for younger adults with neurological diseases or conditions. S. 501, Fostering Independence Through Technology - support. Creates a Medicare pilot program to provide incentives for home health agencies to use home monitoring and communications technologies to help beneficiaries remain at home. Advocating against cuts in Medicare and Medicaid programs as part of the federal budget deficit reduction plan being developed by the Joint Select Committee on Deficit Reduction. S. 818/H.R. 1543, Improving Access to Medicare Coverage Act - support. Would specify that a Medicare beneficiary hospitalized under observation for more than 24 hours would be deemed to have been an inpatient and would be considered to have been discharged upon leaving the hospital. Under these circumstances, the beneficiary would be eligible for Medicare Part A coverage of post-acute care.

Client expense: $87,742 · Firm income: Not reported

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 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