Medicare Mental Health Inpatient Equity Act of 2011

1. Medicare Physician Fee Schedule - AAGP urges Congress to replace the current Medicare reimbursement formula with one that more accurately reflects the volume and intensity of services furnished to Medicare beneficiaries and to take action to avert future cuts in Medicare payments to physicians and other health care providers. AAGP also urges Congress to take action to avert all proposed reductions in Medicare physician reimbursements scheduled to take effect on January 1, 2013. 2. Support S. 374 and H.R. 2783, the "Medicare Mental Health Inpatient Equity Act," to amend Title XVIII (Medicare) of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services. 3. Oppose proposals to shift Medicaid costs to states and families via block grants or overall caps on spending. 4. Oppose any Federal budget or funding agreement that would significantly cut, block grant, or impose harmful spending caps on the Medicaid program with special concern for persons with mental disorders, including senior citizens, who rely on Medicaid as a lifeline. 5. Oppose any cuts in Medicare or Medicaid programs that would adversely impact children and adults with behaviroral health disorders. 6. Support all efforts to ensure that any CMS demonstration programs for beneficiaries that are concurrently eligible for both Medicare and Medicaid ("dual eligibles"") provide protections for all dual eligibles with mental disorders, including access to existing provider networks, passive enrollment processes, retention of current Medicare protections and relevant quality measures. 7. Urge strong Congressional oversight of the implementation of demonstration programs under Section 2602 of the "Affordable Care Act" to ensure that these proposals contain critical protections for dually eligible (Medicare and Medicaid) individuals with mental illness. 8. Oppose the sections on review and reporting of antipsychotics, informed consent, and an IOM study and report (sections 4, 5, and 7) of S.3604, the "Improving Dementia Care Treatment for Older Adults Act of 2012". 9. Support a GAO study on the use of antipsychotic medications by nursing homes.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 and HR 2783 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 1398 Rural Hospital Protection Act, legislation which would amend the Social Security Act to ensure that the full cost of certain provider taxes are considered allowable costs for purposes of Medicare reimbursements to CAHs; S 1486 Long-Term Care Hospital Improvement Act of 201, a bill to amend title XVIII of the Social Security Act to clarify and expand on criteria applicable to patient admission to and care furnished in long-term care hospitals participating in the Medicare program; Raising concerns about CMS flawed methodology that overstates the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to improve the regulation to implement ACOs; Urging CMS to update, streamline, and modernize the Medicare conditions of participation; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expired in September 2011, and the bills would reauthorize the CHGME program for an additional five years, through fiscal year (FY) 2016, at the current authorization level of up to $330 million a year; HR 1683/ S 868 Medicaid MOE, strikes provisions of ACA related to maintaining Medicaid eligibility levels; HR 1543 Improving Access to Medicare Coverage Act of 2011, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare; S 1251Medicare and Medicaid FAST Act, a bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs; HR 2500 Equal Access and Parity for Multi-Campus Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 2674 340B Program Improvement Act, a bill to amend section 340B of the Public Health Service Act to improve the provision of discounts on drug purchases for certain safety net providers; HR 3630 Temporary Payroll Tax Cut Continuation Act of 2011 or Middle Class Tax Relief and Job Creation Act of 2011, a bill that cuts hospitals to pay for the doc fix, it contains the Social Security payroll tax cut and the Unemployment Insurance extension; HR 3519 a bill to amend and exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011; S. 1680 Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act of 2011, a bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program; Letter to Rehberg and DeLauro in support of the CHGME program that was circulated by Reps. Capps and Bilbray; Wyden/Crapo letter to CMS to actively oppose a Senate Dear Colleague letter to CMS in support of updating Medicare payments to ambulatory surgery centers (ASCs). The letter did not request a payment update for ASCs. Rather, the letter advocated against the Medicare payment rate for services provided in hospital outpatient department settings; HR 2954 and S 2474 Health Equity and Accountability Act of 2011, Comprehensive bill focused on eliminating racial and ethnic disparities in health care through improved data collection and reporting, culturally and linguistically-appropriate health care, workforce diversity, health information technology, and other actions; Discussions with the Administration (CMS) on applying the therapy cap to hospital outpatient departments; Worked to change CMS definition of allowed EHR costs for CAH Meaningful Use incentive payments to include capital lease purchases of EHRs; HR 3859 Rural Hospital and Provider Equity (R-HOPE) Act of 2012, to amend title XVIII of the SSA to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program; HR 4245 Veterans Co-Pay Fairness Act, to amend title 38, United States Code, to require the Secretary of Veterans Affairs to reimburse eligible veterans who are entitled to Medicare benefits for Medicare deductibles and other expenses that are owed by the veterans for emergency medical treatment provided in non-Department of Veterans affairs facilities; S 2620 and HR 5943 Rural Hospital Access Act of 2012, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; S 3187 and HR 5651Prescription Drug User Fee Amendments of 2012, a bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs and medical devices, to establish user-fee programs for generic drugs and biosimilars.

Medicare: H.R. 831/S. 483: Medicare Mental Health Access Act S. 374/H.R. 2783: Medicare Mental Health Inpatient Equity Act H.R. 452/S. 668: Medicare Decisions Accountability Act H.R. 3630: Middle Class Tax Relief and Job Creation Act of 2012

Client expense: $106,177 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. Medicare Physician Fee Schedule - AAGP urges Congress to replace the current Medicare reimbursement formula with one that more accurately reflects the volume and intensity of services furnished to Medicare beneficiaries and to take action to avert future cuts in Medicare payments to physicians and other health care providers. AAGP also urges Congress to take action to avert all proposed reductions in Medicare physician reimbursements scheduled to take effect on January 1, 2013. 2. Support S. 374 and H.R. 2783, the "Medicare Mental Health Inpatient Equity Act," to amend Title XVIII (Medicare) of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services. 3. Oppose proposals to shift Medicaid costs to states and families via block grants or overall caps on spending. 4. Oppose any Federal budget or funding agreement that would significantly cut, block grant, or impose harmful spending caps on the Medicaid program with special concern for persons with mental disorders, including senior citizens, who rely on Medicaid as a lifeline. 5. Oppose any cuts in Medicare or Medicaid programs that would adversely impact children and adults with behaviroral health disorders. 6. Support all efforts to ensure that any CMS demonstration programs for beneficiaries that are concurrently eligible for both Medicare and Medicaid ("dual eligibles"") provide protections for all dual eligibles with mental disorders, including access to existing provider networks, passive enrollment processes, retention of current Medicare protections and relevant quality measures. 7. Urge strong Congressional oversight of the implementation of demonstration programs under Section 2602 of the "Affordable Care Act" to ensure that these proposals contain critical protections for dually eligible (Medicare and Medicaid) individuals with mental illness. 8. Oppose the sections on review and reporting of antipsychotics, informed consent, and an IOM study and report (sections 4, 5, and 7) of S.3604, the "Improving Dementia Care Treatment for Older Adults Act of 2012". 9. Support a GAO study on the use of antipsychotic medications by nursing homes.

HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 and HR 2783 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 1398 Rural Hospital Protection Act, legislation which would amend the Social Security Act to ensure that the full cost of certain provider taxes are considered allowable costs for purposes of Medicare reimbursements to CAHs; S 1486 Long-Term Care Hospital Improvement Act of 201, a bill to amend title XVIII of the Social Security Act to clarify and expand on criteria applicable to patient admission to and care furnished in long-term care hospitals participating in the Medicare program; Raising concerns about CMS flawed methodology that overstates the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to improve the regulation to implement ACOs; Urging CMS to update, streamline, and modernize the Medicare conditions of participation; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expired in September 2011, and the bills would reauthorize the CHGME program for an additional five years, through fiscal year (FY) 2016, at the current authorization level of up to $330 million a year; HR 1683/ S 868 Medicaid MOE, strikes provisions of ACA related to maintaining Medicaid eligibility levels; HR 1543 Improving Access to Medicare Coverage Act of 2011, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare; S 1251Medicare and Medicaid FAST Act, a bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs; HR 2500 Equal Access and Parity for Multi-Campus Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 2674 340B Program Improvement Act, a bill to amend section 340B of the Public Health Service Act to improve the provision of discounts on drug purchases for certain safety net providers; HR 3630 Temporary Payroll Tax Cut Continuation Act of 2011 or Middle Class Tax Relief and Job Creation Act of 2011, a bill that cuts hospitals to pay for the doc fix, it contains the Social Security payroll tax cut and the Unemployment Insurance extension; HR 3519 a bill to amend and exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011; S. 1680 Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act of 2011, a bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program; Letter to Rehberg and DeLauro in support of the CHGME program that was circulated by Reps. Capps and Bilbray; Wyden/Crapo letter to CMS to actively oppose a Senate Dear Colleague letter to CMS in support of updating Medicare payments to ambulatory surgery centers (ASCs). The letter did not request a payment update for ASCs. Rather, the letter advocated against the Medicare payment rate for services provided in hospital outpatient department settings; HR 2954 Health Equity and Accountability Act of 2011, Comprehensive bill focused on eliminating racial and ethnic disparities in health care through improved data collection and reporting, culturally and linguistically-appropriate health care, workforce diversity, health information technology, and other actions; Discussions with the Administration (CMS) on applying the therapy cap to hospital outpatient departments; Worked to change CMS definition of allowed EHR costs for CAH Meaningful Use incentive payments to include capital lease purchases of EHRs; HR 3859 Rural Hospital and Provider Equity (R-HOPE) Act of 2012, to amend title XVIII of the SSA to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program. HR 4245 Veterans Co-Pay Fairness Act, to amend title 38, United States Code, to require the Secretary of Veterans Affairs to reimburse eligible veterans who are entitled to Medicare benefits for Medicare deductibles and other expenses that are owed by the veterans for emergency medical treatment provided in non-Department of Veterans Affairs facilities; S 2620 and HR 5943 Rural Hospital Access Act of 2012, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; S 3187 and HR 5651Prescription Drug User Fee Amendments of 2012, a bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs and medical devices, to establish user-fee programs for generic drugs and biosimilars.

Medicare: H.R. 831/S. 483: Medicare Mental Health Access Act S. 374/H.R. 2783: Medicare Mental Health Inpatient Equity Act H.R. 452/S. 668: Medicare Decisions Accountability Act H.R. 3630: Middle Class Tax Relief and Job Creation Act of 2012

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. Medicare Physician Fee Schedule - AAGP urges Congress to replace the current Medicare reimbursement formula with one that more accurately reflects the volume and intensity of services furnished to Medicare beneficiaries and to take action to avert future cuts in Medicare payments to physicians and other health care providers. AAGP also urges Congress to take action to avert all proposed reductions in Medicare physician reimbursements. 2. Support S. 374 and H.R. 2783, the "Medicare Mental Health Inpatient Equity Act," to amend Title XVIII (Medicare) of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services. 3. Oppose proposals to shift Medicaid costs to states and families via block grants or overall caps on spending. 4. Oppose any Federal budget or funding agreement that would significantly cut, block grant, or impose harmful spending caps on the Medicaid program with special concern for persons with mental disorders, including senior citizens, who rely on Medicaid as a lifeline. 5. Oppose any cuts in Medicare or Medicaid programs that would adversely impact children and adults with behaviroral health disorders. 6. Support all efforts to ensure that any CMS demonstration programs for beneficiaries that are concurrently eligible for both Medicare and Medicaid ("dual eligibles"") provide protections for all dual eligibles with mental disorders, including access to existing provider networks, passive enrollment processes, retention of current Medicare protections and relevant quality measures.

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

HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 and HR 2783 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 1398 Rural Hospital Protection Act, legislation which would amend the Social Security Act to ensure that the full cost of certain provider taxes are considered allowable costs for purposes of Medicare reimbursements to CAHs; S 1486 Long-Term Care Hospital Improvement Act of 201, a bill to amend title XVIII of the Social Security Act to clarify and expand on criteria applicable to patient admission to and care furnished in long-term care hospitals participating in the Medicare program; Raising concerns about CMS flawed methodology that overstates the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to improve the regulation to implement ACOs; Urging CMS to update, streamline, and modernize the Medicare conditions of participation; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expired in September 2011, and the bills would reauthorize the CHGME program for an additional five years, through fiscal year (FY) 2016, at the current authorization level of up to $330 million a year; HR 1683/ S 868 Medicaid MOE, strikes provisions of ACA related to maintaining Medicaid eligibility levels; HR 1543 Improving Access to Medicare Coverage Act of 2011, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare; S 1251Medicare and Medicaid FAST Act, a bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs; HR 2500 Equal Access and Parity for Multi-Campus Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 2674 340B Program Improvement Act, a bill to amend section 340B of the Public Health Service Act to improve the provision of discounts on drug purchases for certain safety net providers; HR 3630 Temporary Payroll Tax Cut Continuation Act of 2011 or Middle Class Tax Relief and Job Creation Act of 2011, a bill that cuts hospitals to pay for the doc fix, it contains the Social Security payroll tax cut and the Unemployment Insurance extension; HR 3519 a bill to amend and exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011; S. 1680 Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act of 2011, a bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program; Letter to Rehberg and DeLauro in support of the CHGME program that was circulated by Reps. Capps and Bilbray; Wyden/Crapo letter to CMS to actively oppose a Senate Dear Colleague letter to CMS in support of updating Medicare payments to ambulatory surgery centers (ASCs). The letter did not request a payment update for ASCs. Rather, the letter advocated against the Medicare payment rate for services provided in hospital outpatient department settings; HR 2954 Health Equity and Accountability Act of 2011, Comprehensive bill focused on eliminating racial and ethnic disparities in health care through improved data collection and reporting, culturally and linguistically-appropriate health care, workforce diversity, health information technology, and other actions; Discussions with the Administration (CMS) on applying the therapy cap to hospital outpatient departments; Worked to change CMS definition of allowed EHR costs for CAH Meaningful Use incentive payments to include capital lease purchases of EHRs; HR 3859 Rural Hospital and Provider Equity (R-HOPE) Act of 2012, to amend title XVIII of the SSA to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program.

Medicare: H.R. 831/S. 483: Medicare Mental Health Access Act S. 374/H.R. 2783: Medicare Mental Health Inpatient Equity Act H.R. 452/S. 668: Medicare Decisions Accountability Act H.R. 3630: Middle Class Tax Relief and Job Creation Act of 2012

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. Medicare Physician Fee Schedule - AAGP urges Congress to replace the current Medicare reimbursement formula with one that more accurately reflects the volume and intensity of services furnished to Medicare beneficiaries and to take action to avert future cuts in Medicare payments to physicians and other health care providers. AAGP also urges Congress to take action to avert all proposed reductions in Medicare physician reimbursements. 2. Support S. 374 and H.R. 2783, the "Medicare Mental Health Inpatient Equity Act," to amend Title XVIII (Medicare) of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services. 3. Oppose proposals to shift Medicaid costs to states and families via block grants or overall caps on spending. 4. Oppose any Federal budget agreement that would significantly cut, block grant, or impose harmful spending caps on the Medicaid program with special concern for persons with mental disorders, including senior citizens, who rely on Medicaid as a lifeline. 5. Oppose any cuts in Medicare or Madicaid programs that would adversely impact children and adults with behaviroral health disorders.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

House FY 12 Budget (H.Con.Res. 34) Mental Health in Schools Act (H.R. 751) Medicaid Maintenance-Of-Effort Repeal (H.R.1683/S. 868) Behavioral Health Information Technology Act of 2011 (S. 539) Healthy Lifestyles and Prevention America Act (S.174) Medicare Mental Health Access Act (S.483) Seniors Mental Health Access Improvement Act of 2011 (S.604) Medicare Mental Health Inpatient Equity Act of 2011 (S.374/H.R.2783) CAP Act of 2011 (H.R. 1605/S. 245) Constitutional Balanced Budget Amendment (H.J.Res. 1/S.J.Res. 23) Mental Health on Campus Improvement Act, H.R. 1833 Medicare Decisions Accountability Act of 2011 (HR 452/S 668) Cap, Cut and Balance Bill (HR 2560/S. 1340) Health Equity and Accountability Act of 2011 (H.R.2954) Continuing Appropriations Act, 2012 (HR 2608) Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2012 (S.1599/H.R.3070) Medigap Medical Loss Ratio Improvement Act (S.1416/H.R.2645) Improving Access to Medicare Coverage Act of 2011 (S.818) Consolidated FY2012 Appropriations Act (was Military/Veterans; HR 2055)

Client expense: Not reported · Firm income: Not reported

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

HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 and HR 2783 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 1398 Rural Hospital Protection Act, legislation which would amend the Social Security Act to ensure that the full cost of certain provider taxes are considered allowable costs for purposes of Medicare reimbursements to CAHs; S 1486 Long-Term Care Hospital Improvement Act of 201, a bill to amend title XVIII of the Social Security Act to clarify and expand on criteria applicable to patient admission to and care furnished in long-term care hospitals participating in the Medicare program; Raising concerns about CMS flawed methodology that overstate the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to improve the regulation to implement ACOs; Urging CMS to update, streamline, and modernize the Medicare conditions of participation; Sessions Crowley and Stabenow-Murkowski IPPS letter requesting fixes to the coding offset circulated for signature; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expires in September, and the bills would reauthorize the CHGME program for an additional five years, through fiscal year (FY) 2016, at the current authorization level of up to $330 million a year; HR 1683/ S 868 Medicaid MOE, strikes provisions of ACA related to maintaining Medicaid eligibility levels; HR 1543 Improving Access to Medicare Coverage Act of 2011, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare; S 1251Medicare and Medicaid FAST Act, a bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs; HR 2500 Equal Access and Parity for Multi-Campus Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 2674 340B Program Improvement Act, a bill to amend section 340B of the Public Health Service Act to improve the provision of discounts on drug purchases for certain safety net providers; HR 3630 Temporary Payroll Tax Cut Continuation Act of 2011 or Middle Class Tax Relief and Job Creation Act of 2011, a bill that cuts hospitals to pay for the doc fix, it contains the Social Security payroll tax cut and the Unemployment Insurance extension; HR 3519 a bill to amend and exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011; S. 1680 Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act of 2011, a bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program.

1. Medicare Physician Fee Schedule - AAGP urges Congress to replace the current Medicare reimbursement formula with one that more accurately reflects the volume and intensity of services furnished to Medicare beneficiaries and to take action to avert future cuts in Medicare payments to physicians and other health care providers. AAGP also urges Congress to take action to avert all proposed reductions in Medicare physician reimbursements. 2. Support S. 374 and H.R. 2783, the "Medicare Mental Health Inpatient Equity Act," to amend Title XVIII (Medicare) of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services. 3. Oppose proposals to shift Medicaid costs to states and families via block grants or overall caps on spending. 4. Oppose any Federal budget agreement that would significantly cut, block grant, or impose harmful spending caps on the Medicaid program with special concern for persons with mental disorders, including senior citizens, who rely on Medicaid as a lifeline. 5. Oppose any cuts in Medicare or Madicaid programs that would adversely impact children and adults with behaviroral health disorders. 6. Urge membert of the Joint Select Committee on Deficit Reduction to ensure that "dual eligibles" - who qualify for for Medicare because of age or disability and for Medicaid because of low incomes - are not adversely impacted in efforts to reduce the Federal budget.

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

HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 and HR 2783 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 1398 Rural Hospital Protection Act, legislation which would amend the Social Security Act to ensure that the full cost of certain provider taxes are considered allowable costs for purposes of Medicare reimbursements to CAHs; S 1486 Long-Term Care Hospital Improvement Act of 201, a bill to amend title XVIII of the Social Security Act to clarify and expand on criteria applicable to patient admission to and care furnished in long-term care hospitals participating in the Medicare program; Raising concerns about CMS flawed methodology that overstate the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to improve the regulation to implement ACOs; Urging CMS to update, streamline, and modernize the Medicare conditions of participation; Sessions Crowley and Stabenow-Murkowski IPPS letter requesting fixes to the coding offset circulated for signature; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expires in September, and the bills would reauthorize the CHGME program for an additional five years, through fiscal year (FY) 2016, at the current authorization level of up to $330 million a year; HR 1683/ S 868 Medicaid MOE, strikes provisions of ACA related to maintaining Medicaid eligibility levels; HR 1543 Improving Access to Medicare Coverage Act of 2011, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare; S 1251Medicare and Medicaid FAST Act, a bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs; HR 2500 Equal Access and Parity for Multi-Campus Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 2674 340B Program Improvement Act, a bill to amend section 340B of the Public Health Service Act to improve the provision of discounts on drug purchases for certain safety net providers.

1. Medicare Physician Fee Schedule - AAGP urges Congress to replace the current Medicare reimbursement formula with one that more accurately reflects the volume and intensity of services furnished to Medicare beneficiaries and to take action to avert future cuts in Medicare payments to physicians and other health care providers. 2. Support S. 374 and H.R. 2783, the "Medicare Mental Health Inpatient Equity Act," to amend Title XVIII (Medicare) of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services. 3. Oppose proposals to shift Medicaid costs to states and families via block grants or overall caps on spending. 4. Oppose any Federal budget agreement that would significantly cut, block grant, or impose harmful spending caps on the Medicaid program with special concern for persons with mental disorders, including senior citizens, who rely on Medicaid as a lifeline. 5. Oppose any cuts in Medicare or Madicaid programs that would adversely impact children and adults with behaviroral health disorders.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE