Rural Hospital and Provider Equity Act of 2012

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Tracking progress on the recommendations for changes in methodology for designating areas as underserved. Comments related to the OIG report on location requirments for Critical Access HospitalsRural issues included in the Craig Thomas Rural Hospital and Provider Equity Act Rural issues included in H.R. 3859, The Rural Hospital and Provider Equity Act Issues involving the development of alternative payment methodologies for rural hospitals, CAHs and other providers. Proposed changes in Critical Access Hospital location requirements Proposed limits on Critical Access Hospital payments

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

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Tracking progress on the recommendations for changes in methodology for designating areas as underserved. Comments related to the OIG report on location requirments for Critical Access HospitalsRural issues included in the Craig Thomas Rural Hospital and Provider Equity Act Rural issues included in H.R. 3859, The Rural Hospital and Provider Equity Act Issues involving the development of alternative payment methodologies for rural hospitals, CAHs and other providers. Proposed changes in Critical Access Hospital location requirements Proposed limits on Critical Access Hospital payments

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

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Tracking progress on the recommendations for changes in methodology for designating areas as underserved. Comments related to the OIG report on location requirments for Critical Access HospitalsRural issues included in the Craig Thomas Rural Hospital and Provider Equity Act Rural issues included in H.R. 3859, The Rural Hospital and Provider Equity Act Issues involving the development of alternative payment methodologies for rural hospitals, CAHs and other providers. Proposed changes in Critical Access Hospital location requirements Proposed limits on Critical Access Hospital payments

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

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

H.R. 1250, Medicare Audit Improvement Act of 2013, entire bill. H.R. 351/S. 351, Protecting Seniors' Access to Medicare Act of 2013, entire bill. H.R. 8, American Taxpayer Relief Act of 2012, entire bill with focus on Title VI and Title X.H.R. 4872, Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 1106: physician-owned hospitals and self-referral; Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States; Section 1202: Payments to primary care physicians. H.R. 3590, Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 6001: physician-owned hospital and self-referral; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3401: Independent Payment Advisory Board; Section 3015: hospital readmissions program; Section 3124: Extension of Medicare Dependent Hospital program; Section 3137: Section 508 Reclassification; Section 9007: non-profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: Primary Care Provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: Expansion of Medicaid, CHIP; Sections 1311-1343: CO-OPs and Exchanges; Section 3022: Accountable Care Organizations; Section 3023: Hospital Bundling Provision; Section 6401-6402: Program Integrity Provisions; Section 6501-6503, 6505, 6508: Medicaid Program Integrity Provisions; Section 3141: Changes to the Rural Floor of the Hospital Wage Index. S. 778 (introduced by 112th Congress), Protecting Access to Rural Therapy Services (PARTS) Act, entire bill. H.R. 3859 and S. 1680 (introduced by 112th Congress), Rural Hospital and Provider Equity (R-HOPE) Act of 2012, entire bills. H.R. 5943 and S. 2620 (introduced by 112th Congress), Rural Hospital Access Act of 2012, entire bills. H.R. 3630 (introduced by 112th Congress), Middle Class Tax Relief and Job Creation Act of 2011, Title II, Subtitle C--Medicare Extensions; Other Health Provisions, Part 1--Medicare extensions, Section 2201, Physician payment update. Section 2202: Ambulance Add-ons; Section 2203: Medicare payment for outpatient therapy services; Section 2204: Work geographic Adjustment; Part 3--Offsets, Section 2223: Parity in Medicare payments for hospital outpatient department evaluation and management office visit services; Section 2224, Reduction of bad debt treated as an allowable cost; Section 2225, Rebasing of State DSH allotments for FY 2021. Part 2 of Subtitle C--Other Health Provisions, Section 2213: Modification to requirements for qualifying for exception to Medicare prohibition on certain physician referrals for hospitals. H.R. 3630 (introduced by 112th Congress), Middle Class Tax Relief and Job Creation Act of 2012, entire bill. Other issues: Hospice payment reform. Hospice Quality Reporting Program. Medicare and Medicaid Recovery Audit Contractor programs, including CMS' proposed changes to the rebilling policy for hospitals, CMS1455P. Geographic Variation in Medicare spending, IOM studies on high value and Medicare geographic adjusters. Medicare and Medicaid Electronic Health Record Payment Incentive Programs. Hospital wage index reform, including Section 3137(b) of the Affordable Care Act, and Section 508 reclassification policy. 2013 Outpatient Prospective Payment System rule, entire rule. Proposals surrounding the Sustainable Growth Rate (SGR) and deficit/debt reduction as related to hospitals and physicians. Accountable Care Organizations and the Innovation Center's demonstration programs. Implementation of the state health insurance exchanges. Dual Eligible Demonstration Programs. CMS proposed rule to reduce regulatory burden for Medicare & Medicaid providers (CMS 3267-P). 340B Drug Discount Program. Medicaid provider taxes. CRNA payment issues. CMS' policy relating to the physician supervision of outpatient therapeutic services.

Client expense: $56,484 · Firm income: Not reported

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Progress on the negotiated rulemaking committee recommendations for changes in methodology for designating areas as underserved.Rural issues included in S. 1680, the Craig Thomas Rural Hospital and Provider Equity Act of 2011 Rural issues included in H.R. 3859, The Rural Hospital and Provider Equity Act of 2012 Issues involving the development of alternative payment methodologies for rural hospitals, CAHs and other providers. Issues surrounding potential sequestration of federal money and alternatives to sequestration extension of various Medicare provisions affecting small and rural hospitals

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

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

Legislation and issues related to: Physician/nurse reimbursement; Accountable Care Organizations; Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Graduate Nurse Education demonstration; Home health face-to-face examination requirements; Medicare-Medicaid Program Integrity policies; Ordering of Medicare portable x-ray services; Provisions of the 2013 Medicare physician payment proposed rule; Medicaid payment for primary care services; S. 227/H.R. 2267 - Home Health Care Planning Improvement Act; S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3859 - Rural Hospital and Provider Equity Act; H.R. 5979 - Medicaid Accountability and Care (MAC) Act; H.R. 6079 - Repeal of Obamacare Act; H.R. 8 - American Taxpayer Relief Act.

Client expense: Not reported · Firm income: $15,000

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

Legislation and issues related to: Physician/nurse reimbursement; Medicare Medical Home; Medicaid Health Home; Medicare-Medicaid Advanced Primary Care demonstration; Accountable Care Organizations; Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Repeal/retention of Medicaid maintenance of effort requirements; Graduate Nurse Education demonstration; Home health face-to-face examination requirements; Medicare-Medicaid Program Integrity policies; Independent Payment Advisory Board (IPAB); Medicare-Medicaid hospital conditions of participation; Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges; Medicaid waiver application procedures; State of Florida Section 1115 Medicaid waiver application on managed medical assistance program; Medicare-Medicaid dual eligibles coverage and demonstration; Ordering of Medicare portable x-ray services; Provisions of the 2013 Medicare physician payment proposed rule; Medicaid per capita cap policy options; Medicaid payment for primary care services; Medicaid eligibility expansion and state options; Social Security Administration policies on primary medical evidence of disability; H.R. 2 - Repealing the Job-Killing Health Care Law Act; S. 16 - Patient Choice Restoration Act; S. 56/H.R. 2134 - Medicaid Advanced Practice Nurses and Physician Assistants Access Act; S. 58/H.R. 876 - Registered Nurse Safe Staffing Act; S. 227/H.R. 2267 - Home Health Care Planning Improvement Act; S. 244/H.R. 782 - State Health Care Flexibility Act; H.R. 560 - Rural Representation and Transparency Improvement Act; H.R. 452 - Medicare Decisions Accountability Act; S. 668 - Health Care Bureaucrats Elimination Act; S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3859 - Rural Hospital and Provider Equity Act; H.R. 3630/H.R. 3743/H.R. 3765 - Temporary Payroll Tax Cut Continuation Act; H.R. 3326/S. 1587 - Medicaid Flexibility for States Act; H.R. 4160 - State Health Flexibility Act; S. 2057 - To amend Title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs. H.R. 5979 - Medicaid Accountability and Care (MAC) Act; H.R. 436 - Health Care Cost Reduction Act; H.R. 5707 - Medicare Physician Payment Innovation Act; H.R. 4348 - MAP-21 and offsets for student loan interest rate provisions; H.R. 6079 - Repeal of Obamacare Act; H.R. 6684 - Spending Reduction Act; H.R. 8 - American Taxpayer Relief Act.

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

Legislation and issues related to: Physician/nurse reimbursement; Medicare Medical Home; Medicaid Health Home; Medicare-Medicaid Advanced Primary Care demonstration; Accountable Care Organizations; Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Repeal/retention of Medicaid maintenance of effort requirements; Graduate Nurse Education demonstration; Home health face-to-face examination requirements; Coverage and payment for CPT code 96110; Medicare-Medicaid Program Integrity policies; Independent Payment Advisory Board (IPAB); Medicare-Medicaid hospital conditions of participation; Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges; Medicaid waiver application procedures; State of Florida Section 1115 Medicaid waiver application on managed medical assistance program; Medicare-Medicaid dual eligibles coverage and demonstration; Ordering of Medicare portable x-ray services; Provisions of the 2013 Medicare physician payment proposed rule; Medicaid per capita cap policy options; Medicaid payment for primary care services; Medicaid eligibility expansion and state options; Social Security Administration policies on primary medical evidence of disability; H.R. 2 - Repealing the Job-Killing Health Care Law Act; S. 16 - Patient Choice Restoration Act; S. 56/H.R. 2134 - Medicaid Advanced Practice Nurses and Physician Assistants Access Act; S. 58/H.R. 876 - Registered Nurse Safe Staffing Act; S. 227/H.R. 2267 - Home Health Care Planning Improvement Act; S. 244/H.R. 782 - State Health Care Flexibility Act; H.R. 560 - Rural Representation and Transparency Improvement Act; H.R. 452 - Medicare Decisions Accountability Act; S. 668 - Health Care Bureaucrats Elimination Act; S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3859 - Rural Hospital and Provider Equity Act; H.R. 3630/H.R. 3743/H.R. 3765 - Temporary Payroll Tax Cut Continuation Act; H.R. 3326/S. 1587 - Medicaid Flexibility for States Act; H.R. 4160 - State Health Flexibility Act; S. 2057 - To amend Title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs; H.R. 340 - Amending title XIX (Medicaid) of the Social Security Act to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases; H.R. 669 - Ensuring Continuous Medicaid Coverage for Children Act; H.R. 671 - Ensuring Continuous Coverage under SCHIP Act H.R. 5979 - Medicaid Accountability and Care (MAC) Act; H.R. 436 - Health Care Cost Reduction Act; H.R. 5707 - Medicare Physician Payment Innovation Act; H.R. 4348 - MAP-21 and offsets for student loan interest rate provisions; H.R. 6079 - Repeal of Obamacare Act; H.R. 6684 - Spending Reduction Act; H.R. 8 - American Taxpayer Relief Act.

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

Oppose home health and hospice payment cuts and co-pays. Legislative and regulatory proposals affecting home care and hospice. S. 659/H.R. 6059, Home Health Care Access Protection Act of 2012. S. 501, Fostering Independence Through Technology Act of 2011. S. 227/H.R. 2267, Home Health Care Planning Improvement Act of 2011. H.R. 3859, Rural Hospital and Provider Equity Act of 2012, sections 11, 13, and 16. Implementation of P.L. 111-5, American Recovery and Reinvestment Act of 2009, provisions relating to technology. S. 722/H.R. 3506, Hospice Evaluation and Legitimate Payment Act. H.R. 452, Medicare Decisions Accountability Act of 2011. S. 668, Health Care Bureaucrats Elimination Act. Skilled Home Health Integrity and Program Savings Act of 2011 (SHHIPS) (draft legislation). S. 1680, Craig Thomas Rural Hospital and Provider Equity Act of 2011, sections 12, 13, 15, and 19. H.R. 5, Protecting Access to Healthcare Act, sections 201 and 202. H.R. 8, American Taxpayer Relief Act of 2012, opposing home care and hospice cuts.

Client expense: $350,000 · Firm income: Not reported

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

HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 and HR 2783 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 1398 Rural Hospital Protection Act, legislation which would amend the Social Security Act to ensure that the full cost of certain provider taxes are considered allowable costs for purposes of Medicare reimbursements to CAHs; S 1486 Long-Term Care Hospital Improvement Act of 201, a bill to amend title XVIII of the Social Security Act to clarify and expand on criteria applicable to patient admission to and care furnished in long-term care hospitals participating in the Medicare program; Raising concerns about CMS flawed methodology that overstates the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to improve the regulation to implement ACOs; Urging CMS to update, streamline, and modernize the Medicare conditions of participation; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expired in September 2011, and the bills would reauthorize the CHGME program for an additional five years, through fiscal year (FY) 2016, at the current authorization level of up to $330 million a year; HR 1683/ S 868 Medicaid MOE, strikes provisions of ACA related to maintaining Medicaid eligibility levels; HR 1543 Improving Access to Medicare Coverage Act of 2011, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare; S 1251Medicare and Medicaid FAST Act, a bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs; HR 2500 Equal Access and Parity for Multi-Campus Hospitals Act, a bill to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 2674 340B Program Improvement Act, a bill to amend section 340B of the Public Health Service Act to improve the provision of discounts on drug purchases for certain safety net providers; HR 3630 Temporary Payroll Tax Cut Continuation Act of 2011 or Middle Class Tax Relief and Job Creation Act of 2011, a bill that cuts hospitals to pay for the doc fix, it contains the Social Security payroll tax cut and the Unemployment Insurance extension; HR 3519 a bill to amend and exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011; S. 1680 Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act of 2011, a bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program; Letter to Rehberg and DeLauro in support of the CHGME program that was circulated by Reps. Capps and Bilbray; Wyden/Crapo letter to CMS to actively oppose a Senate Dear Colleague letter to CMS in support of updating Medicare payments to ambulatory surgery centers (ASCs). The letter did not request a payment update for ASCs. Rather, the letter advocated against the Medicare payment rate for services provided in hospital outpatient department settings; HR 2954 and S 2474 Health Equity and Accountability Act of 2011, Comprehensive bill focused on eliminating racial and ethnic disparities in health care through improved data collection and reporting, culturally and linguistically-appropriate health care, workforce diversity, health information technology, and other actions; Discussions with the Administration (CMS) on applying the therapy cap to hospital outpatient departments; Worked to change CMS definition of allowed EHR costs for CAH Meaningful Use incentive payments to include capital lease purchases of EHRs; HR 3859 Rural Hospital and Provider Equity (R-HOPE) Act of 2012, to amend title XVIII of the SSA to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program; HR 4245 Veterans Co-Pay Fairness Act, to amend title 38, United States Code, to require the Secretary of Veterans Affairs to reimburse eligible veterans who are entitled to Medicare benefits for Medicare deductibles and other expenses that are owed by the veterans for emergency medical treatment provided in non-Department of Veterans affairs facilities; S 2620 and HR 5943 Rural Hospital Access Act of 2012, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; S 3187 and HR 5651Prescription Drug User Fee Amendments of 2012, a bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs and medical devices, to establish user-fee programs for generic drugs and biosimilars; H.R.6575 Medicare Audit Improvement Act of 2012 to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Urging HHS and OIG to examine error rates of RAC as part of its Workplan for 2013 studies of RAC effectiveness.

Client expense: $5,350,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

H.R. 8, American Taxpayer Relief Act of 2012, entire bill with focus on Title VI and Title X. H.R. 6575, Medicare Audit Improvement Act, entire bill. H.R. 6611, Patient Access to Drugs in Shortage Act of 2012, entire bill. H.R. 1543 and S. 818, Improving Access to Medicare Coverage Act of 2011, entire bill. H.R. 6684, Spending Reduction Act of 2012, entire bill with focus on Title II and Title VII. H.R. 4872, Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 1106: physician-owned hospitals and self-referral; Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States; Section 1202: Payments to primary care physicians. H.R. 3590, Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 6001: physician-owned hospital and self-referral; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3401: Independent Payment Advisory Board; Section 3015: hospital readmissions program; Section 3124: Extension of Medicare Dependent Hospital program; Section 3137: Section 508 Reclassification; Section 9007: non-profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: Primary Care Provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: Expansion of Medicaid, CHIP; Sections 1311-1343: CO-OPs and Exchanges; Section 3022: Accountable Care Organizations; Section 3023: Hospital Bundling Provision; Section 6401-6402: Program Integrity Provisions; Section 6501-6503, 6505, 6508: Medicaid Program Integrity Provisions; Section 3141: Changes to the Rural Floor of the Hospital Wage Index. H.R. 2674, 340B Program Improvement Act, entire bill. S. 722 and H.R. 3506, Hospice Evaluation and Legitimate Payment Act, entire bills. S. 778, Protecting Access to Rural Therapy Services (PARTS) Act, entire bill. H.R. 3859 and S. 1680, Rural Hospital and Provider Equity (R-HOPE) Act of 2012, entire bills. H.R. 5943 and S. 2620, Rural Hospital Access Act of 2012, entire bills. H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2011, Title II, Subtitle C--Medicare Extensions; Other Health Provisions, Part 1--Medicare extensions, Section 2201, Physician payment update. Section 2202: Ambulance Add-ons; Section 2203: Medicare payment for outpatient therapy services; Section 2204: Work geographic Adjustment; Part 3--Offsets, Section 2223: Parity in Medicare payments for hospital outpatient department evaluation and management office visit services; Section 2224, Reduction of bad debt treated as an allowable cost; Section 2225, Rebasing of State DSH allotments for FY 2021. Part 2 of Subtitle C--Other Health Provisions, Section 2213: Modification to requirements for qualifying for exception to Medicare prohibition on certain physician referrals for hospitals. H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2012, entire bill. Other issues: 2013 Outpatient Prospective Payment System rule, entire rule. 2013 Inpatient Prospective Payment System rule, entire rule. 2013 Physician Fee Schedule rule, entire rule. Proposals surrounding the Sustainable Growth Rate (SGR) and deficit/debt reduction as related to hospitals and physicians. Accountable Care Organizations and the Innovation Center's demonstration programs. Medicare and Medicaid Recovery Audit Contractor programs. Geographic Variation in Medicare spending, IOM studies on high value and Medicare geographic adjusters. Medical Liability Reform. Medicare and Medicaid Electronic Health Record Payment Incentive Programs. Hospital wage index reform, including Section 3137(b) of the Affordable Care Act. Implementation of the state health insurance exchanges. 2013 Inpatient Rehab rule, entire rule. 2013 LTCH rule, entire rule Hospice Quality Reporting Program. 2013 Home Health rule, entire rule. Dual Eligible Demonstration Programs.

Client expense: $53,327 · Firm income: Not reported

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

H.R.8: American Taxpayer Relief Act of 2012; H.R.6352: Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transfer Act; H.R.6575: The Medicare Audit Improvement Act of 2012; H.J. Res.66: Permanent Tax Relief for Families and Small Businesses Act of 2012; S. 958 Children's Hospital GME Support Reauthorization Act of 2011 S. 2620/H.R. 5943, Rural Hospital Access Act (MDH/LV Adjustment 1-year extension) S. 1680/H.R. 3859, Craig Thomas Rural Hospital and Provider Equity (R-HOPE) Act S.1627/H.R. 6562, Resident Physician Shortage Reduction Act (Medicare residency slots) Medicare physician fee schedule fix Medicare and Medicaid Recovery Audit Contractor (RAC) Programs New York State 1115 Medicaid Waiver Application to CMS Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, inpatient coding offset, outpatient department hold harmless for certain rural and Sole Community Hospitals, hospital outpatient department (HOPD) evaluation and management (E/M) services, and Medicaid provider taxes. Medicare and Medicaid Programs; Electronic Health Record Incentive ProgramStage 2; Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology; Final Rules (CMS and ONC Medicare and Medicaid EHR Meaningful Use Incentive Program Stage 2 final rules) Issues related to Superstorm Sandy and the supplemental appropriations bills

Client expense: $210,000 · Firm income: Not reported

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

S. 3295, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013: health care information technology funding and projects. Executive agency action: promote regional electronic health record demonstration and telehealth. H.R. 3859, Rural Hospital and Provider Equity Act of 2012 (entire bill). CONTINUED ON NEXT PAGE..... H.R. 3667, Primary Care Workforce Access Improvement Act of 2011 (entire bill). H.R. 8, American Taxpayer Relief Act of 2012: Medicare reimbursement and hospital rehabilitation rates.

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

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE

H.R. 5652, Sequester Replacement Reconciliation Act (Medicaid provider taxes) Medicare physician fee schedule fix Medicare hospital wage index H.R. 3519, To exempt the Medicaqre program from fallback sequestration under the Budget Control Act of 2011 Medicaid provider taxes Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, CAH payments, IPPS coding offset, rural hospital payments, section 508 wage index reclassification, Medicare Dependent Hospital authorization, inpatient coding offset, small rural clinical hold harmless, Sole Community Hospital (SCH) outpatient department hold harmless, outpatient therapy cap moratorium, and hospital outpatient department (HOPD) evaluation and management (E/M) service. H.R. 3519, To exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011 S. 2620/H.R. 5943, Rural Hospital Access Act (MDH/LV Adjustment 1-year extension) S. 1680/H.R. 3859, Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act H.R. 2224, Improving Physician Access to Teaching Hospitals Act (Medicare residency slots) S.1627/H.R. 6562, Resident Physician Shortage Reduction Act (Medicare residency slots) H.R. 452, Medicare Decisions Accountability Act of 2011 (IPAB repeal) Medicare and Medicaid Programs; Electronic Health Record Incentive ProgramStage 2; Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology; Final Rules (CMS and ONC Medicare and Medicaid EHR Meaningful Use Incentive Program Stage 2 final rules) New York State 1115 Medicaid Waiver Application to CMS Medicare and Medicaid Recovery Audit Contractor (RAC) Programs

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Progress on the negotiated rulemaking committee recommendations for changes in methodology for designating areas as underserved. Rural issues included in S. 1680, the Craig Thomas Rural Hospital and Provider Equity Act of 2011 Rural issues included in H.R. 3859, The Rural Hospital and Provider Equity Act of 2012 Issues involving the development of alternative payment methodologies for rural hospitals, CAHs and other providers. Issues surrounding potential sequestration of federal money and alternatives to sequestration extension of various Medicare provisions affecting small and rural hospitals

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

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

H.R. 452, Medicare Decisions Accountability Act of 2011 - Independent Payment Advisory Board (IPAB) Repeal S. 668, Health Care Bureaucrats Elimination Act H.R. 1044, Medicare Access to Rural Anesthesiology Act: Rural Pass Through S.1680, Craig Thomas Rural Hospital and Provider Equity Act of 2011 S. 848, Consumer Information Enhancement Act of 2011, Physician Data Reporting S. 454, Strengthening Program Integrity in Health Care Act of 2011 H.R. 3859, Rural Hospital and Provider Equity Act of 2012 Budget Control Act of 2011: P.L. 112-25 H.R. 3630, Temporary Payroll Tax Cut Continuation Act of 2011, SGR Issue H.CON.RES.34, Establishing the budget for the United States Government for fiscal year 2012 and setting forth appropriate budgetary levels for fiscal years 2013 through 2021 - Medicare premium support issue H.R. 2560, Cut, Cap, and Balance Act of 2011 - Medicare Physician Payment issues H.R. 5, Protecting Access to Healthcare Act: Independent Payment Advisory Board Historical Medicare payment undervaluation for anesthesiology services (33% problem) Anesthesia Conversion Factor Perioperative Surgical Home (TM) Model Medicare Reform, Payment Issues: Medicare Sustainable Growth Rate repeal Bundled payments CMS Interpretive Guidelines: Hospital Conditions of Participation Related to Anesthesia Services 2013 Medicare Payment Rule - Revisions to payment policies under the Physician Fee Schedule - Chronic Pain/CRNA Scope of Benefit CMS Value-Based purchasing CMS Medicare Data Final Rule CMS Proposed Rule on Sunshine Act CMS Reporting and Returning of Overpayments Conditions of Participation - Anesthesia services, opt-outs, supervision Physician Quality Reporting System, PPACA, Sec. 3007 Quality Modifier implementation President Obama's deficit reduction plans, IPAB cuts MedPAC nominations Accountable Care Organizations Graduate Medical Education Cuts Medicare Local Coverage Determinations HHS Plan for Retrospective Review of Existing Rules 2011 - Conditions of Participation Value-based modifier - PPACA Debt ceiling- Medicare sequestration

Client expense: $230,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE

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

Client expense: $3,550,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Office of Management & Budget (OMB), SENATE, White House Office

S. 659/H.R. 6059, Home Health Care Access Protection Act of 2012. S. 501, Fostering Independence Through Technology Act of 2011. S. 227/H.R. 2267, Home Health Care Planning Improvement Act of 2011. H.R. 3859, Rural Hospital and Provider Equity Act of 2012, sections 11, 13, and 16. P.L. 111-5, American Recovery and Reinvestment Act of 2009, provisions relating to technology. S. 722/H.R. 3506, Hospice Evaluation and Legitimate Payment Act. H.R. 452, Medicare Decisions Accountability Act of 2011. S. 668, Health Care Bureaucrats Elimination Act. Skilled Home Health Integrity and Program Savings Act of 2011 (SHHIPS) (draft legislation). S. 1680, Craig Thomas Rural Hospital and Provider Equity Act of 2011, sections 12, 13, 15, and 19. H.R. 5, Protecting Access to Healthcare Act, sections 201 and 202. H.Con.Res. 112, FY2013 Budget Resolution, provisions related to Medicare and Medicaid/payment for home health and hospice.

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

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

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

Client expense: Not reported · Firm income: Not reported

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

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

Client expense: $190,000 · Firm income: Not reported

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

S. 3295, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013: health care information technology funding and projects. Executive agency action: promote regional electronic health record demonstration and telehealth. H.R. 3859, Rural Hospital and Provider Equity Act of 2012 (entire bill). CONTINUED ON NEXT PAGE..... H.R. 3667, Primary Care Workforce Access Improvement Act of 2011 (entire bill).

Client expense: Not reported · Firm income: $50,000

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE, Transportation, Dept of (DOT)

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Tracking progress on the recommendations for changes in methodology for designating areas as underserved. Rural issues included in the Craig Thomas Rural Hospital and Provider Equity Act Rural issues included in H.R. 3859, The Rural Hospital and Provider Equity Act Issues involving the development of alternative payment methodologies for rural hospitals, CAHs and other providers. Issues surrounding potential sequestration of federal money and alternatives to sequestration.

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

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

Legislation and issues related to: Physician/nurse reimbursement; Medicare Medical Home; Medicaid Health Home; Medicare-Medicaid Advanced Primary Care demonstration; Accountable Care Organizations; Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Repeal/retention of Medicaid maintenance of effort requirements; Graduate Nurse Education demonstration; Home health face-to-face examination requirements; Coverage and payment for CPT code 96110; Medicare-Medicaid Program Integrity policies; Independent Payment Advisory Board (IPAB); Medicare-Medicaid hospital conditions of participation; Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges; Medicaid waiver application procedures; State of Florida Section 1115 Medicaid waiver application on managed medical assistance program; Medicare-Medicaid dual eligibles coverage and demonstration; Ordering of Medicare portable x-ray services; Provisions of the 2013 Medicare physician payment proposed rule; Medicaid per capita cap policy options; Medicaid payment for primary care services; Medicaid eligibility expansion and state options; Social Security Administration policies on primary medical evidence of disability; H.R. 2 - Repealing the Job-Killing Health Care Law Act; S. 16 - Patient Choice Restoration Act; S. 56/H.R. 2134 - Medicaid Advanced Practice Nurses and Physician Assistants Access Act; S. 58/H.R. 876 - Registered Nurse Safe Staffing Act; S. 227/H.R. 2267 - Home Health Care Planning Improvement Act; S. 244/H.R. 782 - State Health Care Flexibility Act; H.R. 560 - Rural Representation and Transparency Improvement Act; H.R. 452 - Medicare Decisions Accountability Act; S. 668 - Health Care Bureaucrats Elimination Act; S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3859 - Rural Hospital and Provider Equity Act; H.R. 3630/H.R. 3743/H.R. 3765 - Temporary Payroll Tax Cut Continuation Act; H.R. 3326/S. 1587 - Medicaid Flexibility for States Act; H.R. 4160 - State Health Flexibility Act; S. 2057 - To amend Title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs; H.R. 340 - Amending title XIX (Medicaid) of the Social Security Act to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases; H.R. 669 - Ensuring Continuous Medicaid Coverage for Children Act; H.R. 671 - Ensuring Continuous Coverage under SCHIP Act H.R. 5979 - Medicaid Accountability and Care (MAC) Act; H.R. 436 - Health Care Cost Reduction Act; H.R. 5707 - Medicare Physician Payment Innovation Act; H.R. 4348 - MAP-21 and offsets for student loan interest rate provisions; H.R. 6079 - Repeal of Obamacare Act.

