To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011.

House Budget Resolution (H.Con.Res. 112), provisions related to Medicaid and Medicare; President Obama's FY 2013 Budget, provisions related to Medicaid provider taxes, DSH, Medicare Independent Payment Advisory Board, graduate medical education, bad debt; Affordable Care Act (P.L. 111-148, P.L. 111-52), provisions affecting hospital reimbursement; Improving Physician Access in Teaching Hospitals Act (H.R. 2224); H.R. 5, the Protecting Access to Healthcare Act, provisions relating to Medicare and medical malpractice; The Resident Physician Shortage Reduction Act of 2011 (S.1627); The Budget Control Act of 2011 (S.365, P.L. 112-25); Middle Class Tax Relief and Job Creation Act of 2011 (H.R.3630), provisions relating to Medicare hospital reimbursement; Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3765); H.R. 3519, a bill to exempt the Medicare program from fallback sequestration; President Obama's deficit reduction recommendations to the Supercommittee; conference agreement to H.R. 3630, provisions relating to Medicare hospital reimbursement and Medicaid payments to states; Highway and Student Loan converence agreement (H.R.4348), provisions relating to Medicaid provider taxes and pension rules; Sequester Replacement Reconciliation Act of 2012 (H.R.5652, provisions relating to Medicare hospital reimbursement and Medicaid payments to states; Graduate Medical Education Reform Act of 2012 (S.3201); Federal Medicaid 1115 Waiver issues; Medicare payments for hospital observation stays; CMS-1588-P Medicare Program proposed rule, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates, including Medicare coding offset proposed cut; The Resident Physician Shortage Reduction Act of 2012 (H.R. 6562); Medicare outpatient hospital payments; Congressional activities related to the IOM Committee on Governance and Financing of GME; the American Taxpayer Relief Act (H.R. 8), provisions related to Medicare hospital reimbursement, Medicaid, and charitable contributions; The Medicare Audit Improvement Act of 2012 (H.R. 6575).

Client expense: $220,000 · Firm income: Not reported

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

House Budget Resolution (H.Con.Res. 112), provisions related to Medicaid and Medicare; President Obama's FY 2013 Budget, provisions related to Medicaid provider taxes, DSH, Medicare Independent Payment Advisory Board, graduate medical education, bad debt; Affordable Care Act (P.L. 111-148, P.L. 111-52), provisions affecting hospital reimbursement; Improving Physician Access in Teaching Hospitals Act (H.R. 2224); H.R. 5, the Protecting Access to Healthcare Act, provisions relating to Medicare and medical malpractice; The Resident Physician Shortage Reduction Act of 2011 (S.1627); The Budget Control Act of 2011 (S.365, P.L. 112-25); Middle Class Tax Relief and Job Creation Act of 2011 (H.R.3630), provisions relating to Medicare hospital reimbursement; Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3765); H.R. 3519, a bill to exempt the Medicare program from fallback sequestration; President Obama's deficit reduction recommendations to the Supercommittee; conference agreement to H.R. 3630, provisions relating to Medicare hospital reimbursement and Medicaid payments to states; Highway and Student Loan converence agreement (H.R.4348), provisions relating to Medicaid provider taxes and pension rules; Sequester Replacement Reconciliation Act of 2012 (H.R.5652, provisions relating to Medicare hospital reimbursement and Medicaid payments to states; Graduate Medical Education Reform Act of 2012 (S.3201); Federal Medicaid 1115 Waiver issues; Medicare payments for hospital observation stays; CMS-1588-P Medicare Program proposed rule, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates, including Medicare coding offset proposed cut; The Resident Physician Shortage Reduction Act of 2012 (H.R. 6562); Medicare outpatient hospital payments; Congressional activities related to the IOM Committee on Governance and Financing of GME; the American Taxpayer Relief Act (H.R. 8), provisions related to Medicare hospital reimbursement, Medicaid, and charitable contributions; The Medicare Audit Improvement Act of 2012 (H.R. 6575).

S.3187 - Food and Drug Administration and Safety and Innovation Act and Related Conference Report PL 112-144 (drug shortage provisions). S.296/H.R.2245 - Preserving Access to Life-Saving Medications Act (drug shortage provisions). S.319 - Pharmaceutical Market Access and Drug Safety Act (drug shortages provisions). H.R.5651 - Food and Drug Administration Reform Act (drug shortage provisions). H.R.3839 - Drug Shortage Prevention Act (drug shortage provisions). Medicare physician fee schedule fix (issue only). Medicare hospital wage index (issue only). Inpatient Prospective Payment system final proposed regulation (coding offset). H.R.3519 - To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011, (entire bill). S.2620/H.R.5943 - Rural Hospital Access Act, (entire bill). H.R.2224 - Improving Physician Access to Teaching Hospitals Act, (entire bill). S.1627/H.R.6562 - Resident Physician Shortage Reduction Act (entire bill). H.R.452 - Medicare Decisions Accountability Act (IPAB repeal). S.668 - Health Care Bureaucrats Elimination Act. Resident Physician Shortage Reduction and Graduate Medical Education Accountability Act, H.R.6352 (entire bill).

Client expense: $209,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE

H.R.2245 - Preserving Access to Life-Saving Medications Act of 2011. H.R.3849 - Rural Hospital and Provide Equity (R-HoPE) Act. H.R.3839 - Drug Shortage Prevention Act. S.2257 - Excellence in Mental Health Act. S.296 - Preserving Access to Life-Saving Medications Act. S. 319 - Pharmaceutical Market Access and Drug Safety Act of 2011. H.R.3630 - Middle Class Tax Relief and Job Creation Act of 2012; Related Conference Report 112-399 H.R.3519 - To exempt the Medicare Program from fallback sequestration under the Budget Control Act of 2011. H.R.2500 - The Equal Access and Parity for Multi-Campus Hospitals Act. H.R. 2224 - Improving Physician Access to Teaching Hospitals. S.1627 - Resident Physician Shortage Reduction Act. H.R.452 - Medicare Decisions Accountability Act of 2011. S.668 - Health Care Bureaucrats Elimination Act. S.218/H.R.5 - Help Efficient, Accessible, Low-Cost, Timely Healthcare (Health) Act of 2011. Medicare Physician Fee Schedule Fix. Medicare Hospital Wage Index.

Client expense: $238,000 · Firm income: Not reported

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

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.

"S. 3187, Food and Drug Administration Safety and Innovation Act (drug shortages in hospitals) and Related Conference Report PL 112-144 "S. 296/H.R. 2245, Preserving Access to Life-Saving Medications Act (drug shortages in hospitals) "S. 319, Pharmaceutical Market Access and Drug Safety Act (drug shortages in hospitals) H.R. 5651, Food and Drug Administration Reform Act (drug shortages in hospitals) H.R. 3839, Drug Shortage Prevention Act (drug shortages in hospitals) Medicaid provider taxes Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, CAH payments, IPPS coding offset, rural hospital payments, section 508 wage index reclassification, Medicare Dependent Hospital authorization, inpatient coding offset, small rural clinical hold harmless, Sole Community Hospital (SCH) outpatient department hold harmless, outpatient therapy cap moratorium, and hospital outpatient department (HOPD) evaluation and management (E/M) service. Medicare physician fee schedule fix Medicare hospital wage index H.R. 3519, To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011 S. 2620/H.R. 5943, Rural Hospital Access Act (MDH/LV Adjustment 1-year extension) S. 1680/H.R. 3859, Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act H.R. 2224, Improving Physician Access to Teaching Hospitals Act (Medicare residency slots) S.1627/H.R. 6562, Resident Physician Shortage Reduction Act (Medicare residency slots) H.R. 452, Medicare Decisions Accountability Act of 2011 (IPAB repeal) Medicare and Medicaid Programs; Electronic Health Record Incentive ProgramStage 2; Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology; Final Rules (CMS and ONC Medicare and Medicaid EHR Meaningful Use Incentive Program Stage 2 final rules) New York State 1115 Medicaid Waiver Application to CMS Medicare and Medicaid Recovery Audit Contractor (RAC) Programs

- S.3187, Food and Drug Administraton Safety and Innovation Act (drug shortages in hospitals) and Related Conference Report P.L.112-144. - S.296/H.R.2245, Preserving Access to Life-Saving Medications Act (drug shortages in hospitals). - H.R.3839, Drug Shortage Prevention Act (drug shortages in hospitals) - S.319, Pharmaceutical Market Access and Drug Safety Act (drug shortages in hospitals). - H.R.5651, Food and Drug Administration Reform Act (drug shortages in hospitals). - Medicaid provider taxes. - Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, CAH payments, IPPS coding offset, rural hospital payments, section 508 wage index reclassification, Medicare Dependent Hospital authorization, inpatient coding offset, small rural clinical hold harmless, Sole Community Hospital (SCH) outpatient department hold harmless, outpatient therapy cap moratorium, and hospital outpatient department (HOPD) evaluation and management (E/M) service. - Medicare physician fee schedule fix. - Medicare hospital wage index. - H.R.3519, To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011. - S.2620/H.R.5943, Rural Hospital Access Act (MDH/LV Adjustment 1-year extension). - S.1680/H.R.3859, Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act. - H.R.2500, The Equal Access and Parity for Multi-Campus Hospitals Act (Electronic Health Record multi-campus incentive bill). - H.R.2224, Improving Physician Access to Teaching Hospitals Act (Medicare residency slots). - S.1627/H.R.6562, Resident Physician Shortage Reduction Act (Medicare residency slots). - H.R.452, Medicare Decisions Accountability Act of 2011 (IPAB repeal). - S.668, Health Care Bureaucrats Elimination Act (IPAB repeal). - Medicare and Medicaid Programs; Electronic Health Record Incentive ProgramStage 2; Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology; Final Rules (CMS and ONC Medicare and Medicaid EHR Meaningful Use Incentive Program Stage 2 final rules). - New York State 1115 Medicaid Waiver Application to CMS. - H.R.6118, Taking Essential Steps for Testing (TEST) Act (unintentional proficiency testing laboratory referrals). - Medicare and Medicaid Recovery Audit Contractor (RAC) Programs.

H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger). H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes. H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) - Medicare secondary payer rules. H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi). H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) - Medicare Advantage enrollment periods. H.R. 2190, Medicare Drug Savings Act (Waxman) - rebates for dual eligibles. H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) - Part D price negotiation. H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) - extension of Medicare cost plans. H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney). H.R. 3519 (Towns) - exempting Medicare from sequestration. H.R. 3691, Senior Medicare Fairness Act (Paulsen) - frailty adjuster for certain MA SNPs. H.R. 4254, Medicare Advantage Program Integrity Act (Stark) - MA payment changes. H.R. 5872, Sequestration Transparency Act (Hensarling). H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs. H.R. 6232, Medicare Better Health Rewards Program Act (Paulsen) - incentives for wellness and prevention. H.R. 6300, Medicaid Long-Term Care Reform Act (Boustany) - LTC and Medicaid issues. S. 31, Prescription Drug and Health Improvement Act (Franken) - Part D price negotiation. S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Part D price negotiation. S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes. S. 1206, Medicare Drug Savings Act (Rockefeller) - rebates for dual eligibles. S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper). S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) - Medicare Advantage enrollment periods. S. 1497, Medicare Cost Contract Extension Act (Klobuchar) - extension of Medicare cost plans. S. 1999, Senior Medicare Fairness Act (Klobuchar) - frailty adjuster for certain MA SNPs. S. 2196, Congressional Health Care for Seniors Act (Paul) - reforms affecting Medicare and Medigap. S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) - incentives for wellness and prevention.

S. 3187, Food and Drug Administration and Safety and Innovation Act and Related Conference Report PL 112-144 (drug shortage provisions) S. 296/H.R. 2245, Preserving Access to Life-Saving Medications Act (drug shortage provisions) S. 319, Pharmaceutical Market Access and Drug Safety Act (drug shortages provisions) H.R. 5651, Food and Drug Administration Reform Act (drug shortage provisions) H.R. 3839, Drug Shortage Prevention Act (drug shortage provisions) Medicare physician fee schedule fix (issue only) Medicare hospital wage index (issue only) Inpatient Prospective Payment system final proposed regulation (coding offset) H.R. 3519, To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011, (entire bill) S. 2620/H.R. 5943, Rural Hospital Access Act, (entire bill) H.R. 2224, Improving Physician Access to Teaching Hospitals Act, (entire bill) S.1627/H.R. 6562, Resident Physician Shortage Reduction Act (entire bill) H.R. 452, Medicare Decisions Accountability Act (IPAB repeal) S. 668, Health Care Bureaucrats Elimination Act Resident Physician Shortage Reduction and Graduate Medical Education Accountability Act, H.R. 6352 (entire bill)

Client expense: $628,940 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE

H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger) 16. Specific Lobbying Issues (continued): H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) Medicare secondary payer rules H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods H.R. 2190, Medicare Drug Savings Act (Waxman) rebates for dual eligibles H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) extension of Medicare cost plans H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney) H.R. 3519 (Towns) exempting Medicare from sequestration H.R. 3691, Senior Medicare Fairness Act (Paulsen) frailty adjuster for certain MA SNPs H.R. 4254, Medicare Advantage Program Integrity Act (Stark) MA payment changes H.R. 5872, Sequestration Transparency Act (Hensarling) H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs H.R. 6232, Medicare Better Health Rewards Program Act (Paulsen) incentives for wellness and prevention H.R. 6300, Medicaid Long-Term Care Reform Act (Boustany) LTC and Medicaid issues S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) incentives for wellness and prevention Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues raised by initial implementation in 2014; implications of sequestration in 2013 for Medicare Advantage and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital Regulatory Issues (continued): days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.

Medicare physician fee schedule fix (issue only) Medicare hospital wage index (issue only) Inpatient Prospective Payment system final proposed regulation (coding offset) H.R. 3519, To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011, (entire bill) S. 2620/H.R. 5943, Rural Hospital Access Act, (entire bill) H.R. 2224, Improving Physician Access to Teaching Hospitals Act, (entire bill) S. 1627/H.R. 6562, Resident Physician Shortage Reduction Act, (entire bill) Resident Physician Shortage Reduction and Graduate Medical Education Accountability Act, H.R. 6352, (entire bill)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

House Budget Resolution (H.Con.Res. 112), provisions related to Medicaid and Medicare; President Obama's FY 2013 Budget, provisions related to Medicaid provider taxes, DSH, Medicare Independent Payment Advisory Board, graduate medical education, bad debt; Affordable Care Act (P.L. 111-148, P.L. 111-52), provisions affecting hospital reimbursement; Improving Physician Access in Teaching Hospitals Act (H.R. 2224); H.R. 5, the Protecting Access to Healthcare Act, provisions relating to Medicare and medical malpractice; The Resident Physician Shortage Reduction Act of 2011 (S.1627); The Budget Control Act of 2011 (S.365, P.L. 112-25); Middle Class Tax Relief and Job Creation Act of 2011 (H.R.3630), provisions relating to Medicare hospital reimbursement; Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3765); H.R. 3519, a bill to exempt the Medicare program from fallback sequestration; President Obama's deficit reduction recommendations to the Supercommittee; conference agreement to H.R. 3630, provisions relating to Medicare hospital reimbursement and Medicaid payments to states; Highway and Student Loan converence agreement (H.R.4348), provisions relating to Medicaid provider taxes and pension rules; Sequester Replacement Reconciliation Act of 2012 (H.R.5652, provisions relating to Medicare hospital reimbursement and Medicaid payments to states; Graduate Medical Education Reform Act of 2012 (S.3201); Federal Medicaid 1115 Waiver issues; Medicare payments for hospital observation stays; CMS-1588-P Medicare Program proposed rule, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates, including Medicare coding offset proposed cut; The Resident Physician Shortage Reduction Act of 2012 (H.R. 6562); Medicare outpatient hospital payments; Congressional activities related to the IOM Committee on Governance and Financing of GME.

S. 3187, Food and Drug Administration Safety and Innovation Act (drug shortages in hospitals) and Related Conference Report PL 112-144 S. 296/H.R. 2245, Preserving Access to Life-Saving Medications Act (drug shortages in hospitals) S. 319, Pharmaceutical Market Access and Drug Safety Act (drug shortages in hospitals) H.R. 5651, Food and Drug Administration Reform Act (drug shortages in hospitals) H.R. 3839, Drug Shortage Prevention Act (drug shortages in hospitals) H.R. 5652, Sequester Replacement Reconciliation Act (Medicaid provider taxes) Medicare physician fee schedule fix Medicare hospital wage index H.R. 3519, To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011 S. 2620/H.R. 5943, Rural Hospital Access Act (MDH/LV Adjustment 1-year extension) S. 1680/H.R. 3859, Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act H.R. 2500, The Equal Access and Parity for Multi-Campus Hospitals Act (Electronic Health Record multi-campus incentive bill) H.R. 2224, Improving Physician Access to Teaching Hospitals Act (Medicare residency slots) S.1627, Resident Physician Shortage Reduction Act (Medicare residency slots) H.R. 452, Medicare Decisions Accountability Act of 2011 (IPAB repeal) S. 668, Health Care Bureaucrats Elimination Act (IPAB repeal) S.218/H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (Medical liability reform)

Client expense: Not reported · 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. HR 4245 Veterans Co-Pay Fairness Act, to amend title 38, United States Code, to require the Secretary of Veterans Affairs to reimburse eligible veterans who are entitled to Medicare benefits for Medicare deductibles and other expenses that are owed by the veterans for emergency medical treatment provided in non-Department of Veterans Affairs facilities; S 2620 and HR 5943 Rural Hospital Access Act of 2012, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; S 3187 and HR 5651Prescription Drug User Fee Amendments of 2012, a bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs and medical devices, to establish user-fee programs for generic drugs and biosimilars.

H.Con.Res. 112, House budget resolution (Ryan) Medicare, Medicaid, ACA issues H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger) H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes 16. Specific Lobbying Issues (continued): H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) Medicare secondary payer rules H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods H.R. 2190, Medicare Drug Savings Act (Waxman) rebates for dual eligibles H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) extension of Medicare cost plans H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney) H.R. 3519 (Towns) exempting Medicare from sequestration H.R. 3691, Senior Medicare Fairness Act (Paulsen) frailty adjuster for certain MA SNPs H.R. 4254, Medicare Advantage Program Integrity Act (Stark) MA payment changes H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) incentives for wellness and prevention Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including; risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to Medigap coverage; and other issues relating to health care reform implementation.

H.Con.Res. 112, House budget resolution (Ryan) - Medicare, Medicaid, ACA issues H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger) H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) - Medicare secondary payer rules H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) - Medicare Advantage enrollment periods H.R. 2190, Medicare Drug Savings Act (Waxman) - rebates for dual eligibles H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) - Part D price negotiation H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) - extension of Medicare cost plans H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney) H.R. 3519 (Towns) - exempting Medicare from sequestration H.R. 3691, Senior Medicare Fairness Act (Paulsen) - frailty adjuster for certain MA SNPs H.R. 4254, Medicare Advantage Program Integrity Act (Stark) - MA payment changes H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs S. 31, Prescription Drug and Health Improvement Act (Franken) - Part D price negotiation S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) - rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) - Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) - extension of Medicare cost plans S. 1999, Senior Medicare Fairness Act (Klobuchar) - frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) - reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) - incentives for wellness and prevention

*Part D price negotiation - S 31, Prescription Drug and Health Improvement Act of 2011; S 44, Medicare Prescription Drug Price Negotiation Act of 2011; HR 2248, Medicare Prescription Drug Price Negotiation Act of 2011. *Medicare Part D changes - HR 999, Medicare Prescription Drug Savings and Choice Act of 2011; S 560, Medicare Prescription Drug Savings and Choice Act of 2011. *Medicare secondary payer rules - HR 1063, Strengthening Medicare And Repaying Taxpayers Act of 2011. *Medicare Advantage enrollment periods - HR 1580, Medicare Beneficiary Preservation of Choice Act of 2011; S 1479, Medicare Beneficiary Preservation of Choice Act of 2011. *Rebates for dual eligibles - HR 2190, Medicare Drug Savings Act of 2011; S 1206, Medicare Drug Savings Act of 2011. *Strengthening Medicare anti-fraud measures - HR 675, Strengthening Medicare Anti-Fraud Measures Act of 2011. *Extension of Medicare cost plans - HR 2770, Medicare Cost Contract Extension Act of 2011; S 1497, Medicare Cost Contract Extension Act of 2011. *Medicare and Medicaid fraud and abuse - S 1251, Medicare and Medicaid FAST Act. *Frailty adjuster for certain MA SNPs - HR 3691, Senior Medicare Fairness Act of 2011; S 1999, Senior Medicare Fairness Act. *MA payment changes - HR 4254, Medicare Advantage Program Integrity Act of 2012. *Reforms affecting Medicare and Medigap - S 2196, Congressional Health Care for Seniors Act of 2012. *Incentives for wellness and prevention - S 2243, Medicare Better Health Rewards Program Act of 2012. *Puerto Rico Medicare Part B - HR 1357, Puerto Rico Medicare Part B Equity Act of 2011. *Medicare and Medicaid - HR 3399, Medicare and Medicaid FAST Act. *Exempting Medicare from sequestration - HR 3519, To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011. *Medicare, Medicaid, ACA issues - HConRes 112, Establishing the budget for the United States Government for fiscal year 2013 and setting forth appropriate budgetary levels for fiscal years 2014 through 2022. *Federal financing of State Medicaid programs - HR 5979, Medicaid Accountability and Care Act of 2012.

S.3187, Food and Drug Administration Safety and Innovation Act (drug shortages in hospitals) and Related Conference Report PL 112-144; S.296/H.R.2245, Preserving Access to Life-Saving Medications Act (drug shortages in hospitals); S.319, Pharmaceutical Market Access and Drug Safety Act (drug shortages in hospitals); H.R. 5651, Food and Drug Administration Reform Act (drug shortages in hospitals); H.R. 3839, Drug Shortage Prevention Act (drug shortages in hospitals); H.R. 5652, Sequester Replacement Reconciliation Act (Medicaid provider taxes); H.R. 3560, Middle Class Tax Relief and Job Creation Act and Related Conference Committee Report PL 112-399: Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, CAH payments, IPPS coding offset, rural hospital payments, section 508 wage index reclassification, Medicare Dependent Hospital authorization, inpatient coding offset, small rural clinical hold harmless, Sole Community Hospital (SCH) outpatient department hold harmless, outpatient therapy cap moratorium, and hospital outpatient department (HOPD) evaluation and management (E/M) service; Medicare physician fee schedule fix; Medicare hospital wage index; H.R. 3519, To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011; S. 2620/H.R. 5943, Rural Hospital Access Act (MDH/LV Adjustment 1-year extension); H.R. 6064 Temporary Surface Transportation Act and Related Conference Report PL 112-140 (Pension provisions); S. 1680/H.R. 3859, Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act; H.R. 2500, The Equal Access and Parity for Multi-Campus Hospitals Act (Electronic Health Record multi-campus incentive bill); H.R. 2224, Improving Physician Access to Teaching Hospitals Act (Medicare residency slots); S.1627, Resident Physician Shortage Reduction Act (Medicare residency slots); H.R. 452, Medicare Decisions Accountability Act of 2011 (IPAB repeal); S. 668, Health Care Bureaucrats Elimination Act (IPAB repeal); S.218/H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (Medical liability reform). Recovery Auditor Contractor program modifications

House Budget Resolution (H.Con.Res. 112), provisions related to Medicaid and Medicare; President Obama's FY 2013 Budget, provisions related to Medicaid provider taxes, DSH, Medicare Independent Payment Advisory Board, graduate medical education, bad debt; Affordable Care Act (P.L. 111-148, P.L. 111-52), provisions affecting hospital reimbursement; Improving Physician Access in Teaching Hospitals Act (H.R. 2224); H.R. 5, the Protecting Access to Healthcare Act, provisions relating to Medicare and medical malpractice; The Resident Physician Shortage Reduction Act of 2011 (S.1627); The Budget Control Act of 2011 (S.365, P.L. 112-25); Middle Class Tax Relief and Job Creation Act of 2011 (H.R.3630), provisions relating to Medicare hospital reimbursement; Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3765); H.R. 3519, a bill to exempt the Medicare program from fallback sequestration; President Obama's deficit reduction recommendations to the Supercommittee; conference agreement to H.R. 3630, provisions relating to Medicare hospital reimbursement and Medicaid payments to states; Highway and Student Loan converence agreement (H.R.4348), provisions relating to Medicaid provider taxes and pension rules; Sequester Replacement Reconciliation Act of 2012 (H.R.5652, provisions relating to Medicare hospital reimbursement and Medicaid payments to states; Graduate Medical Education Reform Act of 2012 (S.3201); Federal Medicaid 1115 Waiver issues; Medicare payments for hospital observation stays; CMS-1588-P Medicare Program proposed rule, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates.

Client expense: $220,000 · Firm income: Not reported

Sustainable growth rate and impact on other Medicare programs, Medicare physician payment, budget offsets - HR 3630, Middle Class Tax Relief and Job Creation Act of 2012. Impact of House budget resolution on Medicare provisions - H Con Res 112, Establishing the budget for the United States Government for fiscal year 2013 and setting forth appropriate budgetary levels for fiscal years 2014 through 2022. *Part D price negotiation - S 31, Prescription Drug and Health Improvement Act of 2011; S 44, Medicare Prescription Drug Price Negotiation Act of 2011; HR 2248, Medicare Prescription Drug Price Negotiation Act of 2011. *Medicare Part D changes - HR 999, Medicare Prescription Drug Savings and Choice Act of 2011; S 560, Medicare Prescription Drug Savings and Choice Act of 2011. *Medicare secondary payer rules - HR 1063, Strengthening Medicare And Repaying Taxpayers Act of 2011. *Medicare Advantage enrollment periods - HR 1580, Medicare Beneficiary Preservation of Choice Act of 2011; S 1479, Medicare Beneficiary Preservation of Choice Act of 2011. *Rebates for dual eligibles - HR 2190, Medicare Drug Savings Act of 2011; S 1206, Medicare Drug Savings Act of 2011. *Strengthening Medicare anti-fraud measures - HR 675, Strengthening Medicare Anti-Fraud Measures Act of 2011. *Extension of Medicare cost plans - HR 2770, Medicare Cost Contract Extension Act of 2011; S 1497, Medicare Cost Contract Extension Act of 2011. *Medicare and Medicaid fraud and abuse - S 1251, Medicare and Medicaid FAST Act. *Budget offsets - S 1944, Middle Class Tax Cut Act of 2011; S 1931, Temporary Tax Holiday and Government Reduction Act. *Frailty adjuster for certain MA SNPs - HR 3691, Senior Medicare Fairness Act of 2011; S 1999, Senior Medicare Fairness Act. *Medicare physician payment, extension of QI and TMA programs, budget offsets - HR 3765, Temporary Payroll Tax Cut Continuation Act of 2011. *MA payment changes - HR 4254, Medicare Advantage Program Integrity Act of 2012. *Reforms affecting Medicare and Medigap - S 2196, Congressional Health Care for Seniors Act of 2012. *Incentives for wellness and prevention - S 2243, Medicare Better Health Rewards Program Act of 2012. *Puerto Rico Medicare Part B - HR 1357, Puerto Rico Medicare Part B Equity Act of 2011. *Medicare and Medicaid - HR 3399, Medicare and Medicaid FAST Act. *Exempting Medicare from sequestration - HR 3519, To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011.

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

H.Con.Res. 112, House budget resolution (Ryan) - Medicare, Medicaid, ACA issues. H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger). H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) - Medicare secondary payer rules. H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) - Medicare Advantage enrollment periods. H.R. 2190, Medicare Drug Savings Act (Waxman) - rebates for dual eligibles. H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) - Part D price negotiation. H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) - extension of Medicare cost plans. H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney). H.R. 3519 (Towns) - exempting Medicare from sequestration. H.R. 3630, Temporary Payroll Tax Cut Continuation Act (Camp) - Medicare physician payment, extension of QI and TMA programs, budget offsets. H.R. 3691, Senior Medicare Fairness Act (Paulsen) - frailty adjuster for certain MA SNPs. H.R. 3765, Temporary Payroll Tax Cut Continuation Act (Camp) - Medicare physician payment, extension of QI and TMA programs, budget offsets.H.R. 4254, Medicare Advantage Program Integrity Act (Stark) - MA payment changes. S. 31, Prescription Drug and Health Improvement Act (Franken) - Part D price negotiation. S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Part D price negotiation. S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes. S. 1206, Medicare Drug Savings Act (Rockefeller) - rebates for dual eligibles. S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper). S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) - Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) - extension of Medicare cost plans. S. 1931, Temporary Tax Holiday and Government Reduction Act (Heller) -budget offsets. S. 1944, Middle Class Tax Cut Act (Casey) - budget offsets. S. 1999, Senior Medicare Fairness Act (Klobuchar) - frailty adjuster for certain MA SNPs. S. 2196, Congressional Health Care for Seniors Act (Paul) - reforms affecting Medicare and Medigap. S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) - incentives for wellness and prevention.

S.296/H.R.2245, Preserving Access to Life-Saving Medications Act (drug shrotages in hospitals) S.319, Pharmaceutical Market Access and Drug Safety Act (drug shortages in hospitals) H.R.3389, Drug Shortage Prevention Act (drug shortages in hospitals) S.218/H.R.5 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (medical liability reform) H.R. 3560, Middle Class Tax Relief and Job Creation Act and Related Conference Committee Report PL 112-399: oMedicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, CAH payments, IPPS coding offset, rural hospital payments, section 508 wage index reclassification, Medicare Dependent Hospital authorization, inpatient coding offset, small rural clinical hold harmless, Sole Community Hospital (SCH) outpatient department hold harmless, outpatient therapy cap moratorium, and hospital outpatient department (HOPD) evaluation and management (E/M) service. Medicare physician fee schedule fix Medicare hospital wage index H.R. 3519, To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011 S. 1680/H.R. 3859, Rural Hospital and Provider Equity (R-HoPE) Act H.R. 2500, The Equal Access and Parity for Multi-Campus Hospitals Act (Electronic Health Record multi-campus incentive bill) H.R. 2224, Improving Physician Access to Teaching Hospitals Act (Medicare residency slots) S.1627, Resident Physician Shortage Reduction Act (Medicare residency slots) H.R. 452, Medicare Decisions Accountability Act of 2011 (IPAB repeal) S. 668, Health Care Bureaucrats Elimination Act (IPAB repeal)

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

S. 296/H.R. 2245, Preserving Access to Life-Saving Medications Act (drug shortages in hospitals) S. 319, Pharmaceutical Market Access and Drug Safety Act (drug shortages in hospitals) H.R. 3839, Drug Shortage Prevention Act (drug shortages in hospitals) H.R. 3560, Middle Class Tax Relief and Job Creation Act and Related Conference Committee Report PL 112-399: oMedicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, CAH payments, IPPS coding offset, rural hospital payments, section 508 wage index reclassification, Medicare Dependent Hospital authorization, inpatient coding offset, small rural clinical hold harmless, Sole Community Hospital (SCH) outpatient department hold harmless, outpatient therapy cap moratorium, and hospital outpatient department (HOPD) evaluation and management (E/M) service. Medicare physician fee schedule fix Medicare hospital wage index H.R. 3519, To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011 S. 1680/H.R. 3859, Rural Hospital and Provider Equity (R-HoPE) Act H.R. 2500, The Equal Access and Parity for Multi-Campus Hospitals Act (Electronic Health Record multi-campus incentive bill) H.R. 2224, Improving Physician Access to Teaching Hospitals Act (Medicare residency slots) S.1627, Resident Physician Shortage Reduction Act (Medicare residency slots) H.R. 452, Medicare Decisions Accountability Act of 2011 (IPAB repeal) S. 668, Health Care Bureaucrats Elimination Act (IPAB repeal) S.218/H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (Medical liability reform)

Client expense: Not reported · Firm income: Not reported

H.R. 2245: Preserving Access to Life-Saving Medications Act of 2011. H.R. 3859: Rural Hospital and Provide Equity (R-HoPE) Act. H.R. 3839: Drug Shortage Prevention Act. S. 2257: Excellence in Mental Health Act. S. 296: Preserving Access to Life-Saving Medications Act. S. 319: Pharmaceutical Market Access and Drug Safety Act of 2011. H.R. 3630: Middle Class Tax Relief and Job Creation Act of 2012. -- Related Conference Report 112-399 H.R. 3519: To exempt the Medicare program from fallback sequestratio under the Budget Control Act of 2011. H.R. 2500: The Equal Access and Parity for Multi-Campus Hospitals Act. H.R. 2224: Improving Physician Access to Teaching Hospitals. S. 1627: Resident Physician Shortage Reduction Act. H.R. 452: Medicare Decisions Accountability Act of 2011. S. 668: Health Care Bureaucrats Elimination Act. S. 218/H.R. 5: Help Efficient, Accessible, Low-cost, Timely Healthcare (Health) Act of 2011 Medicare Physician Fee Schedule Fix Medicare Hospital Wage Index

Client expense: $298,000 · Firm income: Not reported

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

House Budget Resolution (H.Con.Res. 112), provisions related to Medicaid and Medicare; President Obama's FY 2013 Budget, provisions related to Medicaid provider taxes, DSH, Medicare Independent Payment Advisory Board, graduate medical education, bad debt; Affordable Care Act (P.L. 111-148, P.L. 111-52), provisions affecting hospital reimbursement; Improving Physician Access in Teaching Hospitals Act (H.R. 2224); H.R. 5, the Protecting Access to Healthcare Act, provisions relating to Medicare and medical malpractice; The Resident Physician Shortage Reduction Act of 2011 (S.1627); The Budget Control Act of 2011 (S.365, P.L. 112-25); Middle Class Tax Relief and Job Creation Act of 2011 (H.R.3630), provisions relating to Medicare hospital reimbursement; Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3765); H.R. 3519, a bill to exempt the Medicare program from fallback sequestration; President Obama's deficit reduction recommendations to the Supercommittee; conference agreement to H.R. 3630, provisions relating to Medicare hospital reimbursement and Medicaid payments to states.

Client expense: $220,000 · Firm income: Not reported

H.R. 2576 - To amend the Internal Revenue Code of 1986 to modify the calculation of modified adjusted gross income for purposes of determining eligibility for certain healthcare-related programs. S. 1680 - Rural Hospital and Provider Equity Act of 2011. H.R.3519 - To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011. H.R.3516 - To amend title XVIII of the Social Security Act with respect to Medicare payment for long-term care hospital services. H.R.3587 - To amend title XIX of the Social Security Act to provide for the application of Medicaid prompt pay requirement to claims for payment for covered items and services furnished by any Medicaid health care entity. H.R.3630 - Temporary Payroll Tax Cut Continuation Act of 2011; and, H.R.3765 - Temporary Payroll Tax Cut Continuation Act of 2011. Pub.L. 112-25 - Budget Control Act of 2011. Joint Select Committee on Deficit Reduction negotiations (Super committee created by Budget Control Act). H.R.2112 - Consolidated and Further Continuing Appropriations Act, 2012.

Client expense: $201,000 · 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), SENATE, Social Security Administration (SSA)

H.R. 2576: To amend the Internal Revenue Code of 1986 to modify the calculation of modified adjusted gross income for purposes of determining eligibility for certain healthcare-related programs. S. 1680: Rural Hospital and Provider Equity Act of 2011. H.R.3519: To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011. H.R.3516: To amend title XVIII of the Social Security Act with respect to Medicare payment for long-term care hospital services. H.R.3587: To amend title XIX of the Social Security Act to provide for the application of Medicaid prompt pay requirement to claims for payment for covered items and services furnished by any Medicaid health care entity. H.R.3630: Temporary Payroll Tax Cut Continuation Act of 2011; and, H.R.3765: Temporary Payroll Tax Cut Continuation Act of 2011. Pub.L. 112-25: Budget Control Act of 2011. Joint Select Committee on Deficit Reduction negotiations (Super committee created by Budget Control Act). H.R.2112: Consolidated and Further Continuing Appropriations Act, 2012.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), SENATE, Social Security Administration (SSA)

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.

Medicare Extenders: SCH hold harmles; Inpatient Section 508 wage reclassification; Outpatient therapy cap moratorium; Small rural clinical lab hold harmless; Graduate Medical Education, "bad debt" payments, post-acute care payments, CAH payments, IPPS coding offset, rural hospital payments, hopsital outpatient department (HOPD) evaluation and management (E/M) services. Medicare physician fee schedule fix S. 296/H.R. 2245, Preserving Access to Life-Saving Medications Act (drug shortages in hospitals) P.L. 112-25: Budget Control Act of 2011 Joint Select Committee on Deficit Reduction (Super Committee Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, CAH payments, IPPS coding offset, rural hospital payments) H.R. 3519, To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011 S. 1680, Rural Hospital and Provider Equity Act H.R. 3630, Temporary Payroll Tax Cut Continuation Act of 2011 (hospital extenders, HOPD E/M payments, bad debt, IPPS coding offset) P.L. 112-78 (H.R. 3765), Temporary Payroll Tax ut Continuation Act of 2011(hospital extenders, HOPD E/M payments, bad debt, IPPS coding offset) H.R. 2500, The Equal Access and Parity for Multi-Campus Hospitals Act (Electronic Health Record multi-campus incentive bill) H.R. 2224, Improving Physician Access to Teaching Hospitals Act (Medicare residency slots) S.1627, Resident Physician Shortage Reduction Act (Medicare residency slots) Inpatient Prospective Payment System Final Rule, 76 FR 51476, August 18, 2011, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY 2012 Rates; Hospitals FTE Resident Caps for Graduate Medical Education Payment (Coding offset) Medicare and Medicaid programs' electronic health record (EHR) incentive final rule, July 28, 2010 Federal Register (multi-campus provisions) H.R. 452, Medicare Decisions Accountability Act of 2011 (IPAB repeal) S. 668, Health Care Bureaucrats Elimination Act (IPAB repeal) S.218/H.R. 5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (Medical liability reform)

Impact of deficit reduction issues and actions of the Joint Committee on Deficit Reduction on Medicare and Medicare Part D - Proposed legislation re these issues. Sustainable growth rate and impact on other Medicare programs; *Medicare physician payment, extension of QI and TMA programs; *budget offsets - HR 3630, Temporary Payroll Tax Cut Continuation Act of 2011; HR 3765, Temporary Payroll Tax Cut Continuation Act of 2011. Potential changes to Medicare Advantage - Proposed legislation re this issue. *Part D price negotiation - S 31, Prescription Drug and Health Improvement Act of 2011; S 44, Medicare Prescription Drug Price Negotiation Act of 2011; HR 2248, Medicare Prescription Drug Price Negotiation Act of 2011; HR 3399, Medicare and Medicaid FAST Act; HR 3519, To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011; HR 3630, Temporary Payroll Tax Cut Continuation Act of 2011; HR 3691, Senior Medicare Fairness Act of 2011; HR 3765, Temporary Payroll Tax Cut Continuation Act of 2011. *Medicare Part D changes - HR 999, Medicare Prescription Drug Savings and Choice Act of 2011; S 560, Medicare Prescription Drug Savings and Choice Act of 2011. *Medicare secondary payer rules - HR 1063, Strengthening Medicare And Repaying Taxpayers Act of 2011. *Medicare Advantage enrollment periods - HR 1580, Medicare Beneficiary Preservation of Choice Act of 2011; S 1479, Medicare Beneficiary Preservation of Choice Act of 2011; HR 1357, Puerto Rico Medicare Part B Equity Act of 2011. *Rebates for dual eligibles - HR 2190, Medicare Drug Savings Act of 2011; S 1206, Medicare Drug Savings Act of 2011. *Strengthening Medicare anti-fraud measures - HR 675, Strengthening Medicare Anti-Fraud Measures Act of 2011. *Extension of Medicare cost plans - HR 2770, Medicare Cost Contract Extension Act of 2011; S 1497, Medicare Cost Contract Extension Act of 2011. *Medicare and Medicaid fraud and abuse - S 1251, Medicare and Medicaid FAST Act. *Budget offsets - S 1944, Middle Class Tax Cut Act of 2011; S 1931, Temporary Tax Holiday and Government Reduction Act. *Frailty adjuster for certain MA SNPs - S 1999, Senior Medicare Fairness Act.

H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger), H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes, H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) - Medicare secondary payer rules, H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi), H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods, H.R. 2190, Medicare Drug Savings Act, 16. Specific Lobbying Issues (con't): (Waxman) rebates for dual eligibles, H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation, H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) extension of Medicare cost plans, H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney), H.R. 3519 (Towns) exempting Medicare from sequestration, H.R. 3630, Temporary Payroll Tax Cut Continuation Act (Camp) Medicare physician payment, extension of QI and TMA programs, budget offsets, H.R. 3691, Senior Medicare Fairness Act (Paulsen) frailty adjuster for certain MA SNPs, H.R. 3765, Temporary Payroll Tax Cut Continuation Act (Camp) Medicare physician payment, extension of QI and TMA programs, budget offsets, S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation, S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation, S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes, S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles, S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper), S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods, S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans, S. 1931, Temporary Tax Holiday and Government Reduction Act (Heller) budget offsets, S. 1944, Middle Class Tax Cut Act (Casey) budget offsets, S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs MMM (Regulatory Issues): Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including; risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to data warehouses including the Office of Personnel Management and Office of the Inspector General proposals related to the Federal Employee Health Benefits Program and all-payer comparative effectiveness research and health information technology standards and policies.

House Budget Resolution (H.Con.Res. 34), provisions related to Medicaid and Medicare; President Obama's FY 2012 Budget and Deficit Reduction Framework, provisions related to Medicaid provider taxes and Medicare Independent Payment Advisory Board; Affordable Care Act (P.L. 111-148, P.L. 111-52), provisions affecting hospital reimbursement; Accountable Care Organization proposed rule (CMS 1345-P); Value-Based Purchasing proposed rule (CMS 3239-P); Health Information Technology incentive created by the American Recovery and Reinvestment Act (P.L. 111-5); Improving Physician Access in Teaching Hospitals Act (H.R.2224); Affordable Care Act provision extending gainsharing demonstrations; FY 2012 Medicare Inpatient Proposed Rule (CMS-1518-P); FY 2012 Medicare Inpatient Rehabilitation and Psychiatric Unit Rules (CMS 1349-P); The Resident Physician Shortage Reduction Act of 2011 (S.1627); The Budget Control Act of 2011 (S.365, P.L. 112-25); President Obama's American Jobs Act (S.1549); Middle Class Tax Relief and Job Creation Act of 2011 (H.R.3630), provisions relating to Medicare hospital reimbursement; Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3765); H.R. 3519, a bill to exempt the Medicare program from fallback sequestration; President Obama's deficit reduction recommendations to the Supercommittee.

Client expense: $260,000 · Firm income: Not reported

H.R. 2576: To amend the Internal Revenue Code of 1986 to modify the calculation of modified adjusted gross income for purposes of determining eligibility for certain healthcare-related programs. S. 1680: Rural Hospital and Provider Equity Act of 2011. H.R.3519: To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011. H.R.3516: To amend title XVIII of the Social Security Act with respect to Medicare payment for long-term care hospital services. H.R.3587: To amend title XIX of the Social Security Act to provide for the application of Medicaid prompt pay requirement to claims for payment for covered items and services furnished by any Medicaid health care entity. H.R.3630: Temporary Payroll Tax Cut Continuation Act of 2011; and, H.R.3765: Temporary Payroll Tax Cut Continuation Act of 2011. Pub.L. 112-25: Budget Control Act of 2011. Joint Select Committee on Deficit Reduction negotiations (Super committee created by Budget Control Act). H.R.2112: Consolidated and Further Continuing Appropriations Act, 2012.

Client expense: $770,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), SENATE, Social Security Administration (SSA)

S 1680 Rural Hospital and Provider Equity Act of 2011 (entire bill) HR 3519 To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011 HR 3516 To amend title XVII of the Social Security Act with respect to Medicare payment for long-term care hospital services HR 3630 Temporary Payroll Tax Cut Continuation Act of 2011 (issues: hospital extenders, hospital outpatient department payments, bad debt) HR 3765 (PL 112-78), Temporary Payroll Tax Cut Continuation Act of 2011, (issues: hospital extenders, hospital outpatient department payments, bad debt) Pub L 112-25, Budget Control Act, Joint Select Committee on Deficit Reductions negotiations (Super Committee) Hospital Payment Reductions Issues related to Super Committee: Graduate Medical Education, Bad Debt payments, post-acute care payments, critical access hospital payments, IPPS coding payments, rural hospital payments Medicare Expiring Provisions: Inpatient section 508 wage reclassifications Outpatient therapy cap moratorium Geographic physician work payment floor Outpatient hold harmless Mental Health add-ons Ambulance add-ons Independent lab direct Medicare billing Small rural hospital clinical lab hold harmless Graduate Medical Education, Bad Debt payments, post-acute care payments, critical access hospital payments, IPPS coding payments, rural hospital payments Physician Payment Formula (doc fix)

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