Medicare Access to Rehabilitation Services Act of 2011

H.R. 1546/S. 829-Medicare Access to Rehabilitation Services Act (Repeal of Therapy Caps) H.R. 560 Rural Representation and Transparency Improvement Act Payments to Physical Therapists under the Medicare Physician Fee Schedule Permanent Repeal of/alternatives to the Sustainable Growth Rate (SGR) Formula Opposition of Multiple Procedure Payment Reduction for PT Services Physician Quality Reporting System Opposition to Medicaid Funding Cuts Physician Self-Referral - elimination of PT exception Medicare Advanced Imaging Act Opt-Out Locum Tenens Prevention Initiatives for Fraud and Abuse in the Medicare program H.R. 2785 Opposition to Athletic Trainers' Equal Access to Medicare Act, all provisions Accountable Care Organizations Electronic Health Records/ Health Information Technology incentives for Physical Therapists Home Health PPS 2013 Development of Alternatives to Medicare Therapy Cap Medicare Payment Reform H.R. 1700 Medicare Patient Empowerment Act, inclusion of physical therapists S. 668 Health Care Bureacrats Elmination Act (IPAB Repeal), all provisions H.R. 452 Medicare Decisions Accountability Act of 2011 (IPAB Repeal), all provisions Protecting Medicaid Caps or Block Grants Local Coverage Determinations NCCI Edits H.R. 2863 Medicare Oral Health Rehabilitative Enhancement Act of 2011, all provisions H.R. 2499 Lymphedema Diagnosis and Treatment Cost-Saving Act of 2011, all provisions Protection of programs related to physical therapy in deficit reduction H.R. 1958 Medicare Orthotics and Prosthetics Improvement Act of 2011, all provisions H.R. 3000 Empowering Patients First Act, provisions pertaining to physical therapy H.R. 5 Protecting Access to Healthcare Act Medicare Advantage Mobile Health Technology Privacy/Security Meeting (HHS-ONC) Off-the-shelf Othotics Comments PCORI National Priority for Research and Research Agenda USPSTF peripheral arterial disease HR 3258 Medicare Equity Extension Act Health Information Technology :EHR Comments EHR Incentive Program Stage 2 Comments Medicaid Eligibility Comments Medicare Physician Payment Innovation Act H.R. 4378- Ensuring Access to Quality Complex Rehabilitation Technology Act PFS PPS - Functional Limitation Reporting Therapy Cap: manual Medical Review Hospital Outpatient PPS 2013 Essentail Health Benefits Comments Medicare Physician Fee Schedule FInal Rule 2013 H.R. 8 American Taxpayer Relief Act of 2012, provisions on therapy cap, SGR, prevention of MPPR

Client expense: $478,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Election Commission (FEC), Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R.3765, the Temporary Payroll Tax Cut Continuation Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to legislation that allows for Medicare coverage of audiology services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to CMS actions surrounding the therapy cap and the institution of a manual medical review process for therapy services. Various issues related to the Physician Quality Reporting System for audiology and speech-language pathology participation. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act. H.R. 8, the American Taxpayer Relief Act of 2012 as related to the Medicare Part B cap on outpatient therapy services and other Medicare fees.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE

S.829/H.R. 1546: Medicare Access to Rehabilitation Services Act of 2011 - advocate for removal of cap on occupational therapy services and passage of bills. No bill: Multiple Procedure Payment Reduction (MPPR) policy - advocated for separation of occupational therapy from physical therapy/speech language pathology in applicaiton of MPPR policy. No bill: Advocated for exclusion of occuaptional therapy from any additional accreditation requirements for provision of orthotics/prosthetics. H.R. 2468: Medicare Home Health Flexibility Act - advocate for making occupational therapy an initiating service. No bill#: Medicare Physician Fee Schedule - oppose cuts to therapy services and advocate to identify alternative payment options for therapy services. H.R. 2499:Lymphedema Diagnosis and Treatment Cost Savings Act. Lymphedema treatment for Medicare beneficiaries - advocate for role of occupational therapy in lymphedema treatment under Medicare and support passage.. No bill #: Suport proposal for legislation to create new complex rehabilitation device benefit. Promote role of occupational therapy. H.R. 2785: Athletic Trainers Equal Access to Medicare Act - oppose. H.R. 8: American Taxpayer Relief Act of 2012 - advocated for extension of Medicare therapy caps exceptions process; separation of therapies under MPPR and oppose the signicant decrease in payment; and oppose fee schedule cuts to therapy.

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE

HR 3248/S 1283: Lifespan Respite Care Act of 2005; HR 4281: Small Business Health Fairness Act; PL 109-365: Older Americans Act Amendments of 2006; Older Americans Act Reauthorization; HR 3267/S 1760: Healthy Start Reauthorization Act of 2007; HR 6111: Tax Relief and Health Care Act of 2006; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; HR 4213: American Jobs and Closing Tax Loopholes Act; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; S 829/HR 1546: Medicare Access to Rehabilitation Services Act; HR 452: Medicare Decisions Accountability Act; HR 3765: Temporary Payroll Tax Cut Contribution Act of 2011; HR 3630: Middle Class Tax Relief & Job Creation Act of 2011; HR 5: Protecting Access to Health Care Act; HR 1700: Medicare Decision Accountability Act; HR 3497: MODDERN (Modernize Our Drug and Diagnostics Evaluation and Regulatory Network) Cures Act of 2011; HR 4378: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012; S 3289: Children's Mental Health Accessibility Act of 2012; HR 6079: Repeal of Obamacare Act; and H.R. 8: American Taxpayer Relief Act.

Client expense: $66,891 · Firm income: Not reported

Government targets: Access Board, Agriculture, Dept of (USDA), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

S.829/H.R. 1546: Medicare Access to Rehabilitation Services Act of 2011 - advocate for removal of cap on occupational therapy services and passage of bills. No bill: Multiple Procedure Payment Reduction (MPPR) policy - advocated for separation of occupational therapy from physical therapy/speech language pathology in applicaiton of MPPR policy. No bill: Advocated for exclusion of occuaptional therapy from any additional accreditation requirements for provision of orthotics/prosthetics. H.R. 2468: Medicare Home Health Flexibility Act - advocate for making occupational therapy an initiating service. No bill#: Medicare Physician Fee Schedule - oppose cuts to therapy services and advocate to identify alternative payment options for therapy services. H.R. 2499:Lymphedema Diagnosis and Treatment Cost Savings Act. Lymphedema treatment for Medicare beneficiaries - advocate for role of occupational therapy in lymphedema treatment under Medicare and support passage.. No bill #: Suport proposal for legislation to create new complex rehabilitation device benefit. Promote role of occupational therapy. H.R. 2785: Athletic Trainers Equal Access to Medicare Act - oppose.

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE

HR 3248/S 1283: Lifespan Respite Care Act of 2005; HR 4281: Small Business Health Fairness Act; PL 109-365: Older Americans Act Amendments of 2006; Older Americans Act Reauthorization; HR 3267/S 1760: Healthy Start Reauthorization Act of 2007; HR 6111: Tax Relief and Health Care Act of 2006; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; HR 4213: American Jobs and Closing Tax Loopholes Act; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; S 829/HR 1546: Medicare Access to Rehabilitation Services Act; HR 452: Medicare Decisions Accountability Act; HR 3765: Temporary Payroll Tax Cut Contribution Act of 2011; HR 3630: Middle Class Tax Relief & Job Creation Act of 2011; HR 5: Protecting Access to Health Care Act; HR 1700: Medicare Decision Accountability Act; HR 3497: MODDERN (Modernize Our Drug and Diagnostics Evaluation and Regulatory Network) Cures Act of 2011; HR 4378: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012; S 3289: Children's Mental Health Accessibility Act of 2012; and HR 6079: Repeal of Obamacare Act.

Client expense: $74,200 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

H.R. 1546/S. 829-Medicare Access to Rehabilitation Services Act (Repeal of Therapy Caps) H.R. 560 Rural Representation and Transparency Improvement Act Payments to Physical Therapists under the Medicare Physician Fee Schedule Permanent Repeal of/alternatives to the Sustainable Growth Rate (SGR) Formula Opposition of Multiple Procedure Payment Reduction for PT Services Physician Quality Reporting System Opposition to Medicaid Funding Cuts Physician Self-Referral - elimination of PT exception Medicare Advanced Imaging Act Opt-Out Locum Tenens Prevention Initiatives for Fraud and Abuse in the Medicare program H.R. 2785 Opposition to Athletic Trainers' Equal Access to Medicare Act, all provisions Accountable Care Organizations Electronic Health Records/ Health Information Technology incentives for Physical Therapists Home Health PPS 2011/ 2012 Development of Alternatives to Medicare Therapy Cap Medicare Payment Reform H.R. 1700 Medicare Patient Empowerment Act, inclusion of physical therapists S. 668 Health Care Bureacrats Elmination Act (IPAB Repeal), all provisions H.R. 452 Medicare Decisions Accountability Act of 2011 (IPAB Repeal), all provisions Protecting Medicaid Caps or Block Grants SNF PPS FY 2012/MDS 3.0/RUG IV IRF PPS FY 2012 Quality Initiatives & Value Based Purchasing Local Coverage Determinations NCCI Edits H.R. 2863 Medicare Oral Health Rehabilitative Enhancement Act of 2011, all provisions H.R. 2499 Lymphedema Diagnosis and Treatment Cost-Saving Act of 2011, all provisions Protection of programs related to physical therapy in deficit reduction H.R. 1958 Medicare Orthotics and Prosthetics Improvement Act of 2011, all provisions OPPS CY 2012 H.R. 3000 Empowering Patients First Act, provisions pertaining to physical therapy H.R. 5 Protecting Access to Healthcare Act Medicare Advantage Mobile Health Technology Privacy/Security Meeting (HHS-ONC) Medicare Overpayment Proposed Rule Off-the-shelf Othotics Comments PCORI National Priority for Research and Research Agenda USPSTF peripheral arterial disease HR 3258 Medicare Equity Extension Act National Coverage Analysis for TENS comments Health Information Technology :EHR Comments EHR Incentive Program Stage 2 Comments Medicaid Eligibility Comments Medicare Physician Payment Innovation Act H.R. 4378- Ensuring Access to Quality Complex Rehabilitation Technology Act

Client expense: $428,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Election Commission (FEC), Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 4/S. 72 Small Business Paperwork Mandate Elimination Act HR 1546/S829 Medicare Access to Rehabilitation Services Act (Repeal of Medicare Therapy Caps) HR 3000 Empowering Patients First Act, provisions related to physical therapist opt out Locum Tenens Inclusion of Physical Therapists in Health IT Incentives HR 1700 Medicare Patient Empowerment Act, inclusion of PT

Client expense: $428,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Election Commission (FEC), Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

Hospital Outpatient Prospective Payment System Fiscal Year 2013 Proposed Rule (CMS-1589-P) Medicare Access to Rehabilitation Services Act (S.829/H.R.1546) Medicare Diabetes Prevention Act (S.3463) State Flexibility Act (S.868/H.R.1683) - Medicaid/CHIP Maintenance of Effort Repeal Revisions to Payment Policies Under the Physician Fee Schedule for 2013 (CMS-1590-P)

Client expense: $136,382 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Education, Dept of, Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Treasury, Dept of

Health Care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits H.R. 1546/S.829 H.R. 3765

Client expense: $69,200 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Continues to educate Congress on HR 4378 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012. This legislation creates a separate benefit for complex rehab technology under Medicare for individuals with significant disabilities and functional limitations. Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities. Discussed concerns and possible solutions to prior authorization and physician documentation matters regarding the submission of medical claims for Medicare beneficiaries and people with disabilities. Discussed concerns with the dual-eligible population regarding those who are individuals with disabilities and the avaialability of home and community-base services and supports. Discussed our concerns and possible solutions around Medicare caps on rehabilitation therapy for individuals with disabilities. Supports HR 3613, Part D Beneficiary Appeal Fairness Act of 2011. This legislation resolves some of the concerns surrounding high-cost prescription drug coverage in the following ways: It would permit requests from beneficiaries for exceptions and appeals for all tiers in Medicare Part D tiers, including specialty tier drugs. It would prohibit insurance companies from blocking a more favorable cost-sharing structure as an outcome of the exceptions and appeals process decision. This legislation ensures that all Part D beneficiaries have access to an exceptions and appeals process if they find their medications unaffordable and prevents anyone from being at a disadvantage or subject to discrimination due to a specific condition. Supports HR 1546 and S. 829 - the Medicare Access to Rehabilitation Services Act. This legislation would repeal the arbitrary Medicare Part B outpatient therapy caps now affecting an estimated 640,000 Medicare beneficiaries who depend on outpatient rehabiliation therapy. Under Medicaid: Expand managed care where feasible to higher risk, higher cost beneficiaries and those dually eligible for Medicare with strict oversight and patient protections to improve care coordination and achieve efficiencies for these patients. Restore Medicaids discount prescription drug pricing to those dually eligible for Medicare.

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

Government targets: Defense, Dept of (DOD), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), SENATE, Veterans Affairs, Dept of (VA)

H.R. 2595/S. 425, "The National Neurological Diseases Surveillance System Act," all sections; H.R. 3070/S. 3295, "Department of Labor, Health and Human Services, Education and Related Agencies Appropriations," all sections relating to the National Institutes of Health (NIH); H.R. 5856 "Department of Defense Appropriations," all sections relating to the Neurotoxin Exposure Treatment Parkinson's Research (NETPR) program; H.R. 1546/S. 829, "The Medicare Access to Rehabilitation Services Act of 2011," all sections; P.L. 111-148, "Patient Protection and Affordable Care Act," all sections relating to state exchanges and Essential Health Benefits; P.L. 112-25, "Budget Control Act of 2011," all sections relating to sequestration; and proposed legislation relating to the use of telemedicine under Medicare and other Federal health care programs.

Client expense: Not reported · Firm income: Not reported

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

Therapy cap provisions in H.R. 1546, "Medicare Access to Rehabilitation Services Act of 2011" and S. 829, "Medicare Access to Rehabilitation Services Act of 2011." Implementation of P.L. 112-96, "Middle Class Tax Relief and Job Creation Act of 2012," regarding therapy cap reforms.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3765, the Temporary Payroll Tax Cut Continuation Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to legislation that allows for Medicare coverage of audiology services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to CMS actions surrounding the therapy cap and the institution of a manual medical review process for therapy services. Various issues related to the Physician Quality Reporting System for audiology and speech-language pathology participation. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE

H.R. 2595/S.425, "The National Neurological Diseases Surveillance System Act" all sections; "Department of Labor, Health and Human Services, Education and Related Agencies Appropriations," all sections relating to the National Institutes of Health (NIH); "Department of Defense Appropriations," section related to the Neurotoxin Exposure Treatment Parkinson's Research (NETPR) program; H.R. 1546/S.829, "The Medicare Access to Rehabilitation Services Act of 2011" all sections; H.R. 4132, "The Faster Access to Specialized Treatments Act of 2011" all sections; S. 2113 "The Transforming the Regulatory Environment to Accelerate Access to Treatment of 2011" all sections; S. 3187 "The Food and Drug Administration Safety and Innovation Act" all sections;

