Medicare Orthotics and Prosthetics Improvement 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 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. 1958, the "Medicare Orthotics and Prosthetics Improvement Act of 2011" The "Community Choice Act" The "Ending the Medicare Disability Waiting Period Act" Medicaid Block Grants Proposed Reductions in Medicaid Spending

Client expense: $45,061 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

Medicare O&P Improvement Act (S. 2125/H.R. 1958)

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, SENATE

Patient Protection and Affordable Care Act (P.L. 111-148); Health Care and Education Reconciliation Act (P.L. 111-152) Medicare Orthotics and Prosthetics Improvement Act (H.R.1958); Insurance Fairness for Amputees Act (S. 773).

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

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

H.R. 1958, the "Medicare Orthotics and Prosthetics Improvement Act of 2011" The "Community Choice Act" The "Ending the Medicare Disability Waiting Period Act" Medicaid Block Grants Proposed Reductions in Medicaid Spending

Client expense: $83,249 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

H.R. 1958 and S. 2125, the Medicare O&P Improvements Act

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, SENATE

Patient Protection and Affordable Care Act (P.L. 111-148); Health Care and Education Reconciliation Act (P.L. 111-152) Medicare Orthotics and Prosthetics Improvement Act (H.R.1958); Insurance Fairness for Amputees Act (S. 773).

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

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 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

H.R. 1958, the "Medicare Orthotics and Prosthetics Improvement Act of 2011" The "Community Choice Act" The "Ending the Medicare Disability Waiting Period Act" The "Benefits Rating Acceleration for Veterans Entitlement Act (BRAVE)" Medicaid Block Grants Proposed Reductions in Medicaid Spending

Client expense: $92,927 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

Patient Protection and Affordable Care Act (P.L. 111-148); Health Care and Education Reconciliation Act (P.L. 111-152) Medicare Orthotics and Prosthetics Improvement Act (H.R.1958); Insurance Fairness for Amputees Act (S. 773)

Client expense: Not reported · Firm income: $15,000

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 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

H.R. 1958, the "Medicare Orthotics and Prosthetics Improvement Act of 2011" The "Community Choice Act" The "Ending the Medicare Disability Waiting Period Act" The "Benefits Rating Acceleration for Veterans Entitlement Act (BRAVE)" Medicaid Block Grants Proposed Reductions in Medicaid Spending

Client expense: $69,322 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

Patient Protection and Affordable Care Act (P.L. 111-148); Health Care and Education Reconciliation Act (P.L. 111-152) Medicare Orthotics and Prosthetics Improvement Act (H.R.1958); Insurance Fairness for Amputees Act (S. 773)

Client expense: Not reported · Firm income: $23,000

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 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 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

Client expense: $330,000 · Firm income: Not reported

See next page Participated in meetings with CMS concerning round one and the upcoming round two of the Medicare DME Competitive Bidding program. Worked on draft legislation that would create a separate category for complex rehabilitative technology under Medicare. Supported a House bill sponsored by Representatives Glenn Thompson and Jason Altmire to end the Medicare competitive bidding program for home medical equipment and services (HME) in view of its serious flaws and its impact on patients access to medically required home medical equipment and services. Participated with GAO in discussions on state interests in Medicaid managed care models. Supported Senate bill introduced by Senators Cardin and Collins to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. Supported a House bill introduced by Representatives Thornberry and Carnahan to in the House and amend title XVIII of the Social Security Act to permit coverage of certain covered part D drugs for uses that are determined to be for medically accepted indications based upon clinical evidence in peer reviewed medical literature Urged Congress to ensure stable Medicaid and CHIP coverage, per provisions in the Affordable Care Act, by requiring states to hold steady on Medicaid and CHIP eligibility until 2014 for adults and 2019 for children. To date, these stability protections have worked exactly as intended, preventing states from reducing Medicaid and CHIP eligibility and adding red-tape barriers to enrollment just when people need help the most. Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities. Met with the White House staff and House and Senate staff to discuss the Maintenance of Effort (MOE) and proposed blended rate formula under Medicaid. Met with staff of the Joint Select Committee "Super Committee" members to talk about Medicaid and Medicare concerns. Signed on to three letters with other members of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition. Two went to CMS concerning respectively the Summary of Benefits and Coverage procedures glossary and Round 2 of Medicare DMEPOS competitive bidding. The third letter went to Members of Congress in support of HR 1958, the Medicare Orthotics and Prosthetics Improvement Act of 2011. Joined on CCD letter to CMS Administrator to express serious concerns about pending payment cuts in California and other states to Medicaid providers serving individuals with disabilities. Wrote to members of the Joint Select Committee on Deficit Reduction on behalf of the National Disability Leadership Alliance (NDLA) to urge rejection of arbitrary, across-the-board cuts to Medicaid and transitioning the program's culture to emphasize lower cost home and community-based services and supports. Joined with others in the CCD in writing to the "Super Committee" emphasizing that changes to Medicaid, Medicare, Social Security, Supplemental Security Income and veterans' disability compensation and pension benefits must not result in service obstacles, benefit cuts or eligibility restrictions, whether directly or indirectly. Joined with others in Families USA coalition on two letters to the "Super Committee." One was focused on protecting the Affordable Care Act from deficit reduction cuts and other discussed the impacts of possible Medicaid cuts on beneficiaries, there families, providers and states. Joined with others in the MapRx coalition in writing to the Super Committee to protect the effective Medicare prescription drug benefit (Part D) from federal spending cuts to reduce the deficit. Served on Steering Committee to organize the "My Medicaid Rally" involving constituents from more than 90 patient/consumer organizations to speak out on Capitol Hill and with policymakers against reducing the deficit on the backs of Medicaid recipients.

The "Community Choice Act" The "Ending the Medicare Disability Waiting Period Act" The "Benefits Rating Acceleration for Veterans Entitlement Act (BRAVE)" Medicaid Block Grants Proposed Reductions in Medicaid Spending H.R. 1958, the "Medicare Orthotics and Prosthetics Improvement Act of 2011"

Client expense: $81,128 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

Patient Protection and Affordable Care Act (P.L. 111-148); Health Care and Education Reconciliation Act (P.L. 111-152) Medicare Orthotics and Prosthetics Improvement Act (H.R.1958); Insurance Fairness for Amputees Act (S. 773)

Client expense: Not reported · Firm income: $18,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE