Health Care Choice Act of 2011

Successful Insurance Industry Implementation of Health Reforms: "Good faith compliance standard", reasonable effective dates for compliance with P.L. 111-148. State Oversight of Premium Increases: existing state regulatory functions; federal exchanges; state exchanges. Affordable Private Healthcare: Insurer Fees, Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits. Worked on H.R. 3675 Temporary Pay Reduction Act of 2011 provisions.Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Healthcare; Evidence Based Care. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings/Accounts/Medical Savings Accounts; Individual Mandate; MEWAs, H.R. 371 - Healthcare Choice Act of 2011.

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Successful Insurance Industry Implementation of Health Reforms: "Good faith compliance standard", reasonable effective dates for compliance with P.L. 111-148. State Oversight of Premium Increases: existing state regulatory functions; federal exchanges; state exchanges. Affordable Private Healthcare: Insurer Fees, Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits. Worked on H.R. 3675 Temporary Pay Reduction Act of 2011 provisions.Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Healthcare; Evidence Based Care. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings/Accounts/Medical Savings Accounts; Individual Mandate; MEWAs, H.R. 371 - Healthcare Choice Act of 2011.

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Successful Insurance Industry Implementation of Health Reforms: "Good faith compliance standard", reasonable effective dates for compliance with P.L. 111-148. State Oversight of Premium Increases: existing state regulatory functions; federal exchanges; state exchanges. Affordable Private Healthcare: Insurer Fees, Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits. Worked on H.R. 3675 Temporary Pay Reduction Act of 2011 provisions.Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Healthcare; Evidence Based Care. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings/Accounts/Medical Savings Accounts; Individual Mandate; MEWAs, H.R. 371 - Healthcare Choice Act of 2011.

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Successful Insurance Industry Implementation of Health Reforms: "Good faith compliance standard", reasonable effective dates for compliance with P.L. 111-148. State Oversight of Premium Increases: existing state regulatory functions; federal exchanges; state exchanges. Affordable Private Healthcare: Insurer Fees, Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits. Worked on H.R. 3675 Temporary Pay Reduction Act of 2011 provisions. Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Healthcare; Evidence Based Care. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings/Accounts/Medical Savings Accounts; Individual Mandate; MEWAs, H.R. 371 - Healthcare Choice Act of 2011.

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- PL 111-148, "Patient Protection & Affordable Care Act", regarding all provisions. - HR 371, "Health Care Choice Act of 2011", regarding all provisions. - HR 1206, "Access to Professional Health Insurance Advisors Act of 2011", regarding all provisions. - HR 3400, "Interstate Market for Health Insurance", regarding all provisions. - HR 4, "Small Business Paperwork mandate Elimination Act of 2011", regarding repeal of 1099. - HR 10/ S 299, "Regulations from the Executive in Need of Scrutiny Act", regarding provisions related to the "Patient Protection and Affordable Care Act". - Issues regarding the preservation of the tax exclusion for employer-sponsored insurance.

Client expense: $1,610,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

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

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

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

See attached. Supported HR 144, S.18, and HR 4, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 to repeal a provision contained in HR 3590 (Patient Protection and Affordable Care Act) to expand IRS "Form 1099 filing requirements to include business reporting of all payments to corporations for goods or services in excess of $600, beginning in 2012. Monitored HR 371, the Health Care Choice Act of 2011, allowing purchasers to go online to shop for a health care policy. Monitored HR 1184, the Health Care Waiver Transparency Act of 2011.

Client expense: $80,000 · Firm income: Not reported

Government targets: Bureau of Land Management (BLM), Commerce, Dept of (DOC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Highway Traffic Safety Administration (NHTSA), SENATE, U.S. Forest Service

**see addendum page PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 1206 - Access to Professional Health Insurance Advisors Act of 2011, MLR Broker Fee H.R. 371 - Health Care Choice Act of 2011, selling insurance across state lines S. 1049/H.R. 2676 - Small Business Health Relief Act, insurer excise tax H.R.1370 - to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act S. 1880 - the Jobs and Premium Protection Act, insurer excise tax ***, no specific bill(s), Health Savings Accounts/Medical Savings Accounts, Transparency, Health Information Technology, Electronic Prescribing, Insurance Market Reform, Uninsured, Employer Based Health System, Health Care Reform, Small Group Market Reform, Exchanges, Health Care Reform Implementation, Medical Loss Ratios

Client expense: Not reported · Firm income: $70,000

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

**see addendum page PL 111-148 - The Patient Protection and Affordable Care Act, implementation, health care reform H.R. 1206 - Access to Professional Health Insurance Advisors Act of 2011, MLR Broker Fee H.R. 371 - Health Care Choice Act of 2011, selling insurance across state lines S. 1049/H.R. 2676 - Small Business Health Relief Act, insurer excise tax H.R.1370 - to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act S. 1880 - the Jobs and Premium Protection Act, insurer excise tax ***, no specific bill(s), Health Savings Accounts/Medical Saving Accounts, Transparency, Health Information Technology, Electronic Prescribing, Insurance Market Reform, Government Plan Option, Uninsured, Employer Based Health System, Health Care Reform, Small Group Market Reform, Exchanges, Health Care Reform Implementation, Medical Loss Rates, Federal Employees' Health Benefits Program (FEHBP)

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

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached. Supported HR 144, S.18, and HR 4, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 to repeal a provision contained in HR 3590 (Patient Protection and Affordable Care Act) to expand IRS "Form 1099 filing requirements to include business reporting of all payments to corporations for goods or services in excess of $600, beginning in 2012. Monitored HR 371, the Health Care Choice Act of 2011, allowing purchasers to go online to shop for a health care policy. Monitored HR 1184, the Health Care Waiver Transparency Act of 2011.

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

Government targets: Bureau of Land Management (BLM), Commerce, Dept of (DOC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Highway Traffic Safety Administration (NHTSA), SENATE, U.S. Forest Service

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America" State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011"; Multi-State Health Plans Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations; MLR Broker Fees: HR1206 "Access to Professional Health Insurance Act of 2011", S 2068 "Access to Independent Health Insurance Advisors Act of 2012" Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Age Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout

Client expense: $1,880,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office

See attached addendum for General Lobbying Issue HCR - Health Issues Patient Protection and Affordable Care Act (ACA) successful insurance industry implementation of health reforms: reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable private health care: Insurer fees; Essential health benefits; Healthcare delivery system reforms; Health insurance excise tax; Qualified Health Plan requirements State-based regulation: State oversight of premium increases, products and rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; Federal exchanges; Federal rate review; Existing state regulatory functions; Consumer Operated and Oriented Plan Program (CO-OPs); Selling health insurance across state lines; HR371 Health Care Choice Act of 2011; Multi-state Health Plans Medical Loss Ratios: MLR Broker Fee HR1206 Access to Professional Health Insurance Advisors Act of 2011, S2068 Access to Independent Health Insurance Advisors Act of 2012; Quality improvement definition Health Care Quality: Delivery system incentives to promote better care; Payment reforms; Patient-centered primary care/medical home; Comparative effectiveness research; Evidence based care; Health disparities; Wellness; Chronic care management; Childhood obesity; Telemedicine Health Information Technology Standards: Health information privacy; Electronic health records; Administrative simplification; ICD10 implementation; Data sharing; Data aggregation Insurance Market Reform: Individual market reform; Group market reform; Small business healthcare; Guaranteed issue; Community rating; Health Savings Accounts; Age Rating; Health Status Rating; Individual Mandate; Accountable Care Organizations (ACOs) PDUFA V: HR 5651 FDA Reform Act of 2012 sections pertaining to generic drugs and online pharmacies; S1882 Fair and Immediate Release of Generic Drugs Act

Client expense: $760,000 · 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

**see addendum page PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 1206 - Access to Professional Health Insurance Advisors Act of 2011, MLR Broker Fee H.R. 371 - Health Care Choice Act of 2011, selling insurance across state lines S. 1049/H.R. 2676 - Small Business Health Relief Act, insurer excise tax H.R.1370 - to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act S. 1880 - the Jobs and Premium Protection Act, insurer excise tax S. 3187 - The Food and Drug Administration Safety and Innovation Act, e-prescribing ***, no specific bill(s), Health Savings Accounts/Medical Savings Accounts, Transparency, Health Information Technology, Electronic Prescribing, Insurance Market Reform, Uninsured, Employer Based Health System, Health Care Reform, Small Group Market Reform, Exchanges, Health Care Reform Implementation, Medical Loss Ratios

Client expense: Not reported · Firm income: $70,000

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- PL 111-148, "Patient Protection & Affordable Care Act", regarding all provisions. - HR 371, "Health Care Choice Act of 2011", regarding all provisions. - HR 1206, "Access to Professional Health Insurance Advisors Act of 2011", regarding all provisions. - HR 3400, "Interstate Market for Health Insurance", regarding all provisions. - HR 4, "Small Business Paperwork mandate Elimination Act of 2011", regarding repeal of 1099. - HR 10/ S 299, "Regulations from the Executive in Need of Scrutiny Act", regarding provisions related to the "Patient Protection and Affordable Care Act". - Issues regarding the preservation of the tax exclusion for employer-sponsored insurance.

Client expense: $1,220,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America" State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011"; Multi-State Health Plans Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations; MLR Broker Fees: HR1206 "Access to Professional Health Insurance Act of 2011", S 2068 "Access to Independent Health Insurance Advisors Act of 2012" Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Age Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout

Client expense: $450,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011"; Multi-State Health Plans Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations; MLR Broker Fees: HR1206 "Access to Professional Health Insurance Act of 2011", S 2068 "Access to Independent Health Insurance Advisors Act of 2012" Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Age Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout

Client expense: $43,000 · Firm income: Not reported

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

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

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

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America" State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011"; Multi-State Health Plans Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations; MLR Broker Fees: HR1206 "Access to Professional Health Insurance Act of 2011", S 2068 "Access to Independent Health Insurance Advisors Act of 2012" Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Age Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout

Client expense: $35,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Issue Area: HCR - Health Issues Successful Insurance Industry Implementation of Health Reforms: reasonable regulatory implementation timeline for compliance with PL 111-148, Retail store Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America" State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011"; Multi-State Health Plans Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations; MLR Broker Fees: HR1206 "Access to Professional Health Insurance Act of 2011", S 2068 "Access to Independent Health Insurance Advisors Act of 2012" Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Age Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America" State-based regulation: State Oversight of Rates; Properly designated state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 'Health Care Choice Act of 2011"; Multi-State Health Plans Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations; MLR Broker Fees: HR1206 "Access to Professional Health Insurance Act of 2011", S 2068 "Access to Independent Health Insurance Advisors Act of 2012" Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Age Rating; Health Status Rating; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout

Client expense: Not reported · Firm income: Not reported

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

**see addendum page PL 111-148 - The Patient Protection and Affordable Care Act, implementation, health care reform H.R. 1206 - Access to Professional Health Insurance Advisors Act of 2011, MLR Broker Fee H.R. 371 - Health Care Choice Act of 2011, selling insurance across state lines S. 1049/H.R. 2676 - Small Business Health Relief Act, insurer excise tax H.R.1370 - to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act S. 1880 - the Jobs and Premium Protection Act, insurer excise tax ***, no specific bill(s), Health Savings Accounts/Medical Saving Accounts, Transparency, Health Information Technology, Electronic Prescribing, Insurance Market Reform, Government Plan Option, Uninsured, Employer Based Health System, Health Care Reform, Small Group Market Reform, Exchanges, Health Care Reform Implementation, Medical Loss Rates, Federal Employees' Health Benefits Program (FEHBP)

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

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

Successful Insurance Industry Implementation of Health Reforms: "Good faith compliance standard", reasonable effective dates for compliance with P.L. 111-148. State Oversight of Premium Increases: existing state regulatory functions; federal exchanges; state exchanges. Affordable Private Healthcare: Insurer Fees, Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits. Worked on H.R. 3675 Temporary Pay Reduction Act of 2011 provisions. Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Healthcare; Evidence Based Care. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings/Accounts/Medical Savings Accounts; Individual Mandate; MEWAs, H.R. 371 - Healthcare Choice Act of 2011.

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America" State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011" Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout; OPM IG's Statement on FEHBP audits Printed

Client expense: $400,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

See attached. Supported HR 144, S.18, and HR 4, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 to repeal a provision contained in HR 3590 (Patient Protection and Affordable Care Act) to expand IRS "Form 1099 filing requirements to include business reporting of all payments to corporations for goods or services in excess of $600, beginning in 2012. Monitored HR 371, the Health Care Choice Act of 2011, allowing purchasers to go online to shop for a health care policy. Monitored HR 1184, the Health Care Waiver Transparency Act of 2011.

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

Government targets: Bureau of Land Management (BLM), Commerce, Dept of (DOC), Defense, Dept of (DOD), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Highway Traffic Safety Administration (NHTSA), SENATE, U.S. Forest Service

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011" Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform: Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Actof 2012"; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout; OPM IG's Statement on FEHBP audits

Client expense: $44,500 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Successful Insurance Industry Implementation of Health Reforms: "Good faith compliance standard", reasonable effective dates for compliance with P.L. 111-148. State Oversight of Premium Increases: existing state regulatory functions; federal exchanges; state exchanges. Affordable Private Healthcare: Insurer Fees, Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits. Worked on H.R. 3675 Temporary Pay Reduction Act of 2011 provisions. Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Healthcare; Evidence Based Care. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings/Accounts/Medical Savings Accounts; Individual Mandate; MEWAs, H.R. 371 - Healthcare Choice Act of 2011.

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011" Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Electronic Health Records; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout

Client expense: $149,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America" State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011" Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout; OPM IG's Statement on FEHBP audits

Client expense: $2,040,000 · Firm income: Not reported

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

- PL 111-148, "Patient Protection & Affordable Care Act", regarding all provisions. - HR 371, "Health Care Choice Act of 2011", regarding all provisions. - HR 1206, "Access to Professional Health Insurance Advisors Act of 2011", regarding all provisions. - HR 3400, "Interstate Market for Health Insurance", regarding all provisions. - HR 4, "Small Business Paperwork mandate Elimination Act of 2011", regarding repeal of 1099. - HR 10/ S 299, "Regulations from the Executive in Need of Scrutiny Act", regarding provisions related to the "Patient Protection and Affordable Care Act". - Issues regarding the preservation of the tax exclusion for employer-sponsored insurance.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America" State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011" Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout; OPM IG's Statement on FEHBP audits

Client expense: $110,000 · Firm income: Not reported

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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011" Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans

Client expense: $45,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable regulatory implementation timeline for compliance with PL 111-148. Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America". State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011". Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine. Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans. Federal Employed Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout; OPM IG's Statement on FEHBP audits.

Client expense: $8,700 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum on General Issue Area Code: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Tax; Affordable Essential Health Benefits; Inextricable link between Individual Mandate and Insurance Reforms; Healthcare Delivery System Reforms; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America" State-based regulation: State Oversight of Rates; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; existing state regulatory functions; Selling Health Insurance across state lines: HR371 "Health Care Choice Act of 2011" Medical Loss Ratios: MLR Broker Fee; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management; Telemedicine Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts: HR5858 "Health Savings Accounts Improvement Act of 2012"; Individual Mandate; Association Health Plans Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM; HR 2309 "Postal Reform Act of 2011" sections pertaining to FEHBP; S1789 "21st Century Postal Service Act of 2012" sections pertaining to Postal Benefits carveout; OMB Postal Benefit Carveout; OPM IG's Statement on FEHBP audits

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES

**see addendum page PL 111-148 - The Patient Protection and Affordable Care Act, implementation, health care reform H.R. 1206 - Access to Professional Health Insurance Advisors Act of 2011, MLR Broker Fee H.R. 371 - Health Care Choice Act of 2011, selling insurance across state lines S. 1049/H.R. 2676 - Small Business Health Relief Act, insurer excise tax H.R.1370 - to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act S. 1880 - the Jobs and Premium Protection Act, insurer excise tax ***, no specific bill(s), Health Savings Accounts/Medical Saving Accounts, Transparency, Health Information Technology, Electronic Prescribing, Insurance Market Reform, Government Plan Option, Uninsured, Employer Based Health System, Health Care Reform, Small Group Market Reform, Exchanges, Health Care Reform Implementation, Medical Loss Rates, Federal Employees' Health Benefits Program (FEHBP)

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

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

**see addendum page PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 1206 - Access to Professional Health Insurance Advisors Act of 2011, MLR Broker Fee H.R. 371 - Health Care Choice Act of 2011, selling insurance across state lines S. 1049/H.R. 2676 - Small Business Health Relief Act, insurer excise tax H.R.1370 - to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act S. 1880 - the Jobs and Premium Protection Act, insurer excise tax S. 3187 - The Food and Drug Administration Safety and Innovation Act, e-prescribing ***, no specific bill(s), Health Savings Accounts/Medical Savings Accounts, Transparency, Health Information Technology, Electronic Prescribing, Insurance Market Reform, Uninsured, Employer Based Health System, Health Care Reform, Small Group Market Reform, Exchanges, Health Care Reform Implementation, Medical Loss Ratios

Client expense: Not reported · Firm income: $70,000

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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable regulatory implementation timeline for compliance with PL 111-148 Affordable Private Health Care: Health Insurance Excise Tax; Realistic Essential Health Benefits; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; BCBSA's proposal "Building Tomorrow's Healthcare System: The Pathway to High-Quality, Affordable Care in America" State-based regulation: State Oversight of Premium Increases; Properly designed state based health insurance exchanges to improve competition and maximize choice; federal exchanges; federal rate review; existing state regulatory functions; Selling Health Insurance across state lines: HR371 Health Care Choice Act of 2011; HR1213 "Repeal mandatory funding provided to States in the PPACA to Establish Benefit Exchanges"; HR5 "HEALTH Act of 2011" Medical Loss Ratios: MLR Broker Fee HR1206 Access to Professional Health Insurance Advisors Act of 2011; State Innovation Waivers; Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Health Care Quality: Delivery System Incentives to Promote Better Care; Payment Reforms; Patient-centered Primary Care/Medical Home; Comparative Effectiveness Research; Evidence Based Care; Health Disparities; Wellness; Chronic Care Management Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 implementation; Data Sharing; Data Aggregation; Centralized All-Payer Database Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM. Comprehensive Primary Care Initiative grant proposal from CMMI. HR4209 "Patient's Access to Treatments Act of 2012" HR3630 "Middle Class Tax Relief and Job Creation Act of 2012"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE