Senior Medicare Fairness Act of 2011

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.

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

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

H.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.

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.

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.

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.