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 4378 - Ensuring Access to Quality Complex Rehabiliation Technology Act of 2012. Throughout the second quarter, 2012, United Spinal has been advocating on this legislation to create a separate benefit category in Medicare for coverage of complex rehabilitation technology such as highly sophisticated, customized power mobility devices. The bill entails a broader baseline of services than those that are currently referred to under the Medicare program as durable medical equipment. HR 4378 ensures access to appropriate prodcuts and technology based on a person's functional needs in addition to their diagnosis and the severity of their injury or disorder; allows individuals to access devices that can be used outside of the home and in the community, allows individuals to work and participate in community life; and, ensuring access to local CRT suppliers equipped to make repairs and maintenance for specialized devices. United Spinal Association wrote a letter in April to Secretary Sebelius applauding the newly created Administration for Community Living (ACL) in support of the focus on community living and urged the agency to lift the outdated rule that ties Medicare coverage of wheelchairs and other mobility assistive equipment to in-the-home use. United Spinal also met with the ACL to discuss complex rehab technology and Medicaid managed care and there will be a continuing dialogue between the Association and the ACL on these and other matters. In April, United Spinal submitted comments to the Centers for Medicare and Medicaid Services in response to the proposed information collection requirements for the Medicare prior authorization demonstration applied to coverage claims for power mobility devices. We insisted that CMS be proactive in providing guidance, in the form of guides or templates, to assist physicians and treating practitioners in filing claims and documenting medical necessity and functional limitations from the outset. In June comments to the Office of Management and Budget, we continue to urge the creation of an electronic template under this demonstration to help accelerate the delivery of necessary equipment that will enhance mobility-related activities of daily living and support the independendce of individuals with disabilities. In April, United Spinal signed onto a letter to the Food and Drug Administration's Center for Devices and Radiological Health on the Medical Device User Fee and Modernization Act (MDUFA) agreement in principle between industry and FDA (Docket No. FDA-2010-N-0389). The letter supports the agency-industry agreements intent to do the following: significantly improve FDA review times to help speed up safe and effective treatments to patients; vastly enhance the consistency and timeliness of the approval process, helping to provide patients more information and certainty about the process; offer greater accountability and improved transparency resulting in more data points on FDAs performance; provide enhanced resources to give FDA the necessary tools for meeting new performance goals. Medicaid Eligibility Rules United Spinal co-signed a Consortium for Citizens with Disabilities letter to HHS Secretary Kathleen Sebelius, spearheaded by the Healthcare for America Now coalition urging the Centers for Medicare & Medicaid Services (CMS) to reconsider the provision of the final Medicaid rule (CMS-2349-F) that permits important eligibility determination functions to be contracted to private entities. Public accountability for Medicaid eligibility determinations is essential. The best way to ensure accountability is if governmental staff carries out these functions in the best interest of the public, free of bias or conflicts of interest. This has been the policy in Medicaid for decades: to change it without a process for notice and comment would be highly unusual and set a bad precedent. Congressional Hearing on Competitive Acquisition United Spinal Association submitted a statement for the record to the United States House Committee on Ways and Means Subcommittee on Health. United Spinal urged the committee to look closely at how the Centers for Medicare and Medicaid Services is gathering data on the impact this program has on all consumers, including people with disabilities. United Spinal Association will continue to monitor how the program is impacting consumers. United Spinal signed onto a Coalition for Disability Health Equity letter to CMS in response to the agencys proposed rules on the agency's electronic health record incentive program. Health information technology and electronic health records have the power to collect aggregated data on people with disabilities to provide information to improve the quality of care of all people with disabilities. The incentive program offers an important opportunity to reduce health disparities and improve equity in the U.S. health care system. Reducing disparities is included in the first of the five pillars of meaningful use health outcomes policy priorities and health disparities among those with disabilities are included in HHS policies to reduce health disparities, including Healthy People 2020 and the Affordable Care Act. Supported reauthorization of the Traumatic Brain Injury Act. This is the only federal legislation that specifically assists states and other entities to develop and expand service delivery systems, and provide needed advocacy to meet the needs and protect the rights of individuals who have sustained a TBI and their families. HR 3613: Part D Beneficairy Appeal Fairness Act which supports implementation of a fair and reasonable exceptions and appeals process under Medicare Part D coverage for seniors and people with disabilities that depend on 'specialty tier' drugs to improve or maintain their health status and function. Support making the Medicaid Buy In program mandatory nationwide. To maintain their capacity for employment that keeps them off the Medicaid rolls, workers with disabilities often need long-term services and supports. In many states, they are able to purchase affordable Medicaid coverage for this purpose but the benefits vary. To promote the productivity and independence of workers with disabilities, Medicaid buy-in coverage should be made consistent in scope, remain affordable and offered for purchase in all states. Request that DOL issue the Rehab Act Section 503 Final Rules governing Federal Contractor compliance with measurable affirmative action goals for recruiting, hiring and advancing workers with disabilities. Federal contractors and subcontractors account for one-fifth of all jobs in the employment marketplace. It is critical that they be held accountable to the law. HR 1546 and S 829, the Medicare Access to Rehabilitation Services Act which eliminates Medicare Part Bs arbitrary and unfair outpatient rehab therapy payment caps. Advance the use of home and community-based services and supports as mandatory long-term care benefits (currently optional to the states) which are far less costly than nursing home and other facility-based care for such purposes and are currently mandatory under Medicaid. Expand managed care where feasible to higher risk, higher cost beneficiaries and those dually eligible for Medicare as well with strict oversight and patient protections to improve care coordination and achieve efficiencies for these patients. Restore Medicaids discount prescription drug pricing to those dually eligible for Medicare. Intensify efforts to reduce fraud and abuse which accounted for $12.9 billion in Medicaid improper payments in FY 2007. Insist that Medicare restore its pre-2008 catheter policy language around individual consideration that enabled physicians to diagnose and prescribe the proper treatment based on their patients specific needs, circumstances and risk factors. Add a new criterion for Medicare eligibility for a closed system catheter that allows automatic qualification for patients with permanent severe bladder impairments, reducing their risk of bacterial contamination which can lead to life-threatening UTIs.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), SENATE, Veterans Affairs, Dept of (VA)

