MLR Repeal Act of 2011

S.452, Medicare Diabetes Prevention Act - Discussed bill with Senate. Discussed draft language on senior mental health with Senate HELP Committee staff. (no bill) Discussed Medicare Reform (no bill) Discussed Age Rating in the ACA and rate shock. (no bill)Lobbied on preserving funding for the ACA; defended meaningful use of the ACA. (no bill) Discussed need to increase health information technology quality measurements and access to qualified systems. (no bill) H.R. 1099, To repeal the Prevention and Public Health Fund - Lobbied against the repeal of the Prevention and Public Health Trust Fund, is an important component in state and community efforts to prevent illness and promote health. Discussed Pre-existing Condition Insurance Program. (no bill) Discussed Accountable Care Organization and Medical Shared savings. (no bill) Discussed Rate Review. (no bill) Discussed Internal Appeals and External Review Process. (no bill) Discussed Medicare reimbursement issues. Lobbied in support of Medicare physician payment reform. Discussed legislation to make prescription drugs more affordable to older Americans. S. 1416/H.R. 2645 (112th Congress), Medigap Medical Loss Ratio Improvement Act of 2011. Discussed coverage for screening depression and screening and counseling for alcohol misuse. (no bill) Discussed consumer operated and oriented plan programs. (no bill) Discussed standards related to risk adjustment, reinsurance, and risk mitigation as they relate to exchanges. (no bill) H.R.2077, MLR Repeal Act of 2011 - Expressed opposition to the elimination of provision in the Affordable Care Act (P.L. 111-148)Discussed opposition to draft legislation regarding the elimination of grandfathered status. (no bill) Discussed association health plans with DOL, HHS and DOT. (no bill) Discussed quality and care coordination with HHS. (no bill) Discussed Essential Health Benefits with HHS. (no bill) Discussed employer affordability safe harbor. (no bill) Discussed health insurance exchanges - eligibility, enrollment, premium tax credits. (no bill) Discussed Basic Health Plans. (no bill) Discussed Medigap reform. (no bill) Discussed Pre-existing Condition Insurance Program. (no bill) Discussed role of grandfathered plans. (no bill) Discussed reauthorization of the Older Americans Act and other amendments to the OAA. (no bill) Discussed dual eligibles. (no bill) Discussed support for H.R. 2181, Safe Foods for Seniors Act of 2013. Discussed S.1119, Positive Aging Act of 2013. H.R. 2641, Farm Program bill-Discussed the severed nutrition programs from Farm Bill.Discussed inviting FTC to participate in a webinar on how they are and can be engaged on state scope of practice issues. Also sent follow-up items for their review. (no bill) Discussed Medicare and Social Security programs. (no bill) Lobbied against cuts to the health care prevention fund. (no bill) Discussed deficit reduction issues dealing with Medicare and Medicaid including concerns over increasing Medicare's age of eligibility, chained CPI, payroll tax holiday extension, and cuts to Medicaid. (no bill) Discussed Affordable Care Medicaid expansion issues. Centers for Medicare and Medicaid Services, Center for Medicaid and CHIP Services. Discussed Medicaid reform, Medicare-Medicaid integration efforts and financial alignment demonstrations, other CMS demonstration initiatives. (no bill) Discussed Medicaid expansion implementation, as included in the ACA (P.L. 111-140). Discussed Medicaid including concerns over cuts to Medicaid flexibility and Medicaid structural reforms to. (no bill) Discussed Medicare-Medicaid integration efforts and financial alignment demonstrations and other CMS demonstration initiatives. (no bill) PL 112-240 of 2012, American Taxpayer Relief Act - Discussed the Commission on Long-Term Care and and service delivery workforce and caregiving, financing and related long-term care issues and data. Discussed implementation of the Affordable Care Act, its provisions and H.R. 95 to repeal the Patient Protection and Affordable Care Act. H. R. 933, Consolidated and Further Continuing Appropriations Act, 2013 - Lobbied to protect vital health and social services programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. S. Con. Res. 8/ H.Con. Res. 25, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. H.R. 1549, Helping Sick Americans Now Act - Discussed cuts to the health care prevention fund. S. 1284, The Labor, Health and Human Services Appropriations Act, 2014 - Lobbied to protect employment, health and human services and energy assistance programs for seniors, disabled and low income assistance. Discussed Affordable Care Act Medicaid expansion issues, including questions related to the use of premium assistance authority to expand Medicaid. (no bill) Discussed Medicare-Medicaid integration efforts and financial alignment demonstrations, other CMS demonstration initiatives. (no bill) H.R. 1263, Excellence in Mental Health Act - Discussed the bill for eventual endorsement. Discussed Affordable Care Act Medicaid expansion issues, including AARP comments on state 1115 waiver proposals to use premium assistance authority to expand Medicaid. (no bill)

Client expense: $2,520,000 · Firm income: Not reported

Government targets: Administration on Aging, Agriculture, Dept of (USDA), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Council on Disability, Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Comptroller of the Currency (OCC), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

S.452, Medicare Diabetes Prevention Act - Discussed bill with Senate. Discussed draft language on senior mental health with Senate HELP Committee staff. (no bill) Discussed Medicare Reform (no bill) Discussed Age Rating in the ACA and rate shock. (no bill)Lobbied on preserving funding for the ACA; defended meaningful use of the ACA. (no bill) Discussed need to increase health information technology quality measurements and access to qualified systems. (no bill) H.R. 1099, To repeal the Prevention and Public Health Fund - Lobbied against the repeal of the Prevention and Public Health Trust Fund, is an important component in state and community efforts to prevent illness and promote health. Discussed Pre-existing Condition Insurance Program. (no bill) Discussed Accountable Care Organization and Medical Shared savings. (no bill) Discussed Rate Review. (no bill) Discussed Internal Appeals and External Review Process. (no bill) Discussed Medicare reimbursement issues. Lobbied in support of Medicare physician payment reform. Discussed legislation to make prescription drugs more affordable to older Americans. S. 1416/H.R. 2645 (112th Congress), Medigap Medical Loss Ratio Improvement Act of 2011. Discussed coverage for screening depression and screening and counseling for alcohol misuse. (no bill) Discussed consumer operated and oriented plan programs. (no bill) Discussed standards related to risk adjustment, reinsurance, and risk mitigation as they relate to exchanges. (no bill) H.R.2077, MLR Repeal Act of 2011 - Expressed opposition to the elimination of provision in the Affordable Care Act (P.L. 111-148)Discussed opposition to draft legislation regarding the elimination of grandfathered status. (no bill) Discussed association health plans with DOL, HHS and DOT. (no bill) Discussed quality and care coordination with HHS. (no bill) Discussed Essential Health Benefits with HHS. (no bill) Discussed employer affordability safe harbor. (no bill) Discussed health insurance exchanges - eligibility, enrollment, premium tax credits. (no bill) Discussed Basic Health Plans. (no bill) Discussed Medigap reform. (no bill) Discussed Pre-existing Condition Insurance Program. (no bill) Discussed role of grandfathered plans. (no bill) Discussed reauthorization of the Older Americans Act and other amendments to the OAA. (no bill) Discussed dual eligibles. (no bill)Discussed inviting FTC to participate in a webinar on how they are and can be engaged on state scope of practice issues. Also sent follow-up items for their review. (no bill) Discussed Medicare and Social Security programs. (no bill) Lobbied against cuts to the health care prevention fund. (no bill) Discussed deficit reduction issues dealing with Medicare and Medicaid including concerns over increasing Medicare's age of eligibility, chained CPI, payroll tax holiday extension, and cuts to Medicaid. (no bill) Discussed Affordable Care Medicaid expansion issues. Centers for Medicare and Medicaid Services, Center for Medicaid and CHIP Services. Discussed Medicaid reform, Medicare-Medicaid integration efforts and financial alignment demonstrations, other CMS demonstration initiatives. (no bill) Discussed Medicaid expansion implementation, as included in the ACA (P.L. 111-140). Discussed Medicaid including concerns over cuts to Medicaid. (no bill) Discussed Medicare-Medicaid integration efforts and financial alignment demonstrations and other CMS demonstration initiatives. (no bill) H.R. 8/PL 112-240 of 2012, American Taxpayer Relief Act - Discussed the establishment of the Commission on Long-Term Care and process related to the Commission. Discussed Senate amendment 99 to H.R. 933, the Consolidated and Further Continuing Appropriations Act (PL 113-6). Also made changes to Commission on Long-Term Care. Discussed implementation of the Affordable Care Act, its provisions and H.R. 95 to repeal the Patient Protection and Affordable Care Act. H. R. 933, Consolidated and Further Continuing Appropriations Act, 2013 - Lobbied to protect vital health and social services programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. S. Con. Res. 8/ H.Con. Res. 25, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. H.R. 1549, Helping Sick Americans Now Act - Discussed cuts to the health care prevention fund. The Labor, Health and Human Services Appropriations Act, 2014 - Lobbied to protect employment, health and human services and energy assistance programs for seniors, disabled and low income assistance. (no bill) Discussed Affordable Care Act Medicaid expansion issues, including questions related to the use of premium assistance authority to expand Medicaid. (no bill) Discussed Medicare-Medicaid integration efforts and financial alignment demonstrations, other CMS demonstration initiatives. (no bill)

Client expense: $2,460,000 · Firm income: Not reported

Government targets: Administration on Aging, Agriculture, Dept of (USDA), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Council on Disability, Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Comptroller of the Currency (OCC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

S.452, Medicare Diabetes Prevention Act - Discussed bill with Sen. Franken's staff. Discussed draft language on senior mental health with Senate HELP Committee staff. (no bill) Discussed Medicare Reform in meeting with House Energy and Commerce minority staff. (no bill) Discussed Age Rating in the ACA and rate shock in meeting with House Energy and Commerce minority staff. (no bill)Lobbied on preserving funding for the ACA; defended meaningful use of the ACA. (no bill) Discussed need to increase health information technology quality measurements and access to qualified systems. (no bill) H.R. 1099, To repeal the Prevention and Public Health Fund - Lobbied against the repeal of the Prevention and Public Health Trust Fund. This fund is an important component in state and community efforts to prevent illness and promote health. Discussed Pre-existing Condition Insurance Program. (no bill) Discussed Accountable Care Organization and Medical Shared savings. (no bill) Discussed Rate Review. (no bill) Discussed Internal Appeals and External Review Process. (no bill) Discussed Medicare reimbursement issues. Lobbied in support of Medicare physician payment reform. Discussed legislation to make prescription drugs more affordable to older Americans. S. 1416/H.R. 2645 (112th Congress), Medigap Medical Loss Ratio Improvement Act of 2011. Discussed coverage for screening depression and screening and counseling for alcohol misuse. (no bill) Discussed consumer operated and oriented plan programs. (no bill) Discussed standards related to risk adjustment, reinsurance, and risk mitigation as they relate to exchanges. (no bill) H.R.2077, MLR Repeal Act of 2011 - Expressed opposition to the elimination of provision in the Affordable Care Act (P.L. 111-148)Discussed opposition to draft legislation regarding the elimination of grandfathered status. (no bill) Discussed association health plans with DOL, HHS and DOT. (no bill) Discussed quality and care coordination with HHS. (no bill) Discussed Essential Health Benefits with HHS. (no bill) Discussed employer affordability safe harbor. (no bill) Discussed health insurance exchanges - eligibility, enrollment, premium tax credits. (no bill) Discussed Basic Health Plans. (no bill) Discussed Medigap reform. (no bill) Discussed Pre-existing Condition Insurance Program. (no bill) Discussed role of grandfathered plans. (no bill) Discussed reauthorization of the Older Americans Act and other amendments to the OAA. (no bill) Discussed dual eligibles. (no bill) S.3295, the Labor-HHS Appropriations bill for FY 2013 - Lobbied to protect/increase funding for the Social Security Administration, Older Americans Act nutrition, family caregiver & supportive services programs, low income home energy assistance (LIHEAP), and to protect funding for program authorized under the Affordable Care Act, including CMS State Health insurance exchanges, state survey & demonstrations and preventive Care Act, including CMS State Health insurance exchanges, state survey and demonstrations and preventive health. H.R. 8, the American Taxpayer Relief Act of 2012 - Lobbied against inclusion of Social Security, Medicare and Medicaid legislation affecting benefit levels or service delivery in any end-of-the-session budget deal, and urged congress to not reduce spending levels below current services levels for various non-security discretionary programs, including Health Care (including Rx, medical research and premium support), Social Security (administrative expenses), Older Americans Act Supportive Service, Nutrition and Caregiver programs, Low Income Home Energy Assistance, Weatherization, Elderly Housing and Transit/Transportation, Legal and Taxpayer Assistance, Consumer and Worker Protections and Postal Services. H.R. 963, Discussed, Coordination of Pro Bono Medically Recommended Dental Care Act of 2013.Discussed inviting FTC to participate in a webinar on how they are and can be engaged on state scope of practice issues. Also sent follow-up items for their review. (no bill) Discussed Medicare and Social Security programs. (no bill) Lobbied against cuts to the health care prevention fund. (no bill) Discussed deficit reduction issues dealing with Medicare and Medicaid including concerns over increasing Medicare's age of eligibility, chained CPI, payroll tax holiday extension, and cuts to Medicaid. (no bill) Discussed Affordable Care Medicaid expansion issues. Centers for Medicare and Medicaid Services, Center for Medicaid and CHIP Services. Discussed Medicaid reform, Medicare-Medicaid integration efforts and financial alignment demonstrations, other CMS demonstration initiatives. (no bill) Discussed Medicaid expansion implementation, as included in the ACA (P.L. 111-140). Discussed Medicare and Medicaid including concerns over increasing Medicare's age of eligibility and cuts to Medicaid. (no bill) Discussed Affordable Care Act Medicaid expansion issues. Discussed Medicare-Medicaid integration efforts and financial alignment demonstrations and other CMS demonstration initiatives. (no bill) H.R. 8/PL 112-240 of 2012, American Taxpayer Relief Act - Discussed repeal of CLASS Program and the establishment of the Commission on Long-Term Care. H.R. 8/PL 112-240 of 2012, American Taxpayer Relief Act - Discussed a nomination for appointment to the Commission on Long-Term Care and process related to the Commission. Discussed Senate amendment 99 to H.R. 933, the Consolidated and Further Continuing Appropriations Act (PL 113-6). Also made changes to Commission on Long-Term Care. Discussed implementation of the Affordable Care Act, its provisions and H.R. 95 to repeal the Patient Protection and Affordable Care Act. H.R. 152, Disaster Relief Appropriations Act, 2013 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. H.R. 325, Debt Limit Extension - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline on bill to suspend the public debt limit through May 18, 2013, and to prevent repeal of certain financial and health care-related regulation. H. R. 933, Consolidated and Further Continuing Appropriations Act, 2013 - Lobbied to protect vital health and social services programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. S. Con. Res. 8, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. H.Con. Res. 25, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. Discussed evaluation of the Independence at Home Demonstration and it's implementation (CMS). (no bill)