Therapy cap provisions in H.R. 1546, "Medicare Access to Rehabilitation Services Act of 2011" and S. 829, "Medicare Access to Rehabilitation Services Act of 2011." Implementation of P.L. 112-96, "Middle Class Tax Relief and Job Creation Act of 2012," regarding therapy cap reforms.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1546/S. 829-Medicare Access to Rehabilitation Services Act (Repeal of Therapy Caps) H.R. 560 Rural Representation and Transparency Improvement Act Payments to Physical Therapists under the Medicare Physician Fee Schedule Permanent Repeal of/alternatives to the Sustainable Growth Rate (SGR) Formula Opposition of Multiple Procedure Payment Reduction for PT Services Physician Quality Reporting System Opposition to Medicaid Funding Cuts Physician Self-Referral - elimination of PT exception Medicare Advanced Imaging Act Opt-Out Locum Tenens Prevention Initiatives for Fraud and Abuse in the Medicare program H.R. 2785 Opposition to Athletic Trainers' Equal Access to Medicare Act, all provisions Accountable Care Organizations Electronic Health Records/ Health Information Technology incentives for Physical Therapists Home Health PPS 2011/ 2012 Development of Alternatives to Medicare Therapy Cap Medicare Payment Reform H.R. 1700 Medicare Patient Empowerment Act, inclusion of physical therapists S. 668 Health Care Bureacrats Elmination Act (IPAB Repeal), all provisions H.R. 452 Medicare Decisions Accountability Act of 2011 (IPAB Repeal), all provisions Protecting Medicaid Caps or Block Grants SNF PPS FY 2012/MDS 3.0/RUG IV IRF PPS FY 2012 Quality Initiatives & Value Based Purchasing Local Coverage Determinations NCCI Edits H.R. 2863 Medicare Oral Health Rehabilitative Enhancement Act of 2011, all provisions H.R. 2499 Lymphedema Diagnosis and Treatment Cost-Saving Act of 2011, all provisions Protection of programs related to physical therapy in deficit reduction H.R. 1958 Medicare Orthotics and Prosthetics Improvement Act of 2011, all provisions OPPS CY 2012 H.R. 3000 Empowering Patients First Act, provisions pertaining to physical therapy H.R. 5 Protecting Access to Healthcare Act Medicare Advantage Mobile Health Technology Privacy/Security Meeting (HHS-ONC) Medicare Overpayment Proposed Rule Off-the-shelf Othotics Comments PCORI National Priority for Research and Research Agenda AHRQ Pediatric Quality Measures AHRQ TBI draft report USPSTF peripheral arterial disease HR 3258 Medicare Equity Extension Act National Coverage Analysis for TENS comments Health Information Technology :EHR Comments EHR Incentive Program Stage 2 Comments Medicaid Eligibility Comments Medicare Physician Payment Innovation Act

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Election Commission (FEC), Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 4/S. 72 Small Business Paperwork Mandate Elimination Act HR 1546/S829 Medicare Access to Rehabilitation Services Act (Repeal of Medicare Therapy Caps) HR 3000 Empowering Patients First Act, provisions related to physical therapist opt out Locum Tenens Inclusion of Physical Therapists in Health IT Incentives HR 1700 Medicare Patient Empowerment Act, inclusion of PT

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Election Commission (FEC), Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

HR 3248/S 1283: Lifespan Respite Care Act of 2005; HR 4281: Small Business Health Fairness Act; PL 109-365: Older Americans Act Amendments of 2006; Older Americans Act Reauthorization; HR 3267/S 1760: Healthy Start Reauthorization Act of 2007; HR 6111: Tax Relief and Health Care Act of 2006; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; HR 4213 American Jobs and Closing Tax Loopholes Act; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; S 829/HR 1546: Medicare Access to Rehabilitation Services Act; HR 452: Medicare Decisions Accountability Act; HR 3765: Temporary Payroll Tax Cut Contribution Act of 2011; HR 3630: Middle Class Tax Relief & Job Creation Act of 2011; HR 5: Protecting Access to Health Care Act; HR 1700: Medicare Decision Accountability Act; HR 3497: MODDERN (Modernize Our Drug and Diagnostics Evaluation and Regulatory Network) Cures Act of 2011; HR 4378: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012; and S 3289: Children's Mental Health Accessibility Act of 2012.

Client expense: $68,819 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

Health Care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits H.R. 1546/S.829 H.R. 3765

Client expense: $69,200 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R.3765, the Temporary Payroll Tax Cut Continuation Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to legislation that allows for Medicare coverage of audiology services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE

S.829/H.R. 1546: Medicare Access to Rehabilitation Services Act of 2011 - advocate for removal of cap on occupational therapy services and passage of bills. No bill: Multiple Procedure Payment Reduction (MPPR) policy - advocated for separation of occupational therapy from physical therapy/speech language pathology in applicaiton of MPPR policy. No bill: Advocated for exclusion of occuaptional therapy from any additional accreditation requirements for provision of orthotics/prosthetics. H.R. 2468: Medicare Home Health Flexibility Act - advocate for making occupational therapy an initiating service. No bill#: Medicare Physician Fee Schedule - oppose cuts to therapy services and advocate to identify alternative payment options for therapy services. H.R. 2499:Lymphedema Diagnosis and Treatment Cost Savings Act. Lymphedema treatment for Medicare beneficiaries - advocate for role of occupational therapy in lymphedema treatment under Medicare and support passage.. No bill #: Suport proposal for legislation to create new complex rehabilitation device benefit. Promote role of occupational therapy. H.R. 2785: Athletic Trainers Equal Access to Medicare Act - oppose. H.R. 3630 (PL 112-96)- Middle Class Tax Relief and Job Creation Act of 2011 - Medicare therapy cap provisions and the Medicare Physician Fee Schedule SGR (sustainable growth revenue).

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE

Hospital Inpatient Prospective Payment System Fiscal Year 2013 Proposed Rule (CMS-1588-P) Medicare Access to Rehabilitation Services Act (S.829/H.R.1546) State Flexibility Act (S.868/H.R.1683) - Medicaid/CHIP Maintenance of Effort Repeal

Client expense: $186,602 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Education, Dept of, Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Treasury, Dept of

H.R. 2595/S.425, "The National Neurological Diseases Surveillance System Act" all sections; all sections; " all sections relating to the National Institutes of Health (NIH), Cures Acceleration Network at NIH, and National Institute of Environmental Health Sciences; "Department of Defense Appropriations," section related to the Neurotoxin Exposure Treatment Parkinson's Research (NETPR) program; H.R. 1546/S.829, "The Medicare Access to Rehabilitation Services Act of 2011" all sections; H.R. 4132, "The Faster Access to Specialized Treatments Act of 2011" all sections; S. 2113, "The Transforming the Regulatory Environment to Accelerate Access to Treatment Act of 2011" all sections.

Client expense: $24,282 · Firm income: Not reported

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

Therapy cap provisions in H.R. 1546, "Medicare Access to Rehabilitation Services Act of 2011" and S. 829, "Medicare Access to Rehabilitation Services Act of 2011." Therapy cap provisions in H.R. 3630, "Middle Class Tax Relief & Job Creation Act of 2012."

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health Care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits H.R. 1546/S.829 H.R. 3765

Client expense: $69,200 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

HR 3248/S 1283: Lifespan Respite Care Act of 2005; HR 4281: Small Business Health Fairness Act; PL 109-365: Older Americans Act Amendments of 2006; Older Americans Act Reauthorization; HR 3267/S 1760: Healthy Start Reauthorization Act of 2007; HR 6111: Tax Relief and Health Care Act of 2006; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; HR 4213 American Jobs and Closing Tax Loopholes Act; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; S 829/HR 1546: Medicare Access to Rehabilitation Services Act; HR 452: Medicare Decisions Accountability Act; HR 3765: Temporary Payroll Tax Cut Contribution Act of 2011; HR 3630: Middle Class Tax Relief & Job Creation Act of 2011; HR 5: Protecting Access to Health Care Act; HR 1700: Medicare Decision Accountability Act; and HR 3497: MODDERN (Modernize Our Drug and Diagnostics Evaluation and Regulatory Network) Cures Act of 2011.

Client expense: $60,229 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

S.829/H.R. 1546: Medicare Access to Rehabilitation Services Act of 2011 - advocate for removal of cap on occupational therapy services and passage of bills. No bill: Multiple Procedure Payment Reduction (MPPR) policy - advocated for separation of occupational therapy from physical therapy/speech language pathology in applicaiton of MPPR policy. No bill: Advocated for exclusion of occuaptional therapy from any additional accreditation requirements for provision of orthotics/prosthetics. H.R. 2468: Medicare Home Health Flexibility Act - advocate for making occupational therapy an initiating service. No bill#: Medicare Physician Fee Schedule - oppose cuts to therapy services and advocate to identify alternative payment options for therapy services. H.R. 2499:Lymphedema Diagnosis and Treatment Cost Savings Act. Lymphedema treatment for Medicare beneficiaries - advocate for role of occupational therapy in lymphedema treatment under Medicare and support passage.. No bill #: Suport proposal for legislation to create new complex rehabilitation device benefit. Promote role of occupational therapy. H.R. 2785: Athletic Trainers Equal Access to Medicare Act - oppose. H.R. 3630 (PL 112-96)- Middle Class Tax Relief and Job Creation Act of 2011 - Medicare therapy cap provisions and the Medicare Physician Fee Schedule SGR (sustainable growth revenue).

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

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

H.R. 1546/S. 829-Medicare Access to Rehabilitation Services Act (Repeal of Therapy Caps) H.R. 560 Rural Representation and Transparency Improvement Act Payments to Physical Therapists under the Medicare Physician Fee Schedule Permanent Repeal of the Sustainable Growth Rate (SGR) Formula Opposition of Multiple Procedure Payment Reduction Physician Quality Reporting System Opposition to Medicaid Funding Cuts Physician Self-Referral Medicare Advanced Imaging Act Opt-Out Locum Tenens Prevention Initiatives for Fraud and Abuse in the Medicare program H.R. 2785 Opposition to Athletic Trainers' Equal Access to Medicare Act, all provisions Accountable Care Organizations Electronic Health Records/ Health Information Technology for Physical Therapists Home Health PPS 2011/ 2012 Development of Alternatives to Medicare Therapy Cap Medicare Payment Reform H.R. 1700 Medicare Patient Empowerment Act, inclusion of physical therapists S. 668 Health Care Bureacrats Elmination Act (IPAB Repeal), all provisions H.R. 452 Medicare Decisions Accountability Act of 2011 (IPAB Repeal), all provisions Protecting Medicaid Caps or Block Grants SNF PPS FY 2012/MDS 3.0/RUG IV IRF PPS FY 2012 Quality Initiatives & Value Based Purchasing Local Coverage Determinations NCCI Edits H.R. 2863 Medicare Oral Health Rehabilitative Enhancement Act of 2011, all provisions H.R. 2499 Lymphedema Diagnosis and Treatment Cost-Saving Act of 2011, all provisions Protection of programs related to physical therapy in deficit reduction H.R. 1958 Medicare Orthotics and Prosthetics Improvement Act of 2011, all provisions OPPS CY 2012 H.R. 3000 Empowering Patients First Act, provisions pertaining to physical therapy H.R. 5 Protecting Access to Healthcare Act Medicare Advantage Mobile Health Technology Privacy/Security Meeting (HHS-ONC) Medicare Overpayment Proposed Rule Off-the-shelf Othotics Comments PCORI National Priority for Research and Research Agenda AHRQ Pediatric Quality Measures AHRQ TBI draft report USPSTF peripheral arterial disease

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R.3765, the Temporary Payroll Tax Cut Continuation Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. Various issues related to legislation that allows for Medicare coverage of audiology services. H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), 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

Hospital Outpatient Prospective Payment System for 2012 Proposed Rule (CMS-1525-P) Medicare Access to Rehabilitation Services Act (S. 829/H.R. 1546) State Flexibility Act (S. 868/H.R. 1683) - Medicaid/CHIP Maintenance of Effort Repeal

Client expense: $175,818 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Treasury, Dept of

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

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

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

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

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

H.R. 1546/S. 829-Medicare Access to Rehabilitation Services Act (Repeal of Therapy Caps) H.R. 560 Rural Representation and Transparency Improvement Act Payments to Physical Therapists under the Medicare Physician Fee Schedule Permanent Repeal of the Sustainable Growth Rate (SGR) Formula Opposition of Multiple Procedure Payment Reduction Physician Quality Reporting System Opposition to Medicaid Funding Cuts Physician Self-Referral Medicare Advanced Imaging Act To Improve the Treatment & Diagnosis of Lymphedema Under the Medicare Program Opt-Out Locum Tenens Prevention Initiatives for Frad and Abuse in the Medicare program H.R. 2785 Opposition to Athletic Trainers' Equal Access to Medicare Act, all provisions Accountable Care Organizations - Medicare shared savings propsed and interim final rules Electronic Health Records/ Health Information Technology for Physical Therapists Home Health PPS 2011/ 2012 Development of Alternatives to Medicare Therapy Cap Medicare Payment Reform H.R. 1700 Medicare Patient Empowerment Act, inclusion of physical therapists S. 668 Health Care Bureacrats Elmination Act (IPAB Repeal), all provisions H.R. 452 Medicare Decisions Accountability Act of 2011 (IPAB Repeal), all provisions Protecting Medicaid Caps or Block Grants SNF PPS FY 2012/MDS 3.0/RUG IV IRF PPS FY 2012 Quality Initiatives & Value Based Purchasing Local Coverage Determinations NCCI Edits H.R. 2863 Medicare Oral Health Rehabilitative Enhancement Act of 2011, all provisions H.R. 2499 Lymphedema Diagnosis and Treatment Cost-Saving Act of 2011, all provisions Protection of programs related to physical therapy in deficit reduction H.R. 1958 Medicare Orthotics and Prosthetics Improvement Act of 2011, all provisions OPPS CY 2012 H.R. 3000 Empowering Patients First Act, provisions pertaining to physical therapy H.R. 3630 Middle Class Tax and Job Creation Act of 2011; Section 2201 and 2203 provisions relating to Medicare Reimbursement TENS Chronic Low Back Pain national Coverage Analysis by CMS Prepayment Review/Prior Authorization Power Mobility Device Demonstration Health Insurace Exchanges - Establishment of Exchanges and Qualified Health Plans Hospital Conditions of Participation Met with SFC on Medicare Audit process USPSTF Adult Obesity (screening and management) Regulatory reform/transparency Medicare/Medicaid Regulatory Alignment

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

HR 3248/S 1283: Lifespan Respite Care Act of 2005; HR 4281: Small Business Health Fairness Act; PL 109-365: Older Americans Act Amendments of 2006; Older Americans Act Reauthorization; Healthcare reform policy; HR 3267/S 1760: Healthy Start Reauthorization Act of 2007; HR 6111: Tax Relief and Health Care Act of 2006; Combating Autism Act; FY 2011 Labor-HHS-Education Appropriations; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; HR 4213 American Jobs and Closing Tax Loopholes Act; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; S 829/HR 1546: Medicare Access to Rehabilitation Services Act; HR 452: Medicare Decisions Accountability Act; HR 3765: Temporary Payroll Tax Cut Contribution Act of 2011; and HR 3630: Middle Class Tax Relief & Job Creation Act of 2011.

Client expense: $61,777 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

Health Care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits H.R. 1546/S.829 H.R. 3765

Client expense: $69,200 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

S.829/H.R. 1546: Medicare Access to Rehabilitation Services Act of 2011 - advocate for removal of cap on occupational therapy services and passage of bills. No bill: Multiple Procedure Payment Reduction (MPPR) policy - advocated for separation of occupational therapy from physical therapy/speech language pathology in applicaiton of MPPR policy. No bill: Advocated for exclusion of occuaptional therapy from any additional accreditation requirements for provision of orthotics/prosthetics. H.R. 2468: Medicare Home Health Flexibility Act - advocate for making occupational therapy an initiating service. No bill#: Medicare Physician Fee Schedule - oppose cuts to therapy services and advocate to identify alternative payment options for therapy services. H.R. 2499:Lymphedema Diagnosis and Treatment Cost Savings Act. Lymphedema treatment for Medicare beneficiaries - advocate for role of occupational therapy in lymphedema treatment under Medicare and support passage.. No bill #: Suport proposal for legislation to create new complex rehabilitation device benefit. Promote role of occupational therapy. H.R. 2785: Athletic Trainers Equal Access to Medicare Act - oppose. H.R. 3630 - Middle Class Tax Relief and Job Creation Act of 2011 - Medicare therapy cap provisions and the Medicare Physician Fee Schedule SGR (sustainable growth revenue). H.R. 3765: Temporary Payroll Tax Cut Continuation Act of 2011 - Mediare therapy cap provisions and the Medicare Physician Fee Schedule SGR (sustainable growth revenue).

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

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

Therapy cap provisions in H.R. 1546, "Medicare Access to Rehabilitation Services Act of 2011" and S. 829, "Medicare Access to Rehabilitation Services Act of 2011." Therapy cap provisions in H.R. 3630, "Middle Class Tax Relief & Job Creation Act of 2011" and H.R. 3765, the "Temporary Payroll Tax Cut Continuation Act of 2011."

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

Government targets: 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

Monitored and lobbied upon entire bills of the following: H.R.531, the Access to Frontline Health Care Act of 2011 H.R.1546 / S.829, Medicare Access to Rehabilitation Services Act of 2011; repeal of the Therapy Cap on Outpatient Rehabilitation Services The Medicare Patient Access to Physical Therapists Act (no bill number, formerly H.R.1829 / S.950); to improve access to physical therapists for Medicare beneficiaries

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Hospital Outpatient Prospective Payment System for 2012 Proposed Rule (CMS-1525-P) Medicare Access to Rehabilitation Services Act (S. 829/H.R. 1546) Medicare Coverage: Management of Carotid Atherosclerosis (CMS-3253-N) Medicare Coverage: Use of ECG Based Technology to Detect Myocardial Ischemia or Coronary Artery Disease (CMS-3252-N) Medicare National Coverage Analysis for Transcatheter Aortic Valve Replacement (CAG-00430N) Medicare Physician Fee Schedule for 2012 Proposed Rule (CMS-1524-P) State Flexibility Act (S. 868/H.R. 1683) - Medicaid/CHIP Maintenance of Effort Repeal

Client expense: $136,214 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Transportation, Dept of (DOT)

H.R.3765, the Temporary Payroll Tax Cut Continuation Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Issues related to Medicare telehealth, including H.R. 2068 (111th Congress), the Medicare Telehealth Enhancement Act. Various issues related to legislation that allows for Medicare coverage of audiology services. H.R.1546/S.829, the Medicare Access to Rehabilitation Services Act of 2011 as related to the Medicare Part B cap on outpatient therapy services. Various issues related to CMS actions surrounding Medicare physician supervision requirements. Various issues related to the Medicare Physician Fee Schedule (MPFS), as related to fees for audiology and speech-language pathology services. Various issues related to preservation of Medicaid funding. Various issues related to implementation of H.R. 3200 (111th Congress), the America's Affordable Health Choices Act.

Client expense: $190,000 · Firm income: Not reported

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