Client expense: $2,130,000 · Firm income: Not reported

Government targets: Administration on Aging, Agriculture, Dept of (USDA), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Council on Disability, Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Comptroller of the Currency (OCC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

S. 20/H.R. 1744 American Job Protection Act; Affordable Care Act, all provisions, including employer penalities, essential health benefits, exchanges, age rate band compression; Health Care Reform; Health Care Mandate Penalties; Employer/Employee Flexibility; Consumer-Directed Health Care; Health Insurance Exchanges; Medicare Secondary Payer Judgments; Comments on FDA's Suggested Questions & Answers for the Final Patient Protection & Affordable Care Act Section 4205 Guidance; Comments on IRS' "Shared Responsibility for Employers Regargding Health Care Coverage (IRC Sec. 1513)"; H.R.1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act, all provisions; H.R.2077, MLR Repeal Act of 2011, all provisions; S.1098, Family and Retirement Health Investment Act of 2011, all provisions; H.R.5/S.1099, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011, all provisions; H.R.1206, Access to Professional Health Insurance Advisors Act of 2011, all provisions; Summary of Benefit NRPM; Comments regarding employer interactions with insurance exchanges, health premium tax credits, and development of an affordability safe harbor for employers; S.1880, Jobs and Premium Protection Act, all provisions; S.1049/H.R. 2676, Small Business Health Relief Act of 2011, all provisions; H.R.2206, Auto Enroll Repeal Act, all provisions..

Client expense: $900,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Deposit Insurance Corporation (FDIC), Federal Motor Carrier Safety Administration, Federal Reserve System, Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Natl Telecommunications & Information Administration (NTIA), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. International Trade Commission (ITC), U.S. Trade Representative (USTR), White House Office

H.R. 63, Long-Term Care Insurance Reform Act (Doggett) - LTC insurance reforms, H.R. 111, Breast Cancer Patient Protection Act (DeLauro) - minimum hospital stays for mastectomy patients, H.R. 346, Health Care Choice Act (Pearce ) - national marketplace for individual coverage, H.R.371, Health Care Choice Act (Blackburn) - national marketplace for individual coverage, H.R. 416, Health Insurance Rate Review Act (Schakowsky) - rate review, H.R. 1050, Small Business Health Fairness Act (Johnson) - association health plans, H.R. 1150, Competitive Health Insurance Reform Act (Gosar) - antitrust policy, H.R.1206, Access to Professional Health Insurance Advisors Act (Rogers) - agent commissions, medical loss ratios, H.R. 1943, Health Insurance Industry Fair Competition Act (DeFazio) - changes to McCarran-Ferguson Act, H.R. 2077, MLR Repeal Act (Price) - medical loss ratios, H.R. 2645, Medigap Medical Loss Ratio Improvement Act (Stark) - MLRs for Medigap policies, H.R. 2958, Federal Employee Short-Term Disability Insurance Act (Holmes Norton) - disability program for federal employees, H.R. 5838, Health Insurance Industry Antitrust Enforcement Act (Conyers) - changes to McCarran-Ferguson Act, H.R.6283, Guaranteed Access to Health Insurance Act (Burgess) - reinsurance, high risk pools, S. 137, Health Insurance Rate Review Act (Feinstein) - rate review, S. 159, Confidence in Long-Term Care Insurance Act (Kohl) - LTC insurance reforms S. 1416, Medigap Medical Loss Ratio Improvement Act (Kerry) - MLRs for Medigap policies, S. 1500, Ensure Children Have Health Care Act (Murkowski/Enzi) - enrollment period for child-only policies, S. 2068, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) - agent commissions, medical loss ratios, S. 2288, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) - agent commissions, medical loss ratios, S. 3229, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) -- model disclosure form for marketing long-term care insurance policies, S. 3230, Long-Term Care Integrity Act (Klobuchar) -- claims dispute resolution procedures, S. 3271, Equal Access to Medicare Options Act (Kerry) - Medigap provisions, MA enrollment provisions.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues relating to health disparities, health care reform, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, and wellness, including the following legislation: S. 494 and H.R. 912, Colorectal Cancer Prevention, Early Detection & Treatment Act; H.R. 1213, Repeal mandatory funding provided to states in PPACA to establish American Health Benefit Exchanges; H.R. 1217, Repeal Prevention and Public Health Fund; H.R. 1740 and H.R. 5560, the Quality Cancer Care for Life Act of 2010; H.R.2941 and S.3493; H.R.3974, Viral Hepatitis and Liver Cancer Control and Prevention Act of 2009; H.R.4662, the Lymphedema Diagnosis and Treatment Cost Savings Act of 2010; the implementation of P.L. 111-148, the Patient Proection and Affordable Care Act of 2010; S.1064, the Sun Act; S.965, the Family Act; H.R.2954, Health Equity and Accountability Act of 2011; and H.R.2077, the MLR Repeal Act; H.R.2245 and S.296 Preserving Access to Life-Saving Medications Act, issues related to the reauthorization of the prescription drug user fee, S.3187, the FDA Safety and Innovation Act and the House Companion legislation, and issues relating to the ongoing national shortage of cancer drugs, Amendment relating to S.1813, the Moving Ahead for Progress in the 21st Century Act, and H.R.4274, reauthorization of the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act. Issues relating to global health including S.2515, the Clean Cookstoves Support Act of 2012; H.R.6155 & S.3047, the Palliative Care and Hospice Education & Training Act; and H.R.6157, the Patient Centered Quality of Care Act.

Client expense: $810,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), White House Office

H.R. 63, Long-Term Care Insurance Reform Act (Doggett) LTC insurance reforms 16. Specific Lobbying Issues (continued): H.R. 111, Breast Cancer Patient Protection Act (DeLauro) minimum hospital stays for mastectomy patients H.R. 346, Health Care Choice Act (Pearce ) national marketplace for individual coverage H.R.371, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 416, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1050, Small Business Health Fairness Act (Johnson) association health plans H.R. 1150, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R.1206, Access to Professional Health Insurance Advisors Act (Rogers) agent commissions, medical loss ratios H.R. 1943, Health Insurance Industry Fair Competition Act (DeFazio) changes to McCarran-Ferguson Act H.R. 2077, MLR Repeal Act (Price) medical loss ratios H.R. 2645, Medigap Medical Loss Ratio Improvement Act (Stark) MLRs for Medigap policies H.R. 2958, Federal Employee Short-Term Disability Insurance Act (Holmes Norton) disability program for federal employees H.R. 5838, Health Insurance Industry Antitrust Enforcement Act (Conyers) changes to McCarran-Ferguson Act H.R.6283, Guaranteed Access to Health Insurance Act (Burgess) reinsurance, high risk pools S. 137, Health Insurance Rate Review Act (Feinstein) rate review S. 159, Confidence in Long-Term Care Insurance Act (Kohl) LTC insurance reforms S. 1416, Medigap Medical Loss Ratio Improvement Act (Kerry) MLRs for Medigap policies S. 1500, Ensure Children Have Health Care Act (Murkowski/Enzi) enrollment period for child-only policies S. 2068, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 2288, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 3229, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) -- model disclosure form for marketing long-term care insurance policies S. 3230, Long-Term Care Integrity Act (Klobuchar) -- claims dispute resolution procedures S. 3271, Equal Access to Medicare Options Act (Kerry) Medigap provisions, MA enrollment provisions Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; and other issues relating to health care reform implementation.

Client expense: $2,020,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), 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), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office

1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act (H.R.4) Access to Independent Health Insurance Advisors Act (S.2068/S.2288) Access to Professional Health Insurance Advisors Act of 2011 (H.R.1206) Draft Legislation to Prevent Enforcement of Grandfathered Health Plan Regulation Draft Research Priorities (PCORI) EMS Quality, Innovation, and Cost Effectiveness Improvements Act of 2011 (H.R.3144) Essential Health Benefits Data Collection Proposed Rule (HHS) Food and Drug Administration Safety and Innovation Act (FDA User Fee bills, S.3187/H.R.3988) Guidance on Defining Minimum Essential Value of Employer-Sponsored Insurance (Treasury) Guidance on Federally Facilitated Exchanges (HHS) Health Benefit Exchanges (H.R.1213) Health Care Cost Reduction Act (H.R.436) Health Equity and Accountability Act (H.R.2954/S.2474) Health Risk Assessments in Medicare Comments (CDC) Heart Disease Education, Analysis and Research, and Treatment for Women Act (HEART for Women Act) (S.438/H.R.3526) H.R. 436, Health Care Cost Reduction Act Interest Rate Reduction Act (H.R.4628/S.2366) and other legislation using Prevention Fund to offset student loans Josh Miller Helping Everyone Access Responsive Treatment in Schools (HEARTS) Act (H.R.1377) Menu Labeling (ACA Section 4205) Middle Class Tax Relief and Job Promotion Act (H.R.3630) National Prevention Strategy, Request for Comments (HHS - Surgeon General) Patient-Focused Drug Development Initiative (FDA-2012-N-0967) Patient Protection and Affordable Care Act (P.L. 111-148; P.L. 111-152) - Implementation Prevention and Public Health Fund (ACA Section 4002) Proposed rules on essential health benefits (CMS) Proposed rules on health insurance market reforms (CMS) Qualified Health Plan Accreditation Proposed Rule (HHS) Repealing the Job-Killing Health Care Law Act (H.R.2) Request for information on quality in insurance exchanges (CMS) Sequester Replacement Reconciliation Act (H.R.5652) State Flexibility Act (H.R.1683/S.868) To Repeal Mandatory Funding Provided to States in the Patient Protection and Affordable Care Act to Establish American To Repeal the Patient Protection and Affordable Care Act (H.R.6079) Temporary Payroll Tax Cut Continuation Act (H.R.3630 - Medicare therapy caps exceptions process) To Repeal Mandatory Funding to States to Establish American Health Benefit Exchanges (H.R.1213) To Repeal Medical Loss Ratio Requirements (H.R.2077) To Repeal the Prevention and Public Health Fund (H.R.1217) Unique Device Identification System Proposed Rule (FDA-2011-N-0090)

Client expense: $224,984 · 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, Transportation, Dept of (DOT), Treasury, Dept of

(1) Issues related to Public Law 111-148 - The Patient Protection and Affordable Care Act; (2) Issues related to Public Law 111-152 - Health Care and Education Reconciliation Act of 2010; (3) Issues raised by H.R. 2077 - MLR Repeal Act of 2011 (repeal ACA's Medical Loss Ratio requirements); (4) Issues related to Public Law 112-144 - FDA Safety and Innovation Act (medical device user fee); (5) Issues related to the Health Information Technology for Economic and Clinical Health (HITECH) Act; and (6) Issues related to implementation of the Affordable Care Act, including Exchanges, Essential Health Benefits, affordability, health information technology, transparency, employer regulations, and taxes and fees.

Client expense: $1,280,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Personnel Management (OPM), SENATE, Treasury, Dept of

Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace. (no bill) Discussed barriers to care that can result from language differences between providers and patients and/or lack of translation services. (no bill) Lobbied on preserving funding for the ACA; defended meaningful use of the ACA. (no bill) Discussed need to increase health information technology quality measurements and access to qualified systems. (no bill) S. 1019, Hearing Aid Assistance Tax Credit Act - Discussed Hearing Aid Assistance Tax Credit Act which would provide a $500 credit to people of all ages. H.R. 217, To repeal the Prevention and Public Health Fund - Lobbied against the repeal of the Prevention and Public Health Trust Fund. This fund is an important component in state and community efforts to prevent illness and promote health. Discussed Pre-existing Condition Insurance Program. (no bill) Discussed Accountable Care Organization and Medical Shared savings. (no bill) Discussed Rate Review. (no bill) Discussed Internal Appeals and External Review Process. (no bill) Discussed Medicare reimbursement issues. Lobbied in support of Medicare physician payment reform. Discussed legislation to make prescription drugs more affordable to older Americans. S. 1416/H.R. 2645, Medigap Medical Loss Ratio Improvement Act. Discussed Internal Claims, Appeals and external Review Process. (no bill) Discussed HIPAA Privacy Rule Accounting under HITECH Act. (no bill) Discussed coverage for screening depression and screening and counseling for alcohol misuse. (no bill) Discussed consumer operated and oriented plan programs. (no bill) Discussed standards related to risk adjustment, reinsurance, and risk mitigation as they relate to exchanges. (no bill) H.R.2077, MLR Repeal Act of 2011 - Expressed opposition to the elimination of provision in the Affordable Care Act (P.L. 111-148)Discussed opposition to draft legislation regarding the elimination of grandfathered status. (no bill) Discussed association health plans with DOL, HHS and DOT. (no bill) Discussed quality and care coordination with HHS. (no bill) Discussed Essential Health Benefits with HHS. (no bill) Discussed employer affordability safe harbor. (no bill) Discussed health insurance exchanges - eligibility, enrollment, premium tax credits. (no bill) Discussed Basic Health Plans. (no bill) Discussed Medigap reform. (no bill) Discussed Pre-existing Condition Insurance Program. (no bill) Discussed role of grandfathered plans. (no bill) Discussed reauthorization of the Older Americans Act and other amendments to the OAA. (no bill) Discussed dual eligibles. (no bill) S.3295, the Labor-HHS Appropriations bill for FY 2013 - Lobbied to protect/increase funding for the Social Security Administration, Older Americans Act nutrition, family caregiver & supportive services programs, low income home energy assistance (LIHEAP), and to protect funding for program authorized under the Affordable Care Act, including CMS State Health insurance exchanges, state survey & demonstrations and preventive Care Act, including CMS State Health insurance exchanges, state survey and demonstrations and preventive health. H.R. 8, the American Taxpayer Relief Act of 2012 - Lobbied against inclusion of Social Security, Medicare and Medicaid legislation affecting benefit levels or service delivery in any end-of-the-session budget deal, and urged congress to not reduce spending levels below current services levels for various non-security discretionary programs, including Health Care (including Rx, medical research and premium support), Social Security (administrative expenses), Older Americans Act Supportive Service, Nutrition and Caregiver programs, Low Income Home Energy Assistance, Weatherization, Elderly Housing and Transit/Transportation, Legal and Taxpayer Assistance, Consumer and Worker Protections and Postal Services. Discussed Hospital & Critical Access Hospitals Conditions of Participation proposed regulations; requested that advanced practice registered nurses and physicians assistants be allowed the full scope of services in hospital admitting and visiting privileges. (no bill) Discussed Hospital Outpatient Therapeutic Services Final Rule underscoring that advanced practice registered nurses and physicians should be allowed to supervise such outpatient service clinics without physician oversight as long as in line with state scope of practice laws. (no bill) Discussed Medicare GNE demonstration design problems. Discussed inviting FTC to participate in a webinar on how they are and can be engaged on state scope of practice issues. Also sent follow-up items for their review. (no bill) Discussed Medicare and Social Security programs. (no bill) Lobbied against cuts to the health care prevention fund. (no bill) Discussed fiscal cliff issues dealing with Medicare and Medicaid including concerns over increasing Medicare's age of eligibility, chained CPI, payroll tax holiday extension, and cuts to Medicaid. (no bill) Discussed Affordable Care Medicaid expansion issues. Centers for Medicare and Medicaid Services, Center for Medicaid and CHIP Services. Discussed Medicaid reform, Medicare-Medicaid integration efforts and financial alignment demonstrations, other CMS demonstration initiatives. (no bill) Discussed Medicaid expansion implementation, as included in the ACA (P.L. 111-140).

Client expense: $2,490,000 · Firm income: Not reported

Government targets: Administration on Aging, Agriculture, Dept of (USDA), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Comptroller of the Currency (OCC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

S. 915, American Health Security Act of 2011 - single payer health plan P.L 111-148, Patient Protection and Affordable Care Act: proposed repeal of the law; implementation of Medicaid expansion H.R. 1200, American Health Security Act of 2011: provisions establishing a single payer health plan H.R. 1206, Access to Professional Health Insurance Advisors Act of 2011 H.R. 2077, Medical Loss Ratio Repeal Act of 2011: provisions that would repeal medical loss ratio requirements for insurers Medicare Rules Preservation of the income tax exclusion for employer-provided healthcare benefits Preservation of Medicare benefits: Medicare eligibility age cost-sharing requirements Restructuring of Medicaid financing for deficit reduction: use of block grants or per capita caps to reduce funding PL 112-152, Health Care and Education Reconciliation Act of 2010 Healthcare Regulations ACA Implementation: employer responsibility requirements, exchange and Summary of Benefits and Coverage Rules Medicaid: premium assistance programs

Client expense: $700,000 · Firm income: Not reported

Government targets: Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Deposit Insurance Corporation (FDIC), Federal Reserve System, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Pension Benefit Guaranty Corporation (PBGC), SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

H.R. 2, Repealing the Job-Killing Health Care Law Act H.R. 4, Small Business Paperwork Mandate Elimination Act of 2011 H.R. 5, Protecting Access to Healthcare Act H.R. 436, Health Care Cost Reduction Act of 2012 H.R. 450, Restoring Assistance for Families and Seniors Health Expenses Act of 2011 H.R. 452, Medicare Decisions Accountability Act of 2011 H.R. 605 / S. 312, Patients Freedom Choose Act H.R. 1051, Medicare Beneficiary Freedom to Choose Act of 2011 H.R. 1173, Fiscal Responsibility and Retirement Security Act of 2011 H.R. 1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act. H.R. 1509, Medicare Identity Theft Prevention Act of 2011 H.R. 1744 / S. 20, American Job Protection Act H.R. 1845 / S. 960, Medicare IVIG Access Act H.R. 2010, Family and Retirement Health Investment Act of 2011 H.R. 2077, MLR Repeal Act of 2011 H.R. 2529 / S.1368, Restoring Access to Medication Act H.R. 2590, Seniors Protection Act of 2011 H.R. 2676, Small Business Health Relief Act of 2011 H.R. 3682, Patient Centered Healthcare Savings Act of 2011 H.R. 4095 / S. 2002, Online Pharmacy Safety Act H.R. 4626, Health Insurance Fair Competition Act H.R. 5141/S. 3578, Small Business Paperwork Mandate Elimination Act H.R. 5651, Food and Drug Administration Reform Act of 2012 H.R. 5842, Restoring Access to Medication Act of 2012 H.R. 5853, Fiscal Responsibility and Retirement Security Act H.R. 5906, To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices H.R. 6048, Healthcare Tax Relief and Mandate Repeal Act S. 17, Medical Device Access and Innovation Protection Act S. 312, Patients Freedom to Choose Act S. 510, FDA Food Safety Modernization Act, including provisions relating to 1099 reporting amendments S. 668, Health Care Bureaucrats Elimination Act S. 720, Repeal the CLASS Entitlement Act S. 848, Consumer Information Enhancement Act of 2011 S. 1049, Small Business Health Relief Act of 2011 S. 1098, Family and Retirement Health Investment Act of 2011 S. 1880, Jobs and Premium Protection Act S. 2068, Access to Independent Health Insurance Advisors Act of 2012 S. 3187, Food and Drug Administration Safety and Innovation Act S. 3501, American Job Protection Act S. 3673, Patients Freedom Choice Act Notice of Proposed Rulemaking and Notice of Public Hearing Regarding Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes Research Trust Fund (77 Fed. Reg. 22691-22706, Apr. 17, 2012) Notice and Request for Comments on Minimum Value of an Employer-Sponsored Plan (Notice 2012-31, Apr. 26, 2012) Request for Information Regarding Stop Loss Coverage (77 Fed. Reg. 25788-25790, May 1, 2012) Notice and Request for Comments on Reporting of Health Insurance Coverage (Notice 2012-32, May 14, 2012) Notice and Request for Comments on Reporting by Applicable Large Employers on Health Insurance Coverage Under Employer-Sponsored Plans (Notice 2012-33, May 14, 2012) Final Regulations on Health Insurance Premium Tax Credit (77 Fed. Reg. 30377-30400, May 23, 2012 (to be codified at 26 C.F.R. pts 1 and 602)) Notice and Request for Comments on Health Flexible Spending Arrangements (Notice 2012-40, May 30, 2012) Notice and Request for Comments on the Guidance on 90-Day Waiting Period Limitation (DOL Technical Release 2012-02, Aug. 31, 2012) Notice and Request for Comments on Determining Full-Time Employees For Purposes of Shared Responsibility for Employers Regarding Health Coverage (Notice 2012-58, Aug. 31, 2012) Proposed Regulation on the Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation (77 Fed. Reg. 70,644-70,676, November 26, 2012 (to be codified at 45 CFR pts 147, 155, and 156)) Proposed Rule on the Health Insurance Market Rules; Rate Review (77 Fed. Reg. 70,584-70,617, November 26, 2012 (to be codified at 45 CFR pts 144, 147, and 150)) Proposed Rule on the HHS Notice of Benefit and Payment Parameters for 2014 (77 Fed. Reg. 73,118-73,218, December 7, 2012 (to be codified at 45 CFR pts 153, 155, 156, 157 and 158)) Various issues relating to the implementation of the Patient Protection and Affordable Care Act (P.L. 111-148), including implementation of regulatory process, legislative corrections, coverage, financing, delivery reform, 1099 reporting, Grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, employer mandate, medical loss ratio, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts; regulatory process and legislative corrections to Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including ERISA preemption and the impact on small business

Client expense: $29,510,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Deposit Insurance Corporation (FDIC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Justice, Dept of (DOJ), Labor, Dept of (DOL), Maritime Administration (MARAD), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office

HR 2: Repealing the Job Killing Health Care Law Act; HR 5: Protecting Access to Healthcare Act; HR 369: Health Savings and Affordability Act of 2011; HR 436: Protect Medical Innovation Act of 2011; HR 605: Patients Freedom to Choose Act; HR 1206: Access to Professional Health Insurance Advisors Act; HR 1580: Medicare Beneficary Preservation of Choice Act of 2011; HR 1744: American Job Protection Act; HR 2010: Family and Retirement Health Investment Act of 2011; HR 2077: MLR Repeal Act of 2011; HR 3239: SAFE Medicate Patient Act; HR 3586: The Good Samaritan Medical Professionals Act; S 20: American Job Protection Act; S 312: Patient Freedom to Choose Act; S 720: Repeal the CLASS Entilement Act; S 2068: Access to Independent Health Insurance Advisors Act; S 2288 Access to Independent Health Insurance Advisors Act.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

Insurance Market Reform General Issues; PL 111-148 "good faith compliance standard" of HCR Implementation S. 3078/HR. 4757 Rate Authority Act State Based Regulations: Exchanges/Sales Across State Lines HR. 371 MLR - Medical Loss Ratio: HR. 1206 Access to Professional Health Insurance Advisors Act: MLR Repeal Act HR. 2077 IPAB - Medicare Decisions Accountability Act of 2011 HR. 452 State Innovation Waivers / Consistent Reporting Requirements Healthcare Quality: Delivery System Incentives to Promote Better Care; Patient Safety and Quality Improvement; Payment Reforms; Patient-Centered Primary/Medical Home; Bundled Payments; Wellness/Health Disparities; Employer & School Wellness; Chronic Care & Medical Management; Childhood Obesity; Infant Mortality Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues relating to health disparities, health care reform, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, and wellness, including the following legislation: S. 494 and H.R. 912, Colorectal Cancer Prevention, Early Detection & Treatment Act; H.R. 1213, Repeal mandatory funding provided to states in PPACA to establish American Health Benefit Exchanges; H.R. 1217, Repeal Prevention and Public Health Fund; H.R. 1740 and H.R. 5560, the Quality Cancer Care for Life Act of 2010; H.R.2941 and S.3493; H.R.3974, Viral Hepatitis and Liver Cancer Control and Prevention Act of 2009; H.R.4662, the Lymphedema Diagnosis and Treatment Cost Savings Act of 2010; the implementation of P.L. 111-148, the Patient Proection and Affordable Care Act of 2010; S.1064, the Sun Act; S.965, the Family Act; H.R.2954, Health Equity and Accountability Act of 2011; and H.R.2077, the MLR Repeal Act; H.R.2245 and S.296 Preserving Access to Life-Saving Medications Act, issues related to the reauthorization of the prescription drug user fee, S.3187, the FDA Safety and Innovation Act and the House Companion legislation, and issues relating to the ongoing national shortage of cancer drugs, Amendment relating to S.1813, the Moving Ahead for Progress in the 21st Century Act, and H.R.4274, reauthorization of the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act. Issues relating to global health including S.2515, the Clean Cookstoves Support Act of 2012; H.R.6155 & S.3047, the Palliative Care and Hospice Education & Training Act; and H.R.6157, the Patient Centered Quality of Care Act.

Client expense: $620,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), White House Office

H.R. 2 Repealing the Job-Killing Health Care Law Act; H.R. 4 Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act; H.R. 1063 Strengthening Medicare and Repaying Taxpayers Act; S. 18 Small Business Paperwork Mandate Elimination Act; S. 19 American Liberty Restoration Act; S. 20/H.R. 1744 American Job Protection Act; Affordable Care Act, all provisions; S. 192 Repealing the Job-Killing Health Care Law Act; S. 312 Patients Freedom to Choose Act; Health Care Reform; Health Care Mandate Penalties; Employer/Employee Flexibility; Consumer-Directed Health Care; Health Insurance Exchanges; Medicare Secondary Payer Judgments; Comments on FDA's Suggested Questions & Answers for the Final Patient Protection & Affordable Care Act Section 4205 Guidance; Comments on IRS' "Shared Responsibility for Employers Regargding Health Care Coverage (IRC Sec. 1513)"; H.R.1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act, all provisions; H.R.2077, MLR Repeal Act of 2011, all provisions; S.1098, Family and Retirement Health Investment Act of 2011, all provisions; H.R.5/S.1099, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011, all provisions; H.R.1206, Access to Professional Health Insurance Advisors Act of 2011, all provisions; Summary of Benefit NRPM; Comments regarding employer interactions with insurance exchanges, health premium tax credits, and development of an affordability safe harbor for employers; S.1880, Jobs and Premium Protection Act, all provisions; S.1049/H.R. 2676, Small Business Health Relief Act of 2011, all provisions; H.R.2206, Auto Enroll Repeal Act, all provisions.; H.R. 6079, Repeal of Obamacare Act, all provisions.

Client expense: $820,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Deposit Insurance Corporation (FDIC), Federal Motor Carrier Safety Administration, Federal Reserve System, Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Natl Telecommunications & Information Administration (NTIA), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. International Trade Commission (ITC), U.S. Trade Representative (USTR), White House Office

(1) Issues related to Public Law 111-148 The Patient Protection and Affordable Care Act; (2) Issues related to Public Law 111-152 Health Care and Education Reconciliation Act of 2010; (3) Issues raised by H.R. 2077 - MLR Repeal Act of 2011(repeal ACA's Medical Loss Ratio requirements); (4) Issues related to Public Law 112-144 FDA Safety and Innovation Act (medical device user fee); (5) Issues related to the Health Information Technology for Economic and Clinical Health (HITECH) Act; and (6) Issues related to implementation of the Affordable Care Act, including Exchanges, Essential Health Benefits, affordability, health information technology, transparency, employer regulations, and taxes and fees.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Personnel Management (OPM), SENATE, Treasury, Dept of

S. 915, American Health Security Act of 2011 - single payer health plan P.L 111-148, Patient Protection and Affordable Care Act: Implementation, affordability standard in employer requirement to provide coverage; definition of full time employee for purposes of employer requirement; proposed repeal of the law; implementation of Medicaid expansion H.R. 1200, American Health Security Act of 2011: provisions establishing a single payer health plan H.R. 1206, Access to Professional Health Insurance Advisors Act of 2011 - provisions allowing for insurance brokers to be exempted H.R. 2077, MLR Repeal Act of 2011: provisions that would repeal medical loss ratio requirements for insurers Medicare Rules Preservation of the income tax exclusion for employer-provided healthcare benefits Preservation of Medicare benefits: Medicare eligibility age cost-sharing requirements Restructuring of Medicaid financing for deficit reduction: use of block grants or per capita caps to reduce funding H.R. 6079, Repeal of Obama Care Act: provisions related to repeal of the Affordable Care Act H.R. 1063, Strengthening Medicare and Repaying Taxpayers Act of 2011: provisions related to payments from trust fund PL 112-152, Health Care and Education Reconciliation Act of 2010: affordability standard in employer requirement to provide coverage definition of full time employee Health: regulatory agenda, SGR fix

Client expense: $840,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Council of Economic Advisers (CEA), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), Executive Office of the President (EOP), Federal Reserve System, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. International Trade Commission (ITC), U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), Vice President of the U.S., White House Office

H.R. 63, Long-Term Care Insurance Reform Act (Doggett) - LTC insurance reforms. H.R. 111, Breast Cancer Patient Protection Act (DeLauro) - minimum hospital stays for mastectomy patients. H.R. 346, Health Care Choice Act (Pearce ) - national marketplace for individual coverage. H.R.371, Health Care Choice Act (Blackburn) - national marketplace for individual coverage. H.R. 416, Health insurance Rate Review Act (Schakowsky) - rate review. H.R. 1050, Small Business Health Fairness Act (Johnson) - association health plans. H.R. 1150, Competitive Health Insurance Reform Act (Gosar) - antitrust policy. H.R.1206, Access to Professional Health Insurance Advisors Act (Rogers) - agent commissions, medical loss ratios. H.R. 1943, Health Insurance Industry Fair Competition Act (DeFazio) - changes to McCarran-Ferguson Act. H.R. 2077, MLR Repeal Act (Price) - medical loss ratios. H.R. 2645, Medigap Medical Loss Ratio Improvement Act (Stark) - MLRs for Medigap policies. H.R. 2958, Federal Employee Short-Term Disability Insurance Act (Holmes Norton) - disability program for federal employees. H.R. 5838, Health Insurance Industry Antitrust Enforcement Act (Conyers) - changes to McCarran-Ferguson Act. H.R.6283, Guaranteed Access to Health Insurance Act (Burgess) - reinsurance, high risk pools. S. 137, Health Insurance Rate Review Act (Feinstein) - rate review. S. 159, Confidence in Long-Term Care Insurance Act (Kohl) - LTC insurance reforms. S. 1416, Medigap Medical Loss Ratio Improvement Act (Kerry) - MLRs for Medigap policies. S. 1500, Ensure Children Have Health Care Act (Murkowski/Enzi) - enrollment period for child-only policies. S. 2068, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) - agent commissions, medical loss ratios. S. 2288, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) - agent commissions, medical loss ratios. S. 3229, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) -- model disclosure form for marketing long-term care insurance policies. S. 3230, Long-Term Care Integrity Act (Klobuchar) -- claims dispute resolution procedures. S. 3271, Equal Access to Medicare Options Act (Kerry) - Medigap provisions, MA enrollment provisions.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace. (no bill) Discussed barriers to care that can result from language differences between providers and patients and/or lack of translation services. (no bill) Lobbied on preserving fund for the ACA; defended meaningful use of the ACA. (no bill) Discussed need to increase health information technology quality measurements and access to qualified systems. (no bill) S. 1019, Hearing Aid Assistance Tax Credit Act - Discussed Hearing Aid Assistance Tax Credit Act which would provide a $500 credit to people of all ages. H.R. 217, To repeal the Prevention and Public Health Fund - Lobbied against the repeal of the Prevention and Public Health Trust Fund. This fund is an important component in state and community efforts to prevent illness and promote health. Discussed Pre-existing Condition Insurance Program. (no bill) Discussed Accountable Care Organization and Medical Shared savings. (no bill) Discussed Rate Review. (no bill) Discussed Internal Appeals and External Review Process. (no bill) Discussed Medicare reimbursement issues. Lobbied in support of Medicare physician payment reform. Discussed legislation to make prescription drugs more affordable to older Americans. S. 1416/H.R. 2645, Medigap Medical Loss Ratio Improvement Act - Lobbied for bill introduction and helped with crafting. Discussed Internal Claims, Appeals and external Review Process. (no bill) Discussed HIPAA Privacy Rule Accounting under HITECH Act. (no bill) Discussed coverage for screening depression and screening and counseling for alcohol misuse. (no bill) Discussed consumer operated and oriented plan programs. (no bill) Discussed standards related to risk adjustment, reinsurance, and risk mitigation as they relate to exchanges. (no bill) H.R.2077, MLR Repeal Act of 2011 - Expressed opposition to the elimination of provision in the Affordable Care Act (P.L. 111-148)Discussed opposition to draft legislation regarding the elimination of grandfathered status. (no bill) Discussed association health plans with DOL, HHS and DOT. (no bill) Discussed quality and care coordination with HHS. (no bill) Discussed Essential Health Benefits with HHS. (no bill) Discussed employer affordability safe harbor. (no bill) Discussed health insurance exchanges - eligibility, enrollment, premium tax credits. (no bill) Discussed Basic Health Plans. (no bill) Discussed Medigap reform. (no bill) Discussed Pre-existing Condition Insurance Program. (no bill) Discussed role of grandfathered plans. (no bill) Discussed reauthorization of the Older Americans Act and other amendments to the OAA. (no bill) Discussed dual eligibles with Medpac. (no bill) S.3295, the Labor-HHS Appropriations bill for FY 2013 - Lobbied to protect/increase funding for the Social Security Administration, Older Americans Act nutrition, family caregiver & supportive services programs, low income home energy assistance (LIHEAP), and to protect funding for program authorized under the Affordable Care Act, including CMS State Health insurance exchanges, state survey & demonstrations and preventive Care Act, including CMS State Health insurance exchanges, state survey and demonstrations and preventive health. Discussed Hospital & Critical Access Hospitals Conditions of Participation proposed regulations; requested that advanced practice registered nurses and physicians assistants be allowed the full scope of services in hospital admitting and visiting privileges. (no bill) Discussed Hospital Outpatient Therapeutic Services Final Rule underscoring that advanced practice registered nurses and physicians should be allowed to supervise such outpatient service clinics without physician oversight as long as in line with state scope of practice laws. (no bill) Discussed Medicare GNE demonstration design problems. Discussed inviting FTC to participate in a webinar on how they are and can be engaged on state scope of practice issues. Also sent follow-up items for their review. (no bill) Discussed Medicare and Social Security programs. (no bill) Lobbied against cuts to the health care prevention fund. (no bill)

Client expense: $2,720,000 · Firm income: Not reported

Government targets: Administration on Aging, Agriculture, Dept of (USDA), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Comptroller of the Currency (OCC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

HR 2: Repealing the Job Killing Health Care Law Act; HR 5: Protecting Access to Healthcare Act; HR 369: Health Savings and Affordability Act of 2011; HR 436: Protect Medical Innovation Act of 2011; HR 605: Patients Freedom to Choose Act; HR 1206: Access to Professional Health Insurance Advisors Act; HR 1580: Medicare Beneficary preservation of Choice Act of 2011; HR 1744: American Job Protection Act; HR 2010: Family and Retirement Health Investment Act of 2011; HR 2077: MLR Repeal Act of 2011; HR 3239: SAFE Medicate Patient Act; HR 3586: The Good Samaritan Medical Professionals Act; S 20: American Job Protection Act; S 312: Patients Freedom to Choose Act; S 720: Repeal the CLASS Entitlement Act; S 2068: Access to Independent Health Insurance Advisors Act; S 2288: Access to Independent Health Insurance Advisors Act.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act (H.R.4) Access to Independent Health Insurance Advisors Act (S.2068/S.2288) Access to Professional Health Insurance Advisors Act of 2011 (H.R.1206) Draft Legislation to Prevent Enforcement of Grandfathered Health Plan Regulation Draft Research Priorities (PCORI) EMS Quality, Innovation, and Cost Effectiveness Improvements Act of 2011 (H.R.3144) Essential Health Benefits Data Collection Proposed Rule (HHS) Experimental Study on Consumer Responses to Nutrition Facts Labels with Various Footnote Formats and Declaration of Amount of Added Sugars (FDA-2012-N-0495) Food and Drug Administration Safety and Innovation Act (FDA User Fee bills, S.3187/H.R.3988) Guidance on Defining Minimum Essential Value of Employer-Sponsored Insurance (Treasury) Guidance on Federally Facilitated Exchanges (HHS) Health Benefit Exchanges (H.R.1213) Health Care Cost Reduction Act (H.R.436) Health Equity and Accountability Act (H.R.2954/S.2474) Health Risk Assessments in Medicare Comments (CDC) Heart Disease Education, Analysis and Research, and Treatment for Women Act (HEART for Women Act) (S.438/H.R.3526) H.R. 436, Health Care Cost Reduction Act Interest Rate Reduction Act (H.R.4628/S.2366) and other legislation using Prevention Fund to offset student loans Josh Miller Helping Everyone Access Responsive Treatment in Schools (HEARTS) Act (H.R.1377) Menu Labeling (ACA Section 4205) Middle Class Tax Relief and Job Promotion Act (H.R.3630) National Prevention Strategy, Request for Comments (HHS - Surgeon General) Patient Protection and Affordable Care Act (P.L. 111-148; P.L. 111-152) - Implementation Prevention and Public Health Fund (ACA Section 4002) Qualified Health Plan Accreditation Proposed Rule (HHS) Repealing the Job-Killing Health Care Law Act (H.R.2) Sequester Replacement Reconciliation Act (H.R.5652) State Flexibility Act (H.R.1683/S.868) To Repeal Mandatory Funding Provided to States in the Patient Protection and Affordable Care Act to Establish American To Repeal the Patient Protection and Affordable Care Act (H.R.6079) Temporary Payroll Tax Cut Continuation Act (H.R.3630 - Medicare therapy caps exceptions process) To Repeal Mandatory Funding to States to Establish American Health Benefit Exchanges (H.R.1213) To Repeal Medical Loss Ratio Requirements (H.R.2077) To Repeal the Prevention and Public Health Fund (H.R.1217)

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

H.R. 2, Repealing the Job-Killing Health Care Law Act H.R. 4, Small Business Paperwork Mandate Elimination Act of 2011 H.R. 5, Protecting Access to Healthcare Act H.R. 436, Health Care Cost Reduction Act of 2012 H.R. 450, Restoring Assistance for Families and Seniors Health Expenses Act of 2011 H.R. 452, Medicare Decisions Accountability Act of 2011 H.R. 605 / S. 312, Patients Freedom to Choose Act H.R. 1051, Medicare Beneficiary Freedom to Choose Act of 2011 H.R. 1173, Fiscal Responsibility and Retirement Security Act of 2011 H.R. 1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 1744 / S. 20, American Job Protection Act H.R. 2010, Family and Retirement Health Investment Act of 2011 H.R. 2077, MLR Repeal Act of 2011 H.R. 2112, Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, Vitter Amendment (#769 - prescription drug reimportation) H.R. 2529, Restoring Access to Medication Act H.R. 2590, Seniors Protection Act of 2011 H.R. 2676, Small Business Health Relief Act of 2011 H.R. 3487, Job Creation Act of 2011 H.R. 3682, Patient Centered Healthcare Savings Act of 2011 H.R. 4095 / S. 2002, Online Pharmacy Safety Act H.R. 4626, Health Insurance Fair Competition Act H.R. 5141/S. 3578, Small Business Paperwork Mandate Elimination Act H.R. 5651, Food and Drug Administration Reform Act of 2012 H.R. 5842, Restoring Access to Medication Act of 2012 H.R. 5853, Fiscal Responsibility and Retirement Security Act H.R. 6048, Healthcare Tax Relief and Mandate Repeal Act H.R. 6079, Repeal of Obamacare Act S. 17, Medical Device Access and Innovation Protection Act S. 20, American Job Protection Act S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the Amendment offered by Senator McConnell to repeal P.L. 111-148, the Patient Protection and Affordable Care Act and an Amendment offered by Senator Stabenow which would repeal Section 9006 of the Patient Protection and Affordable Care Act S. 493, SBIR/STTR Reauthorization Act of 2011, including an Amendment offered by Senator Johanns which would fully repeal Section 9006 of the Patient Protection and Affordable Care Act and Amendment Number 197 offered by Senator Hutchison S. 510, FDA Food Safety Modernization Act, issues related to 1099 reporting amendments S. 668, Health Care Bureaucrats Elimination Act S. 720, Repeal the CLASS Entitlement Act S. 848, Consumer Information Enhancement Act of 2011 S. 1049, Small Business Health Relief Act of 2011 S. 1098, Family and Retirement Health Investment Act of 2011 S. 1368, Restoring Access to Medication Act S. 1880, Jobs and Premium Protection Act S. 2068, Access to Independent Health Insurance Advisors Act of 2012 S. 3187, Food and Drug Administration Safety and Innovation Act S. 3501, American Job Protection Act S. 3673, Patients Freedom Choice Act Filed comments and met with relevant agencies on regulations implementing health care reform (P.L. 111-148 and P.L. 111-152) Notice of Proposed Rulemaking and Notice of Public Hearing Regarding Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes Research Trust Fund (77 Fed. Reg. 22691-22706, Apr. 17, 2012) Notice and Request for Comments on Minimum Value of an Employer-Sponsored Plan (Notice 2012-31, Apr. 26, 2012) Request for Information Regarding Stop Loss Coverage (77 Fed. Reg. 25788-25790, May 1, 2012) Notice and Request for Comments on Reporting of Health Insurance Coverage (Notice 2012-32, May 14, 2012) Notice and Request for Comments on Reporting by Applicable Large Employers on Health Insurance Coverage Under Employer-Sponsored Plans (Notice 2012-33, May 14, 2012) Final Regulations on Health Insurance Premium Tax Credit (77 Fed. Reg. 30377-30400, May 23, 2012 (to be codified at 26 C.F.R. pts 1 and 602)) Notice and Request for Comments on Health Flexible Spending Arrangements (Notice 2012-40, May 30, 2012) Notice and Request for Comments on the Guidance on 90-Day Waiting Period Limitation (DOL Technical Release 2012-02, Aug. 31, 2012) Notice and Request for Comments on Determining Full-Time Employees For Purposes of Shared Responsibility for Employers Regarding Health Coverage (Notice 2012-58, Aug. 31, 2012) Various issues relating to the implementation of the Patient Protection and Affordable Care Act (P.L. 111-148), including implementation of regulatory process, legislative corrections, coverage, financing, delivery reform, 1099 reporting, grandfathering, CMS claims database, IPAB, CLASS program, employer mandate, medical loss ratio, mandated insurance requirements, medical malpractice reform, exchanges, Medicare reform, regulatory reform, essential health benefits package, health insurance tax, medical device tax, flexible spending accounts and health savings accounts, cost impact analyses, lack of quantified benefit analysis, and the need for empirical data sources on which to base cost and benefits; regulatory process and legislative corrections to Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including ERISA preemption and the impact on small business

Client expense: $31,650,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Maritime Administration (MARAD), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of the Vice President of the United States, Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office

H.R. 1580, Medicare Beneficiary Preservation of Choice Act of 2011 S. 1479, Medicare Beneficiary Preservation of Choice Act of 2011 S. 1880, Jobs and Premium Protection Act H.R. 1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 2077, MLR Repeal Act of 2011 S. 1049, Small Business Health Relief Act of 2011 H.R. 1540, National Defense Authorization Act for Fiscal Year 2012 (Tricare-related issues) S. 1867, National Defense Authorization Act for Fiscal Year 2012 (Tricare-related issues) H.R. 4310, National Defense Authorization Act for Fiscal Year 2013 (Tricare-related issues)

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

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

H.R. 63, Long-Term Care Insurance Reform Act (Doggett) LTC insurance reforms 16. Specific Lobbying Issues (continued): H.R. 111, Breast Cancer Patient Protection Act (DeLauro) minimum hospital stays for mastectomy patients H.R. 346, Health Care Choice Act (Pearce ) national marketplace for individual coverage H.R.371, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 416, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1050, Small Business Health Fairness Act (Johnson) association health plans H.R. 1150, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R.1206, Access to Professional Health Insurance Advisors Act (Rogers) agent commissions, medical loss ratios H.R. 1943, Health Insurance Industry Fair Competition Act (DeFazio) changes to McCarran-Ferguson Act H.R. 2077, MLR Repeal Act (Price) medical loss ratios H.R. 2645, Medigap Medical Loss Ratio Improvement Act (Stark) MLRs for Medigap policies H.R. 2958, Federal Employee Short-Term Disability Insurance Act (Holmes Norton) disability program for federal employees H.R. 5838, Health Insurance Industry Antitrust Enforcement Act (Conyers) changes to McCarran-Ferguson Act H.R.6283, Guaranteed Access to Health Insurance Act (Burgess) reinsurance, high risk pools S. 137, Health Insurance Rate Review Act (Feinstein) rate review S. 159, Confidence in Long-Term Care Insurance Act (Kohl) LTC insurance reforms S. 1416, Medigap Medical Loss Ratio Improvement Act (Kerry) MLRs for Medigap policies S. 1500, Ensure Children Have Health Care Act (Murkowski/Enzi) enrollment period for child-only policies S. 2068, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 2288, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 3229, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) -- model disclosure form for marketing long-term care insurance policies S. 3230, Long-Term Care Integrity Act (Klobuchar) -- claims dispute resolution procedures S. 3271, Equal Access to Medicare Options Act (Kerry) Medigap provisions, MA enrollment provisions Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; compliance with the transitional reinsurance program; and other issues relating to health care reform implementation.

Client expense: $2,630,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office

Issues relating to health disparities, health care reform, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, and wellness, including the following legislation: S. 494 and H.R. 912, colorectal Cancer Prevention, Early Detection & Treatment Act; H.R. 1213, repeal mandatory funding provided to states in PPACA to establish American Health Benefit Exchanges; H.R. 1217, repeal Prevention and Public Health Fund; H.R. 1740 and H.R. 5560, the Quality Cancer Care for Life Act of 2010; H.R. 2941 and S. 3493; the Patient Protection and Affordable Care Act of 2010; S. 1064, the Sun Act; S. 965, the Family Act; H.R. 2954, Health Equity and Accountability Act of 2011; and H.R. 2077, the MLR Repeal Act; H.R. 2245 and S. 296 Preserving Access to Life-Saving Medications Act, issues related to the reauthorization of the prescription drug user fee, S. 3187, the FDA Safety and Innovation Act and the House Companion legislation, and issues relating to the ongoing national shortage of cancer drugs, amendment relating to S. 1813, the Moving Ahead for Progress in the 21st Century Act, and H.R. 4274, reauthorization of the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health insurance taxes included in Patient Protection and Affordable Care Act - HR 1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act; proposed legislation re this issue. Repeal IAPB provisions sof PL 111-148, PL 111-152 - HR 5, Protecting Access to Healthcare Act; HR 452, Medicare Decisions Accountability Act of 2011; S 2118, Health Care Bureaucrats Elimination Act. Funding for HHS programs and agencies - HJRes 17, Continuing Appropriations Resolution, 2013; S 3295, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013; proposed legislation re this issue. Proposed changes to PPACA, PL 111-148, PL 111-152, involving medical loss ratio - HR 1206, Access to Professional Health Insurance Advisors Act of 2011; HR 2077, MLR Repeal Act of 2011; HR 2645, Medigap Medical Loss Ratio Improvement Act.

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

Government targets: HOUSE OF REPRESENTATIVES

Insurance Market Reform General Issues; PL 111-148 "good faith compliance standard" of HCR Implementation S. 3078/ HR 4757 Rate Authority Act State Based Regulations: Exhanges/Sales Across State Lines HR 371 MLR - Medical Loss Ratio: HR 1206 Access to Professional Health Insurance Advisors Act: MLR Repeal Act HR 2077 IPAB - Medicare Decisions Accountability Act of 2011 HR 452 State Innovation Waivers / Consistent Reporting Requirements Healthcare Quality: Delivery System Incentives to Promote Better Care; Patient Safety and Quality Improvement; Payment Reforms; Patient-Centered Primary/Medical Home; Bundled Payments; Wellness/Health Disparities; Employer & School Wellness; Chronic Care & Medical Management; Childhood Obesity; Infant Mortality Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue HCR - Healthcare Patient Protection and Affordable Care Act (ACA) successful insurance industry implementation of health reforms: reasonable effective dates for compliance with PL 111-148 Affordable private health care: Insurer fees; Essential health benefits; Healthcare delivery system reforms; Small employer tax credits; Individual responsibility to obtain and maintain insurance coverage; Health insurance excise tax; Grandfathered policies; Qualified Health Plans requirements State-based regulation: State oversight of premium increases, products and rates; Creation of State-based exchanges; State health insurance exchanges; Federal exchanges; Federal rate review; Existing state regulatory functions; Consumer Operated and Oriented Plan Program (CO-OPs); Selling health insurance across state lines: HR371 Health Care Choice Act of 2011 Medical Loss Ratios: MLR Broker Fee HR1206 Access to Professional Health Insurance Advisors Act of 2011; Quality improvement definition; HR 2077 MLR Repeal Act of 2011 Health Care Quality: Delivery system incentives to promote better care; Payment reforms; Patient-centered primary care/medical home; Comparative effectiveness research; Evidence based care; Health disparities; Wellness; Chronic care management; Childhood obesity Health Information Technology Standards: Health information privacy; Electronic health records; Administrative simplification; ICD10 real time claims adjudication; Data sharing; Data aggregation Insurance Market Reform: Individual market reform; Small group market reform; Guaranteed issue; Community rating; Health status rating; Health Savings Accounts Accountable Care Organizations (ACOs) HR 5651 "FDA Reform Act of 2012" sections pertaining to generic drugs and online pharmacies; S 1882 "Fair and Immediate Release of Generic Drugs Act" BCBSAs proposal Building Tomorrows Healthcare System: The Pathway to High-Quality, Affordable Care in America

Client expense: $910,000 · Firm income: Not reported

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

Issues relating to health disparities, health care reform, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, and wellness, including the following legislation: S. 494 and H.R. 912 Colorectal Cancer Prevention, Early Detection & Treatment Act; H.R. 1213, repeal mandatory funding provided to states in PPACA to establish American Health Benefit Exchanges; H.R. 1217, Repeal Prevention and Public Health Fund; H.R. 1740 and H.R. 5560, the quality Cancer Care for Life Act of 2010; H.R. 2941 and S. 3493; H.R. 3974, Viral Hepatatis and Liver Cancer Control and Prevention Act of 2009; H.R. 4662, the Lymphedema Diagnosis and Treatment Cost Savings Act of 2010; S. 1064, The Sun Act; S. 965, the Family Act; H.R. 2954, Health Equity and Accountability Act of 2011; and H.R. 2077, the MLR Repeal Act; H.R. 2245and S.296 Preserving Access to Life-Saving Medications Act, issues related to the reauthorization of the prescription drug user fee, S. 3187, the FDA Safety and Innovation Act and the House Companion legislation, and issues relating to the ongoig the national shortage of cancer drugs. Amendment relating to S. 1813, the Moving Ahead for Progress in the 21st Century Act, and H.R. 4274, reauthorization of the Best Pharmaceutials for Children Act and the Pediatric Research Equity Act.

Client expense: $420,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues relating to health disparities, health care reform, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, and wellness, including the following legislation: S. 494 and H.R. 912, Colorectal Cancer Prevention, Early Detection & Treatment Act; H.R. 1213, Repeal mandatory funding provided to states in PPACA to establish American Health Benefit Exchanges; H.R. 1217, Repeal Prevention and Public Health Fund; H.R. 1740 and H.R. 5560, the Quality Cancer Care for Life Act of 2010; H.R. 2941 and S. 3493; H.R. 3974, Viral Hepatitis and Liver Cancer Control and Prevention Act of 2009; H.R. 4662, the Lymphedema Diagnosis and Treatment Cost Savings Act of 2010; the implementation of P.L. 111-148, the Patient Proection and Affordable Care Act of 2010; S. 1064, the Sun Act; S 965, the Family Act; H.R. 2954, Health Equity and Accountability Act of 2011; and H.R. 2077, the MLR Repeal Act; H.R. 2245 and S. 296 Preserving Access to Life-Saving Medications Act, issues related to the reauthorization of the prescription drug user fee, S.3187, the FDA Safety and Innovation Act and the House Companion legislation, and issues relating to the ongoing national shortage of cancer drugs, Amendment relating to S.1813, the Moving Ahead for Progress in the 21st Century Act, and H.R. 4274, reauthorization of the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act. Issues relating to global health including S. 2515, the Clean Cookstoves Support Act of 2012.

Client expense: $590,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), White House Office

(1) Issues related to Public Law 111-148 The Patient Protection and Affordable Care Act; (2) Issues related to Public Law 111-152 Health Care and Education Reconciliation Act of 2010; (3) Issues raised by H.R. 2077 - MLR Repeal Act of 2011(repeal ACA's Medical Loss Ratio requirements); and (4) Issues related to implementation of the Affordable Care Act, including Exchanges, Essential Health Benefits, affordability, health information technology, transparency, employer regulations, and taxes and fees.

Client expense: $820,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Personnel Management (OPM), SENATE, Treasury, Dept of

S. 915, American Health Security Act of 2011 - single payer health plan P.L 111-148, Patient Protection and Affordable Care Act: Implementation H.R. 5, Protecting Access to Healthcare Act: provisions eliminating the Independent Payment Advisory Board H.R. 1200, American Health Security Act of 2011: provisions establishing a single payer health plan H.R. 1206, Access to Professional Health Insurance Advisors Act of 2011 - provisions allowing for insurance brokers to be exempted H.R. 2077, MLR Repeal Act of 2011: provisions that would repeal medical loss ration requirements for insurers Medicare Rules Preservation of the income tax exclusion for employer-provided healthcare benefits Deficit Reduction Packages: provisions that would reduce Medicare and Medicaid spending Preservation of Medicare benefits Restructuring of Medicaid financing for deficit reduction S. Amdt. 2111, to provide substantial savings in health care costs to the federal government and consumers by fostering competition among generic pharmaceutical manufacturers Infectious Disease standard (non-bill matter)

Client expense: $840,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), Executive Office of the President (EOP), Federal Mediation & Conciliation Service, Federal Reserve System, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), Veterans Employment & Training Service, Vice President of the U.S.

H.R. 63, Long-Term Care Insurance Reform Act (Doggett) LTC insurance reforms H.R. 111, Breast Cancer Patient Protection Act (DeLauro) minimum hospital stays for mastectomy patients H.R. 346, Health Care Choice Act (Pearce ) national marketplace for individual coverage 16. Specific Lobbying Issues (continued): H.R.371, Health Care Choice Act (Blackburn) national marketplace for individual coverage H.R. 416, Health Insurance Rate Review Act (Schakowsky) rate review H.R. 1050, Small Business Health Fairness Act (Johnson) association health plans H.R. 1150, Competitive Health Insurance Reform Act (Gosar) antitrust policy H.R.1206, Access to Professional Health Insurance Advisors Act (Rogers) agent commissions, medical loss ratios H.R. 1943, Health Insurance Industry Fair Competition Act (DeFazio) changes to McCarran-Ferguson Act H.R. 2077, MLR Repeal Act (Price) medical loss ratios H.R. 2645, Medigap Medical Loss Ratio Improvement Act (Stark) MLRs for Medigap policies H.R. 2958, Federal Employee Short-Term Disability Insurance Act (Holmes Norton) disability program for federal employees H.R. 5838, Health Insurance Industry Antitrust Enforcement Act (Conyers) changes to McCarran-Ferguson Act S. 137, Health Insurance Rate Review Act (Feinstein) rate review S. 159, Confidence in Long-Term Care Insurance Act (Kohl) LTC insurance reforms S. 1416, Medigap Medical Loss Ratio Improvement Act (Kerry) MLRs for Medigap policies S. 1500, Ensure Children Have Health Care Act (Murkowski/Enzi) enrollment period for child-only policies S. 2068, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 2288, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) agent commissions, medical loss ratios S. 3229, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) -- model disclosure form for marketing long-term care insurance policies S. 3230, Long-Term Care Integrity Act (Klobuchar) -- claims dispute resolution procedures S. 3271, Equal Access to Medicare Options Act (Kerry) Medigap provisions, MA enrollment provisions Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; issues related to genetic nondiscrimination; summary of benefits and coverage disclosures; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; treatment of expatriate plans; and other issues relating to health care reform implementation.

Client expense: $2,240,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), 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), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office

H.R. 1580, Medicare Beneficiary Preservation of Choice Act of 2011 S. 1479, Medicare Beneficiary Preservation of Choice Act of 2011 S. 1880, Jobs and Premium Protection Act H.R. 1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 2077, MLR Repeal Act of 2011 S. 1049, Small Business Health Relief Act of 2011

Client expense: $200,000 · Firm income: Not reported

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

H.R. 2, Repealing the Job-Killing Health Care Law Act H.R. 4, Small Business Paperwork Mandate Elimination Act of 2011 H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Protect Medical Innovation Act of 2011 H.R. 450, Restoring Assistance for Families and Seniors Health Expenses Act of 2011 H.R. 452, Medicare Decisions Accountability Act H.R. 605 / S. 312, Patients Freedom Choose Act H.R. 1051, Medicare Beneficiary Freedom to Choose Act of 2011 H.R. 1173 / S. 720, Fiscal Responsibility and Retirement Security Act of 2011 H.R. 1370 / S.1880, To repeal the annual fee on health insurance providers enacted by the Patient H.R. 1744 / S. 20, American Job Protection Act Protection and Affordable Care Act H.R. 2010, Family and Retirement Health Investment Act of 2011 H.R. 2077, MLR Repeal Act H.R. 2112, Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, Vitter Amendment (#769 - prescription drug reimportation) H.R. 2529 / S. 1368, Restoring Access to Medication Act H.R. 2590, Seniors Protection Act of 2011 H.R. 2676, Small Business Health Relief Act of 2011H.R. 4095 / S. 2002, The Online Pharmacy Safety Act H.R. 3682, Patient Centered Healthcare Savings Act of 2011 H.R. 4095 / S. 2002, Online Pharmacy Safety Act H.R. 4626, Health Insurance Fair Competition Act H.R. 5141/S. 3578, Small Business Paperwork Mandate Elimination Act H.R. 5842 / S.1368, Restoring Access to Medication Act H.R. 5858, Health Savings Accounts Improvements Act of 2012 H.R. 5651, Food and Drug Administration Reform Act of 2012 H.R. 5853, Fiscal Responsibility and Retirement Security Act S. 1049, Small Business Health Relief Act S. 17, Medical Device Access and Innovation Protection Act S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the Amendment offered by Senator McConnell to repeal P.L. 111-148, the Patient Protection and Affordable Care Act and an Amendment offered by Senator Stabenow which would repeal Section 9006 of the Patient Protection and Affordable Care Act S. 312, Patients Freedom to Choose Act S. 493, SBIR/STTR Reauthorization Act of 2011, including an Amendment offered by Senator Johanns which would fully repeal Section 9006 of the Patient Protection and Affordable Care Act and Amendment Number 197 offered by Senator Hutchison S. 510, FDA Food Safety Modernization Act, issues related to 1099 reporting amendments S. 668, Health Care Bureaucrats Elimination Act S. 720, Repeal the CLASS Entitlement Act S. 848, Consumer Information Enhancement Act of 2011 S. 1049, Small Business Health Relief Act S. 1098, Family and Retirement Health Investment Act of 2011 S. 1880, Jobs and Premium Protection Act S. 2068, Access to Independent Health Insurance Advisors Act of 2012 S. 2516, Food and Drug Administration Safety and Innovation Act including amendments related to company market exclusivity S. 3187, Food and Drug Administration Safety and Innovation Act including amendments related to company market exclusivity S. 3501, American Job Protection Act S. 3673, Patients Freedom Choice Act Filed comments and met with relevant agencies on regulations implementing health care reform (P.L. 111-148 and P.L. 111-152) Regulations commented on include: Medical Loss Ratio (MLR) Request for Information; Adult Child Coverage (Age 26) Interim Final Rule; Grandfathered Plan Status Interim Final Rule; Preexisting Condition Exclusion; Lifetime & Annual Limits; Rescissions; Patient Protections Interim Final Rule; Preventive Services Coverage Interim Final Rule; Internal Claims & Appeals and External Review Processes Interim Final Rule; Preexisting Condition Insurance Plan (PCIP) Interim Final Rule; 1099 Reporting Requirements Request for Comments; Planning and Establishment of State-level Exchanges Request for Comments; Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments; Essential Health Benefits (IOM Study); Amended Interim Final Rule for Grandfathered Plan Status; Guidance on OTC Medicine & Definition of Medical Expenses; Development of Health Risk Assessment; Medical Loss Ratio; Nondiscrimination in favor of Highly Compensated Individuals - second notice re: timing; DOL: Retrospective Review Under E.O. 13563; Treasury: Retrospective Review Under E.O. 13563; State Innovation Waivers; ACOs & Medicare Shared Savings Program; Shared Responsibility for Employers Regarding Health Coverage (Section 4980H); Amendment to the Interim Final Rule on Internal Claims and Appeals and External Review Processes; HIPAA Privacy Rule Accounting of Disclosures; Medical Data Sharing. Summary of benefits and Coverage and the Uniform Glossary; Exchange Functions in the Individual market; Health Insurance Premium Tax Credit; Establishment of Exchanges and Qualified Health Plans; Health Coverage Affordability Safe Harbor for Employers; Medical Loss Ratio (MLR) Requirements Final Rule; Medical Loss Ratio (MLR) Notice of Rebate Forms; Essential Health Benefits Bulletin - Response to Request for Comments; Establishment of Exchanges and Qualified Health Plans / Exchange Standards for Employers Final Rule and Interim Final Rule; FAQs from Employers Regarding Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods Request for Comments; Notice 2012-31 Minimum Value of an Employer-Sponsored Plan Request for Comments; Notice 2012-32 Reporting of Health Insurance Coverage Request for Comments; Notice 2012-33 Reporting by Applicable Large Employers on Health Insurance Coverage Under Employer-Sponsored Plans Request for Comments. Comprehensive health reform (bills in the Senate and House) including all aspects relating to coverage, financing, and delivery reform, including: 1099 reporting, Grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS Act, employer mandate, medical loss ratio, mandated insurance requirements, Exchanges, Medicare reform, regulatory reform, Essential Health Benefits Package, Health Insurance Tax, and the Medical Device Tax Various issues relating to the Patient Protection and Affordable Care Act (P.L. 111-148), including implementation of regulatory process, legislative corrections, coverage, financing, delivery reform, 1099 reporting, grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, employer mandate, medical loss ratio, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts; regulatory process and legislative corrections to Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152) including ERISA preemption and the impact on small business; importation of foreign pharmaceuticals into the United States

Client expense: $22,520,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Deposit Insurance Corporation (FDIC), Federal Highway Administration (FHA), Federal Reserve System, Federal Transit Administration (FTA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of the Comptroller of the Currency (OCC), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office

HR 2: Repealing the Job Killing Health Care Law Act; HR 5: Protecting Access to Healthcare Act; HR 369: Health Savings and Affordability Act of 2011; HR 436: Protect Medical Innovation Act of 2011; HR 605: Patients Freedom to Choose Act; HR 1206: Access to Professional Health Insurance Advisors Act; HR 1580: Medicare Beneficiary Preservation of Choice Act of 2011; HR 1744: American Job Protection Act; HR 2010: Family and Retirement Health Investment Act of 2011; HR 2077: MLR Repeal Act of 2011; HR 3239: SAFE Medicate Patient Act; HR 3586: The Good Samaritan Medical Professionals Act; S 20: American Job Protection Act; S 312: Patients Freedom to Choose Act; S 720: Repeal the CLASS Entitlement Act; S 2068: Access to Independent Health Insurance Advisors Act; S 2288: Access to Independent Health Insurance Advisors Act

Client expense: $330,000 · 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), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

H.R. 63, Long-Term Care Insurance Reform Act (Doggett) - LTC insurance reforms H.R. 111, Breast Cancer Patient Protection Act (DeLauro) - minimum hospital stays for mastectomy patients H.R. 346, Health Care Choice Act (Pearce ) - national marketplace for individual coverage H.R.371, Health Care Choice Act (Blackburn) - national marketplace for individual coverage H.R. 416, Health Insurance Rate Review Act (Schakowsky) - rate review H.R. 1050, Small Business Health Fairness Act (Johnson) - association health plans H.R. 1150, Competitive Health Insurance Reform Act (Gosar) - antitrust policy H.R.1206, Access to Professional Health Insurance Advisors Act (Rogers) - agent commissions, medical loss ratios H.R. 1943, Health Insurance Industry Fair Competition Act (DeFazio) - changes to McCarran-Ferguson Act H.R. 2077, MLR Repeal Act (Price) - medical loss ratios H.R. 2645, Medigap Medical Loss Ratio Improvement Act (Stark) - MLRs for Medigap policies H.R. 2958, Federal Employee Short-Term Disability Insurance Act (Holmes Norton) - disability program for federal employees H.R. 5838, Health Insurance Industry Antitrust Enforcement Act (Conyers) - changes to McCarran-Ferguson Act S. 137, Health Insurance Rate Review Act (Feinstein) - rate review S. 159, Confidence in Long-Term Care Insurance Act (Kohl) - LTC insurance reforms S. 1416, Medigap Medical Loss Ratio Improvement Act (Kerry) - MLRs for Medigap policies S. 1500, Ensure Children Have Health Care Act (Murkowski/Enzi) - enrollment period for child-only policies S. 2068, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) - agent commissions, medical loss ratios S. 2288, Access to Independent Health Insurance Advisors Act (Landrieu/Isakson) - agent commissions, medical loss ratios S. 3229, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) -- model disclosure form for marketing long-term care insurance policies S. 3230, Long-Term Care Integrity Act (Klobuchar) -- claims dispute resolution procedures S. 3271, Equal Access to Medicare Options Act (Kerry) - Medigap provisions, MA enrollment provisions

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 2 Repealing the Job-Killing Health Care Law Act; HR 4 Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act; HR 1063 Strengthening Medicare and Repaying Taxpayers Act; S. 18 Small Business Paperwork Mandate Elimination Act; S. 19 American Liberty Restoration Act; S. 20/H.R. 1744 American Job Protection Act; Affordable Care Act, all provisions; S. 192 Repealing the Job-Killing Health Care Law Act; S. 312 Patients Freedom to Choose Act; Health Care Reform; Health Care Mandate Penalties; Employer/Employee Flexibility; Consumer-Directed Health Care; Health Insurance Exchanges; Medicare Secondary Payer Judgments; Comments on FDA's Suggested Questions & Answers for the Final Patient Protection & Affordable Care Act Section 4205 Guidance; Comments on IRS' "Shared Responsibility for Employers Regargding Health Care Coverage (IRC Sec. 1513)"; H.R.1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act, all provisions; H.R.2077, MLR Repeal Act of 2011, all provisions; S.1098, Family and Retirement Health Investment Act of 2011, all provisions; H.R.5/S.1099, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011, all provisions; H.R.1206, Access to Professional Health Insurance Advisors Act of 2011, all provisions; Summary of Benefit NRPM; Comments regarding employer interactions with insurance exchanges, health premium tax credits, and development of an affordability safe harbor for employers; S.1880, Jobs and Premium Protection Act, all provisions; S.1049/H.R. 2676, Small Business Health Relief Act of 2011, all provisions; H.R.2206, Auto Enroll Repeal Act, all provisions.

Client expense: $1,070,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Deposit Insurance Corporation (FDIC), Federal Motor Carrier Safety Administration, Federal Reserve System, Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Natl Telecommunications & Information Administration (NTIA), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Treasury, Dept of, U.S. Customs & Border Protection, U.S. International Trade Commission (ITC), U.S. Trade Representative (USTR), White House Office

Insurance Market Reform General Issues; PL 111-148 "good faith compliance standard" of HCR Implementation S. 3078/ HR 4757 Rate Authority Act State Based Regulations: Exchanges/Sales Across State Lines HR 371 MLR - Medical Loss Ratio: HR 1206 Access to Professional Health Insurance Advisors Act: MLR Repeal Act HR 2077 IPAB - Medicare Decisions Accountability Act of 2011 HR 452 State Innovation Waivers / Consistent Reporting Requirements Healthcare Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-Centered Primary/Medical Home; Wellness/Health Disparities; Childhood Obesity; Infant Mortality Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

*LTC insurance reforms - HR 63, Long-Term Care Insurance Reform Act of 2011; S 159, Confidence in Long-Term Care Insurance Act of 2011. *Minimum hospital stays for matectomy patients - HR 111, Breast Cancer Patient Protection Act of 2011. *National marketplace for individual coverage - HR 346, Health Care Choice Act of 2011; HR 371, Health Care Choice Act of 2011. *Rate review - HR 416, Health Insurance Rate Review Act; S 137, Health Insurance Rate Review Act. *Association health plans - HR 1050, Small Business Health Fairness Act of 2011. *Antitrust policy - HR 1150, Competitive Health Insurance Reform Act of 2011. *Changes to McCarran-Ferguson Act - HR 1943, Health Insurance Industry Fair Competition Act; HR 5838, Health Insurance Industry Antitrust Enforcement Act of 2012. *Medical loss ratios - HR 2077, MLR Repeal Act of 2011. *MLRs for Medigap policies - HR 2645, Medigap Medical Loss Ratio Improvement Act; S 1416, Medigap Medical Loss Ratio Improvement Act of 2011. *Disability program for Federal employees - HR 2958, Federal Employee Short-Term Disability Insurance Act of 2011. *Enrollment period for child-only policies - S 1500, Ensure Children Have Health Care Act. *Agent commissions, medical loss ratios - HR 1206, Access to Professional Health Insurance Advisors Act of 2011; S 2068, Access to Independent Health Insurance Advisors Act of 2012; S 2288, Access to Independent Health Insurance Advisors Act of 2012. *Model disclosure form for marketing long-term care insurance policies - S 3229, Long-Term Care Insurance Consumer Right-to-Know Act of 2012. *Claims dispute resolution procedures - S 3230, Long Term Care Insurance Integrity Act of 2012. *Medigap provisions, MA enrollment provisions - S 3271, Equal Access to Medicare Options Act of 2012.

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

Government targets: HOUSE OF REPRESENTATIVES

Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace. (no bill) Discussed barriers to care that can result from language differences between providers and patients and/or lack of translation services. (no bill) Lobbied on preserving fund for the ACA; defended meaningful use of the ACA. (no bill) Discussed need to increase health information technology quality measurements and access to qualified systems. (no bill) S. 1019, Hearing Aid Assistance Tax Credit Act - Discussed Hearing Aid Assistance Tax Credit Act which would provide a $500 credit to people of all ages. H.R. 217, To repeal the Prevention and Public Health Fund - Lobbied against the repeal of the Prevention and Public Health Trust Fund. This fund is an important component in state and community efforts to prevent illness and promote health. Discussed Pre-existing Condition Insurance Program. (no bill) Discussed Accountable Care Organization and Medical Shared savings. (no bill) Discussed Rate Review. (no bill) Discussed Internal Appeals and External Review Process. (no bill) Discussed Medicare reimbursement issues. Lobbied in support of Medicare physician payment reform. Discussed legislation to make prescription drugs more affordable to older Americans. S. 159/H.R. 63, Discussed the Confidence in Long-Term Care Insurance Act/Long-Term Insurance Reform Act which improves the consumer protections of LTC insurance policies and make more and better information available to consumers to help them make informed decisions about such policies. S. 1416/H.R. 2645, Medigap Medical Loss Ratio Improvement Act - Lobbied for bill introduction and helped with crafting. Discussed Internal Claims, Appeals and external Review Process. (no bill) Discussed HIPAA Privacy Rule Accounting under HITECH Act. (no bill) Discussed coverage for screening depression and screening and counseling for alcohol misuse. (no bill) Discussed consumer operated and oriented plan programs. (no bill) Discussed standards related to risk adjustment, reinsurance, and risk mitigation as they relate to exchanges. (no bill) H.R.2077, MLR Repeal Act of 2011 - Expressed opposition to the elimination of provision in the Affordable Care Act (P.L. 111-148)Discussed opposition to draft legislation regarding the elimination of grandfathered status. (no bill) Discussed association health plans with DOL, HHS and DOT. (no bill) Discussed quality and care coordination with HHS. (no bill) Discussed Essential Health Benefits with HHS. (no bill) Discussed employer affordability safe harbor. (no bill) Discussed health insurance exchanges - eligibility, enrollment, premium tax credits. (no bill) Discussed Basic Health Plans. (no bill) Discussed Medigap reform. (no bill) Discussed Pre-existing Condition Insurance Program. (no bill) Discussed role of grandfathered plans. (no bill) Discussed status of the CLASS Program. (no bill) Discussed opposition to repeal of the CLASS Program (no bill, but also as S. 720, the Repeal the CLASS Entitlement Act. Discussed opposition to H.R. 1173, the Fiscal Responsibility and Retirement Security Act, to repeal the CLASS Program and shared stories and information related to long-term services and supports. Discussed reauthorization of the Older Americans Act and other amendments to the OAA. (no bill) Discussed cost effectiveness of home and community-based services. (no bill) Discussed dual eligibles with Medpac. (no bill) S.3295, the Labor-HHS Appropriations bill for FY 2013 - Lobbied to protect/increase funding for the Social Security Administration, Older Americans Act nutrition, family caregiver & supportive services programs, low income home energy assistance (LIHEAP), and to protect funding for program authorized under the Affordable Care Act, including CMS State Health insurance exchanges, state survey & demonstrations and preventive Care Act, including CMS State Health insurance exchanges, state survey and demonstrations and preventive health. Discussed Hospital & Critical Access Hospitals Conditions of Participation proposed regulations; requested that advanced practice registered nurses and physicians assistants be allowed the full scope of services in hospital admitting and visiting privileges. (no bill) Discussed Hospital Outpatient Therapeutic Services Final Rule underscoring that advanced practice registered nurses and physicians should be allowed to supervise such outpatient service clinics without physician oversight as long as in line with state scope of practice laws. (no bill) Discussed Medicare GNE demonstration design problems. Discussed inviting FTC to participate in a webinar on how they are and can be engaged on state scope of practice issues. Also sent follow-up items for their review. (no bill) Discussed legislation to make long-term care insurance available under cafeteria plans and flexible spending arrangements and to improve consumer protections. (no bill) Discussed Medicare and Social Security programs. (no bill)

Client expense: $2,740,000 · Firm income: Not reported

Government targets: Administration on Aging, Agriculture, Dept of (USDA), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Comptroller of the Currency (OCC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act (H.R.4) Access to Independent Health Insurance Advisors Act (S.2068/S.2288) Access to Professional Health Insurance Advisors Act of 2011 (H.R.1206) Draft Legislation to Prevent Enforcement of Grandfathered Health Plan Regulation Draft Research Priorities (PCORI) EMS Quality, Innovation, and Cost Effectiveness Improvements Act of 2011 (H.R.3144) Food and Drug Administration Safety and Innovation Act (FDA User Fee bills, S.3187/H.R.3988) Guidance on Defining Minimum Essential Value of Employer-Sponsored Insurance (Treasury) Guidance on Federally Facilitated Exchanges (HHS) Health Care Cost Reduction Act (H.R.436) Health Equity and Accountability Act (H.R.2954/S.2474) Health Risk Assessments in Medicare Comments (CDC) Heart Disease Education, Analysis and Research, and Treatment for Women Act (HEART for Women Act) (S.438/H.R.3526) H.R. 436, Health Care Cost Reduction Act Interest Rate Reduction Act (H.R.4628/S.2366) and other legislation using Prevention Fund to offset student loans Josh Miller Helping Everyone Access Responsive Treatment in Schools (HEARTS) Act (H.R.1377) Menu Labeling (ACA Section 4205) Middle Class Tax Relief and Job Promotion Act (H.R.3630) National Prevention Strategy, Request for Comments (HHS - Surgeon General) Patient Protection and Affordable Care Act (P.L. 111-148; P.L. 111-152) - Implementation Prevention and Public Health Fund (ACA Section 4002) Repealing the Job-Killing Health Care Law Act (H.R.2) Sequester Replacement Reconciliation Act (H.R.5652) State Flexibility Act (H.R.1683/S.868) To Repeal Mandatory Funding Provided to States in the Patient Protection and Affordable Care Act to Establish American Health Benefit Exchanges (H.R.1213) Temporary Payroll Tax Cut Continuation Act (H.R.3630 - Medicare therapy caps exceptions process) To Repeal Mandatory Funding to States to Establish American Health Benefit Exchanges (H.R.1213) To Repeal Medical Loss Ratio Requirements (H.R.2077) To Repeal the Prevention and Public Health Fund (H.R.1217) Transcatheter Atrial Septal Defect Occluders (FDA-2011-N-001)

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

Affordable Health Insurance Provisions Related to PL 111-148: health insurance tax; connection between individual mandate and insurance reforms (guaranteed issue and community rating); Medical Loss Ratio: HR 2077 the "MLR Repeal Act of 2011"; State-Based Regulations: state health insurance exchanges and implementation efforts, selling health insurance across state lines

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2, Repealing the Job-Killing Health Care Law Act H.R. 4, Small Business Paperwork Mandate Elimination Act of 2011 H.R. 5, Protecting Access to Healthcare Act, including issues related to Med Malpractice and IPAB Reform H.R. 436, Protect Medical Innovation Act of 2011 H.R. 450, Restoring Assistance for Families' and Seniors' Health Expenses Act of 2011 H.R. 452, Medicare Decisions Accountability Act of 2011 H.R. 605 / S. 312, Patients Freedom Choose Act H.R. 1051, Medicare Beneficiary Freedom to Choose Act of 2011 H.R. 1173 / S. 720, Fiscal Responsibility and Retirement Security Act of 2011 H.R. 1370, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 1744 / S. 20, American Job Protection Act H.R. 2010, Family and Retirement Health Investment Act of 2011 H.R. 2077, MLR Repeal Act of 2011 H.R. 2112, Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, Vitter Amendment (#769 - prescription drug reimportation) H.R. 2529 / S. 1368, Restoring Access to Medication Act H.R. 2590, Seniors Protection Act of 2011 H.R. 2676, Small Business Health Relief Act of 2011 H.R. 3682, Patient Centered Healthcare Savings Act of 2011 H.R. 4095 / S. 2002, Online Pharmacy Safety Act H.R. 4626, Health Insurance Fair Competition Act H.R. 4853, Middle Class Tax Act of 2010 H.R. 5141/S. 3578, Small Business Paperwork Mandate Elimination Act H.R. 5853, Fiscal Responsibility and Retirement Security Act S. 17, Medical Device Access and Innovation Protection Act S. 223, FAA Air Transportation Modernization and Safety Improvement Act, including the Amendment offered by Senator McConnell to repeal P.L. 111-148, the Patient Protection and Affordable Care Act and an Amendment offered by Senator Stabenow which would repeal Section 9006 of the Patient Protection and Affordable Care Act S. 312, Patients Freedom to Choose Act S. 493, SBIR/STTR Reauthorization Act of 2011, including an Amendment offered by Senator Johanns which would fully repeal Section 9006 of the Patient Protection and Affordable Care Act and Amendment Number 197 offered by Senator Hutchison S. 510, FDA Food Safety Modernization Act, issues related to 1099 reporting amendments S. 668, Health Care Bureaucrats Elimination Act S. 720, Repeal the CLASS Entitlement Act S. 848, Consumer Information Enhancement Act of 2011 S. 1049, Small Business Health Relief Act S. 1098, Family and Retirement Health Investment Act of 2011 S. 1880, Jobs and Premium Protection Act S. 2068, Access to Independent Health Insurance Advisors Act of 2012 S. 3501, American Job Protection Act S. 3673, Patients Freedom Choice Act Filed comments and met with relevant agencies on regulations implementing health care reform (P.L. 111-148 and P.L. 111-152) Regulations commented on include: Medical Loss Ratio (MLR) Request for Information; Adult Child Coverage (Age 26) Interim Final Rule; Grandfathered Plan Status Interim Final Rule; Preexisting Condition Exclusion; Lifetime & Annual Limits; Rescissions; Patient Protections Interim Final Rule; Preventive Services Coverage Interim Final Rule; Internal Claims & Appeals and External Review Processes Interim Final Rule; Preexisting Condition Insurance Plan (PCIP) Interim Final Rule; 1099 Reporting Requirements Request for Comments; Planning and Establishment of State-level Exchanges Request for Comments; Non-Discrimination in Favor of Highly Compensated Individuals Request for Comments; Essential Health Benefits (IOM Study); Amended Interim Final Rule for Grandfathered Plan Status; Guidance on OTC Medicine & Definition of Medical Expenses; Development of Health Risk Assessment; Medical Loss Ratio; Nondiscrimination in favor of Highly Compensated Individuals - second notice re: timing; DOL: Retrospective Review Under E.O. 13563; Treasury: Retrospective Review Under E.O. 13563; State Innovation Waivers; ACOs & Medicare Shared Savings Program; Shared Responsibility for Employers Regarding Health Coverage (Section 4980H); Amendment to the Interim Final Rule on Internal Claims and Appeals and External Review Processes; HIPAA Privacy Rule Accounting of Disclosures; Medical Data Sharing. Summary of benefits and Coverage and the Uniform Glossary; Exchange Functions in the Individual market; Health Insurance Premium Tax Credit; Establishment of Exchanges and Qualified Health Plans; Health Coverage Affordability Safe Harbor for Employers; Medical Loss Ratio (MLR) Requirements Final Rule; Medical Loss Ratio (MLR) Notice of Rebate Forms Comprehensive health reform (bills in the Senate and House) - all aspects relating to coverage, financing, and delivery reform, including: 1099 reporting, Grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS Act, employer mandate, medical loss ratio, mandated insurance requirements, Exchanges, Medicare reform, regulatory reform, Essential Health Benefits Package, Health Insurance Tax; Medical Device Tax Various issues relating to the Patient Protection and Affordable Care Act (P.L. 111-148), including: implementation of, regulatory process, legislative corrections, coverage, financing, delivery reform, 1099 reporting, Grandfathering, HSA and FSA changes, CMS claims database, IPAB, CLASS program, employer mandate, medical loss ratio, medical malpractice reform, exchanges, and flexible spending accounts and health savings accounts. Various issues relating to the regulatory process and legislative corrections to Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152); ERISA preemption; impact on small business

Client expense: $20,200,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of the Comptroller of the Currency (OCC), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office