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

Legislation and issues related to: Physician/nurse reimbursement; Medicare Medical Home; Medicaid Health Home; Medicare-Medicaid Advanced Primary Care demonstration; Accountable Care Organizations; Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Repeal/retention of Medicaid maintenance of effort requirements; Graduate Nurse Education demonstration; Home health face-to-face examination requirements; Medicare-Medicaid Program Integrity policies; Independent Payment Advisory Board (IPAB); Medicare-Medicaid hospital conditions of participation; Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges; Medicaid waiver application procedures; State of Florida Section 1115 Medicaid waiver application on managed medical assistance program; Medicare-Medicaid dual eligibles coverage and demonstration; Ordering of Medicare portable x-ray services; Provisions of the 2013 Medicare physician payment proposed rule; Medicaid per capita cap policy options; Medicaid payment for primary care services; Medicaid eligibility expansion and state options; Social Security Administration policies on primary medical evidence of disability; H.R. 2 - Repealing the Job-Killing Health Care Law Act; S. 16 - Patient Choice Restoration Act; S. 56/H.R. 2134 - Medicaid Advanced Practice Nurses and Physician Assistants Access Act; S. 58/H.R. 876 - Registered Nurse Safe Staffing Act; S. 227/H.R. 2267 - Home Health Care Planning Improvement Act; S. 244/H.R. 782 - State Health Care Flexibility Act; H.R. 560 - Rural Representation and Transparency Improvement Act; H.R. 452 - Medicare Decisions Accountability Act; S. 668 - Health Care Bureaucrats Elimination Act; S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3859 - Rural Hospital and Provider Equity Act; H.R. 3630/H.R. 3743/H.R. 3765 - Temporary Payroll Tax Cut Continuation Act; H.R. 3326/S. 1587 - Medicaid Flexibility for States Act; H.R. 4160 - State Health Flexibility Act; S. 2057 - To amend Title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs. H.R. 5979 - Medicaid Accountability and Care (MAC) Act; H.R. 436 - Health Care Cost Reduction Act; H.R. 5707 - Medicare Physician Payment Innovation Act; H.R. 4348 - MAP-21 and offsets for student loan interest rate provisions; H.R. 6079 - Repeal of Obamacare Act.

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

Legislation and issues related to: Physician/nurse reimbursement; Accountable Care Organizations; Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Graduate Nurse Education demonstration; Home health face-to-face examination requirements; Medicare-Medicaid Program Integrity policies; Ordering of Medicare portable x-ray services; Provisions of the 2013 Medicare physician payment proposed rule; Medicaid payment for primary care services; S. 227/H.R. 2267 - Home Health Care Planning Improvement Act; S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3859 - Rural Hospital and Provider Equity Act; H.R. 5979 - Medicaid Accountability and Care (MAC) Act; H.R. 6079 - Repeal of Obamacare Act.

Client expense: Not reported · Firm income: $7,500

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

H.R. 1543 and S. 818, Improving Access to Medicare Coverage Act of 2011, entire bill. H.R. 6365, the National Security and Job Protection Act of 2011, entire bill. H.R. 4872, the Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 1106: physician-owned hospitals and self-referral; Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States; Section 1202: Payments to primary care physicians. H.R. 3590, the Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 6001: physician-owned hospital and self-referral; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3401: Independent Payment Advisory Board; Section 3015: hospital readmissions program; Section 3124: Extension of Medicare Dependent Hospital program; Section 3137: Section 508 Reclassification; Section 9007: non-profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: Primary Care Provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: Expansion of Medicaid, CHIP; Sections 1311-1343: CO-OPs and Exchanges; Section 3022: Accountable Care Organizations; Section 3023: Hospital Bundling Provision; Section 6401-6402: Program Integrity Provisions; Section 6501-6503, 6505, 6508: Medicaid Program Integrity Provisions. H.R. 2674, 340B Program Improvement Act, entire bill. S. 722 and H.R. 3506, Hospice Evaluation and Legitimate Payment Act, entire bills. S. 778, Protecting Access to Rural Therapy Services (PARTS) Act, entire bill. H.R. 3285, Medicare Equity Extension Act, entire bill. H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2011, Title II, Subtitle C--Medicare Extensions; Other Health Provisions, Part 1--Medicare extensions, Section 2201, Physician payment update. Section 2202: Ambulance Add-ons; Section 2203: Medicare payment for outpatient therapy services; Section 2204: Work geographic Adjustment; Part 3--Offsets, Section 2223: Parity in Medicare payments for hospital outpatient department evaluation and management office visit services; Section 2224, Reduction of bad debt treated as an allowable cost; Section 2225, Rebasing of State DSH allotments for FY 2021. Part 2 of Subtitle C--Other Health Provisions, Section 2213: Modification to requirements for qualifying for exception to Medicare prohibition on certain physician referrals for hospitals. H.R. 3859 and S. 1680, The Rural Hospital and Provider Equity (R-HOPE) Act of 2012, entire bills. H.R. 3630, The Middle Class Tax Relief and Job Creation Act of 2012, entire bill. H.R. 5943 and S. 2620, the Rural Hospital Access Act of 2012, entire bills. H.R. 2461, Physician Pathology Services Continuity Act of 2011, entire bill. H.R. 2104, Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2011, entire bill. 2013 Outpatient Prospective Payment System proposed rule, entire rule. 2013 Inpatient Prospective Payment System final rule, entire rule. 2013 Physician Fee Schedule proposed rule, entire rule. Other issues: Proposals surrounding the Sustainable Growth Rate (SGR) and deficit/debt reduction as related to hospitals and physicians. Accountable Care Organizations and the Innovation Center's demonstration programs. Medicare and Medicaid Recovery Audit Contractor programs. Geographic Variation in Medicare spending, IOM studies on high value and Medicare geographic adjusters. Medical Liability Reform. Medicare and Medicaid Electronic Health Record Payment Incentive Programs. Hospital wage index reform, including Section 3137(b) of the Affordable Care Act. Implementation of the state health insurance exchanges. 2013 Inpatient Rehab rule, entire rule. 2013 LTCH rule, entire rule Hospice Quality Reporting Program. 2013 Home Health rule, entire rule. Dual Eligible Demonstration Programs.

Client expense: $50,463 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE

H.R. 452, Medicare Decisions Accountability Act of 2011 - Independent Payment Advisory Board (IPAB) Repeal S. 668, Health Care Bureaucrats Elimination Act H.R. 1044, Medicare Access to Rural Anesthesiology Act: Rural Pass Through S.1680, Craig Thomas Rural Hospital and Provider Equity Act of 2011 S. 848, Consumer Information Enhancement Act of 2011, Physician Data Reporting S. 454, Strengthening Program Integrity in Health Care Act of 2011 H.R. 3859, Rural Hospital and Provider Equity Act of 2012 Budget Control Act of 2011: P.L. 112-25 H.R. 3630, Temporary Payroll Tax Cut Continuation Act of 2011, SGR Issue H.CON.RES.34, Establishing the budget for the United States Government for fiscal year 2012 and setting forth appropriate budgetary levels for fiscal years 2013 through 2021 - Medicare premium support issue H.R. 2560, Cut, Cap, and Balance Act of 2011 - Medicare Physician Payment issues H.R. 5, Protecting Access to Healthcare Act: Independent Payment Advisory Board H.R. 5707, Physician Payment Innovation Act of 2012 Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, CY 2013: Certified Registered Nurse Anesthetists and Chroni Pain Management Services Historical Medicare payment undervaluation for anesthesiology services (33% problem) Anesthesia Conversion Factor Perioperative Surgical Home (TM) Model Medicare Reform, Payment Issues: Medicare Sustainable Growth Rate repeal Bundled payments CMS Interpretive Guidelines: Hospital Conditions of Participation Related to Anesthesia Services CMS Value-Based purchasing CMS Medicare Data Final Rule CMS Proposed Rule on Sunshine Act CMS Reporting and Returning of Overpayments Conditions of Participation - Anesthesia services, opt-outs, supervision Physician Quality Reporting System, PPACA, Sec. 3007 Quality Modifier implementation President Obama's deficit reduction plans, IPAB cuts MedPAC nominations Accountable Care Organizations Graduate Medical Education Cuts Medicare Local Coverage Determinations HHS Plan for Retrospective Review of Existing Rules 2011 - Conditions of Participation Value-based modifier - PPACA Debt ceiling- Medicare sequestration

Client expense: $120,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE

The importance of maintaining State based licensure; H.R. 3859 - Rural Hospital and Provider Equity Act of 2012; S. 1680-Craig Thomas Rural Hospital and Provider Equity Act of 2011; H.R. 6107 - Veterans E-Health & Telemedicine Support Act of 2012

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 659/H.R. 6059, Home Health Care Access Protection Act of 2012. S. 501, Fostering Independence Through Technology Act of 2011. S. 227/H.R. 2267, Home Health Care Planning Improvement Act of 2011. H.R. 3859, Rural Hospital and Provider Equity Act of 2012, sections 11, 13, and 16. P.L. 111-5, American Recovery and Reinvestment Act of 2009, provisions relating to technology. S. 722/H.R. 3506, Hospice Evaluation and Legitimate Payment Act. H.R. 452, Medicare Decisions Accountability Act of 2011. Skilled Home Health Integrity and Program Savings Act of 2011 (SHHIPS) (draft legislation). S. 1680, Craig Thomas Rural Hospital and Provider Equity Act of 2011, sections 12, 13, 15, and 19. H.R. 5, Protecting Access to Healthcare Act, sections 201 and 202. H.Con.Res. 112, FY2013 Budget Resolution, provisions related to Medicare and Medicaid/payment for home health and hospice.

Client expense: $270,000 · Firm income: Not reported

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

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

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

Client expense: $4,150,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Office of Management & Budget (OMB), SENATE, White House Office

Legislation and issues related to: Physician/nurse reimbursement; Medicare Medical Home; Medicaid Health Home; Medicare-Medicaid Advanced Primary Care demonstration; Accountable Care Organizations; Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Repeal/retention of Medicaid maintenance of effort requirements; Graduate Nurse Education demonstration; Home health face-to-face examination requirements; Coverage and payment for CPT code 96110; Medicare-Medicaid Program Integrity policies; Independent Payment Advisory Board (IPAB); Medicare-Medicaid hospital conditions of participation; Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges; Medicaid waiver application procedures; State of Florida Section 1115 Medicaid waiver application on managed medical assistance program; Medicare-Medicaid dual eligibles coverage and demonstration; Ordering of Medicare portable x-ray services; Medicaid per capita cap policy options; Medicaid payment for primary care services; Medicaid eligibility expansion and state options; Social Security Administration policies on primary medical evidence of disability; H.R. 2 - Repealing the Job-Killing Health Care Law Act; S. 16 - Patient Choice Restoration Act; S. 56/H.R. 2134 - Medicaid Advanced Practice Nurses and Physician Assistants Access Act; S. 58/H.R. 876 - Registered Nurse Safe Staffing Act; S. 227/H.R. 2267 - Home Health Care Planning Improvement Act; S. 244/H.R. 782 - State Health Care Flexibility Act; H.R. 560 - Rural Representation and Transparency Improvement Act; H.R. 452 - Medicare Decisions Accountability Act; S. 668 - Health Care Bureaucrats Elimination Act; S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3859 - Rural Hospital and Provider Equity Act; H.R. 3630/H.R. 3743/H.R. 3765 - Temporary Payroll Tax Cut Continuation Act; H.R. 3326/S. 1587 - Medicaid Flexibility for States Act; H.R. 4160 - State Health Flexibility Act; S. 2057 - To amend Title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs; H.R. 340 - Amending title XIX (Medicaid) of the Social Security Act to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases; H.R. 669 - Ensuring Continuous Medicaid Coverage for Children Act; H.R. 671 - Ensuring Continuous Coverage under SCHIP Act H.R. 5979 - Medicaid Accountability and Care (MAC) Act; H.R. 436 - Health Care Cost Reduction Act; H.R. 5707 - Medicare Physician Payment Innovation Act; H.R. 4348 - MAP-21 and offsets for student loan interest rate provisions.

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

Legislation and issues related to: Physician/nurse reimbursement; Medicare Medical Home; Medicaid Health Home; Medicare-Medicaid Advanced Primary Care demonstration; Accountable Care Organizations; Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Repeal/retention of Medicaid maintenance of effort requirements; Graduate Nurse Education demonstration; Home health face-to-face examination requirements; Medicare-Medicaid Program Integrity policies; Independent Payment Advisory Board (IPAB); Medicare-Medicaid hospital conditions of participation; Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges; Medicaid waiver application procedures; State of Florida Section 1115 Medicaid waiver application on managed medical assistance program; Medicare-Medicaid dual eligibles coverage and demonstration; Ordering of Medicare portable x-ray services; Medicaid per capita cap policy options; Medicaid payment for primary care services; Medicaid eligibility expansion and state options; Social Security Administration policies on primary medical evidence of disability; H.R. 2 - Repealing the Job-Killing Health Care Law Act; S. 16 - Patient Choice Restoration Act; S. 56/H.R. 2134 - Medicaid Advanced Practice Nurses and Physician Assistants Access Act; S. 58/H.R. 876 - Registered Nurse Safe Staffing Act; S. 227/H.R. 2267 - Home Health Care Planning Improvement Act; S. 244/H.R. 782 - State Health Care Flexibility Act; H.R. 560 - Rural Representation and Transparency Improvement Act; H.R. 452 - Medicare Decisions Accountability Act; S. 668 - Health Care Bureaucrats Elimination Act; S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3859 - Rural Hospital and Provider Equity Act; H.R. 3630/H.R. 3743/H.R. 3765 - Temporary Payroll Tax Cut Continuation Act; H.R. 3326/S. 1587 - Medicaid Flexibility for States Act; H.R. 4160 - State Health Flexibility Act; S. 2057 - To amend Title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs; H.R. 5979 - Medicaid Accountability and Care (MAC) Act; H.R. 436 - Health Care Cost Reduction Act; H.R. 5707 - Medicare Physician Payment Innovation Act; H.R. 4348 - MAP-21 and offsets for student loan interest rate provisions.

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

H.R. 452, Medicare Decisions Accountability Act of 2011 - Independent Payment Advisory Board (IPAB) Repeal S. 668, Health Care Bureaucrats Elimination Act H.R. 1044, Medicare Access to Rural Anesthesiology Act: Rural Pass Through S.1680, Craig Thomas Rural Hospital and Provider Equity Act of 2011 S. 848, Consumer Information Enhancement Act of 2011, Physician Data Reporting S. 454, Strengthening Program Integrity in Health Care Act of 2011 H.R. 3859, Rural Hospital and Provider Equity Act of 2012 Budget Control Act of 2011: P.L. 112-25 H.R. 3630, Temporary Payroll Tax Cut Continuation Act of 2011, SGR Issue H.CON.RES.34, Establishing the budget for the United States Government for fiscal year 2012 and setting forth appropriate budgetary levels for fiscal years 2013 through 2021 - Medicare premium support issue H.R. 2560, Cut, Cap, and Balance Act of 2011 - Medicare Physician Payment issues H.R. 5, Protecting Access to Healthcare Act: Independent Payment Advisory Board Historical Medicare payment undervaluation for anesthesiology services (33% problem) Anesthesia Conversion Factor Perioperative Surgical Home (TM) Model Medicare Reform, Payment Issues: Medicare Sustainable Growth Rate repeal Bundled payments CMS Interpretive Guidelines: Hospital Conditions of Participation Related to Anesthesia Services CMS Value-Based purchasing CMS Medicare Data Final Rule CMS Proposed Rule on Sunshine Act CMS Reporting and Returning of Overpayments Conditions of Participation - Anesthesia services, opt-outs, supervision Physician Quality Reporting System, PPACA, Sec. 3007 Quality Modifier implementation President Obama's deficit reduction plans, IPAB cuts MedPAC nominations Accountable Care Organizations Graduate Medical Education Cuts Medicare Local Coverage Determinations HHS Plan for Retrospective Review of Existing Rules 2011 - Conditions of Participation Value-based modifier - PPACA Debt ceiling- Medicare sequestration

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Tracking progress on the recommendations for changes in methodology for designating areas as underserved. Rural issues included in the Craig Thomas Rural Hospital and Provider Equity Act Rural issues included in H.R. 3859, The Rural Hospital and Provider Equity Act Issues involving the development of alternative payment methodologies for rural hospitals, CAHs and other providers.

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

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

S. 3295, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013: health care information technology funding and projects. Executive agency action: promote regional electronic health record demonstration and telehealth. H.R. 3859, Rural Hospital and Provider Equity Act of 2012 (entire bill). CONTINUED ON NEXT PAGE..... H.R. 3667, Primary Care Workforce Access Improvement Act of 2011 (entire bill).

Client expense: Not reported · Firm income: $50,000

Government targets: Commerce, Dept of (DOC), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Interior, Dept of (DOI), SENATE, Transportation, Dept of (DOT)

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

Client expense: $210,000 · Firm income: Not reported

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

H.R. 4872, the Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 1106: physician-owned hospitals and self-referral; Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States; Section 1202: Payments to primary care physicians. H.R. 3590, Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice, and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 6001: physician-owned hospital and self-referral; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3403: Independent Payment Advisory Board; Section 3025: hospital readmissions provision; Section 3124: extension of Medicare Dependent Hospital program; Section 3137: Section 508 reclassification; Section 9007: non profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: primary care provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: expansion of Medicaid, CHIP; Sections 1311-1343: CO-OPs and Exchanges; Section 3022: accountable care organizations; Section 3023: hospital bundling provision; Section 6401-6402, Program Integrity Provisions; Section 6501-6503, 6505, 6508, Medicaid Program Integrity Provisions. H.R. 2674, 340B Program Improvement Act, entire bill. S. 722 and H.R. 3506, Hospice Evaluation and Legitimate Payment Act, entire bills. S. 778, Protecting Access to Rural Therapy Services (PARTS) Act, entire bill. H.R. 3285, Medicare Equity Extension Act, entire bill. H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2011, Title II, Subtitle C--Medicare Extensions; Other Health Provisions, Part 1--Medicare extensions, Section 2201. Physician payment update; Section 2202. Ambulance add-ons; Section 2203. Medicare payment for outpatient therapy services; Section 2204. Work geographic adjustment. Part 3--Offsets, Section 2223, Parity in Medicare payments for hospital outpatient department evaluation and management office visit services; Section 2224, Reduction of bad debt treated as an allowable cost; Section 2225, Rebasing of State DSH allotments for FY 2021. Part 2 of Subtitle C--Other Health Provisions, Sec. 2213. Modification to requirements for qualifying for exception to Medicare prohibition on certain physician referrals for hospitals. H.R. 3859 and S.1680, The Rural Hospital and Provider Equity (R-HOPE) Act of 2012, entire bills. H.R. 3630, The Middle Class Tax Relief and Job Creation Act of 2012, entire bill. H.R. 2461, Physician Pathology Services Continuity Act of 2011, entire bill. S. 3187, the FDA Safety and Innovation Act, entire bill. H.R. 5651, FDA Reform Act, entire bill. S. 2516, Food and Drug Administration Safety and Innovation Act, entire bill. H.R. 5943 and S. 2620, the Rural Hospital Access Act of 2012, entire bills. H.R. 876, Registered Nurse Safe Staffing Act of 2011, entire bill. H.R. 4966, Sequester Replacement Act of 2012, entire bill. H.R. 3839, the Drug Shortage Prevention Act, entire bill. H.R. 2245, the Preserving Access to Lifesaving Medications Act, entire bill. S. 1734, Generating Antibiotic Incentives Now Act of 2011, entire bill. 2012 Outpatient Prospective Payment System rule, focusing on provisions affecting physicians and hospitals including: policies related to the physician supervision of outpatient therapeutic services and hospital value-based purchasing program. 2012, 2013 Inpatient prospective payment system rules: entire rules. 2012 Hospice wage index proposed rule, entire rule. Changes to Hospital CoPs, entire rule. Reporting and Returning Medicare Overpayments, entire rule. Other issues: "Super Committee" deliberations related to S. 365, Budget Control Act of 2012. Proposals involving the Sustainable Growth Rate (SGR) formula. The Deficit Commission Report and President's 2013 budget proposal, including proposals that involve Medicare and Medicaid payments to hospitals. 2011 March CBO proposal to eliminate the CAH, SCH, MDH programs. Accountable Care Organizations regulations and the Innovation Center's demonstration programs. Medicare and Medicaid Recovery Audit Contractor programs. Geographic Variation in Medicare spending, IOM studies on high value and Medicare geographic adjusters. Medical Liability Reform. Medicare and Medicaid Electronic Health Record Payment Incentive Programs (Meaningful Use), including the release of the Stage 2 Meaningful Use regulation. Hospital wage index reform, including Section 3137(b) of the Affordable Care Act. Implementation of state health insurance exchanges.

Client expense: $62,554 · Firm income: Not reported

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

Legislation and issues related to: Physician/nurse reimbursement; Medicare Medical Home; Medicaid Health Home; Medicare-Medicaid Advanced Primary Care demonstration; Accountable Care Organizations; Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Graduate Nurse Education demonstration; Home health face-to-face examination requirements; Independent Payment Advisory Board (IPAB); Medicare-Medicaid hospital conditions of participation; Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges; Ordering of Medicare portable x-ray services; Medicaid per capita cap policy options; H.R. 2 - Repealing the Job-Killing Health Care Law Act; S. 16 - Patient Choice Restoration Act; S. 56/H.R. 2134 - Medicaid Advanced Practice Nurses and Physician Assistants Access Act; S. 58/H.R. 876 - Registered Nurse Safe Staffing Act; S. 227/H.R. 2267 - Home Health Care Planning Improvement Act; S. 244/H.R. 782 - State Health Care Flexibility Act; H.R. 560 - Rural Representation and Transparency Improvement Act; H.R. 452 - Medicare Decisions Accountability Act; S. 668 - Health Care Bureaucrats Elimination Act; S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3859 - Rural Hospital and Provider Equity Act; H.R. 3630/H.R. 3743/H.R. 3765 - Temporary Payroll Tax Cut Continuation Act; H.R. 3326/S. 1587 - Medicaid Flexibility for States Act; H.R. 4160 - State Health Flexibility Act; S. 2057 - To amend Title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs; Coverage and payment for CPT code 96110; H.R. 340 - Amending title XIX (Medicaid) of the Social Security Act to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases; H.R. 669 - Ensuring Continuous Medicaid Coverage for Children Act; H.R. 671 - Ensuring Continuous Coverage under SCHIP Act

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

Legislation and issues related to: Physician/nurse reimbursement; Medicare Medical Home; Medicaid Health Home; Medicare-Medicaid Advanced Primary Care demonstration; Accountable Care Organizations; Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Graduate Nurse Education demonstration; Home health face-to-face examination requirements; Independent Payment Advisory Board (IPAB); Medicare-Medicaid hospital conditions of participation; Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges; Ordering of Medicare portable x-ray services; Medicaid per capita cap policy options; H.R. 2 - Repealing the Job-Killing Health Care Law Act; S. 16 - Patient Choice Restoration Act; S. 56/H.R. 2134 - Medicaid Advanced Practice Nurses and Physician Assistants Access Act; S. 58/H.R. 876 - Registered Nurse Safe Staffing Act; S. 227/H.R. 2267 - Home Health Care Planning Improvement Act; S. 244/H.R. 782 - State Health Care Flexibility Act; H.R. 560 - Rural Representation and Transparency Improvement Act; H.R. 452 - Medicare Decisions Accountability Act; S. 668 - Health Care Bureaucrats Elimination Act; S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3859 - Rural Hospital and Provider Equity Act; H.R. 3630/H.R. 3743/H.R. 3765 - Temporary Payroll Tax Cut Continuation Act; H.R. 3326/S. 1587 - Medicaid Flexibility for States Act; H.R. 4160 - State Health Flexibility Act; S. 2057 - To amend Title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs.

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

H.R. 4872, the Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 1106: physician-owned hospitals and self-referral; Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States; Section 1202: Payments to primary care physicians. H.R. 3590, Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice, and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 6001: physician-owned hospital and self-referral; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3403: Independent Payment Advisory Board; Section 3128: Method II billing; Section 3025: hospital readmissions provision; Section 3124: extension of Medicare Dependent Hospital program; Section 3137: Section 508 reclassification; Section 9007: non profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: primary care provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: expansion of Medicaid, CHIP; Sections 1311-1343: CO-OPs and Exchanges; Section 3022: accountable care organizations; Section 3023: hospital bundling provision; Section 6401-6402, Program Integrity Provisions; Section 6501-6503, 6505, 6508, Medicaid Program Integrity Provisions. H.R. 2674, 340B Program Improvement Act, entire bill. S. 722 and H.R. 3506, Hospice Evaluation and Legitimate Payment Act, entire bills. S. 778, Protecting Access to Rural Therapy Services (PARTS) Act, entire bill. S. 1680, Craig Thomas Rural Hospital and Provider Equity Act of 2011, entire bill. H.R. 3285, Medicare Equity Extension Act, entire bill. H.R. 3765, Temporary Payroll Tax Cut Continuation Act of 2011, TITLE IIITEMPORARY EXTENSION OF HEALTH PROVISIONS, including: Sec. 301. Medicare physician payment update; Sec. 302. 2-month extension of MMA section 508 reclassifications; Sec. 303. Extension of Medicare work geographic adjustment floor; Sec. 304. Extension of exceptions process for Medicare therapy caps; Sec. 305. Extension of payment for technical component of certain physician pathology services; Sec. 306. Extension of ambulance add-ons; Sec. 307. Extension of physician fee schedule mental health add-on payment; Sec. 308. Extension of outpatient hold harmless provision. H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2011, Title II, Subtitle C--Medicare Extensions; Other Health Provisions, Part 1--Medicare extensions, Section 2201. Physician payment update; Section 2202. Ambulance add-ons; Section 2203. Medicare payment for outpatient therapy services; Section 2204. Work geographic adjustment. Part 3--Offsets, Section 2223, Parity in Medicare payments for hospital outpatient department evaluation and management office visit services; Section 2224, Reduction of bad debt treated as an allowable cost; Section 2225, Rebasing of State DSH allotments for FY 2021. Part 2 of Subtitle C--Other Health Provisions, Sec. 2213. Modification to requirements for qualifying for exception to Medicare prohibition on certain physician referrals for hospitals. H.R. 3859, The Rural Hospital and Provider Equity (R-HOPE) Act of 2012, entire bill. H.R. 452, The Medicare Decisions Accountability Act, entire bill. H.R. 3839, The Drug Shortage Prevention Act, entire bill. H.R. 2245, Preserving Access to Life-Saving Medications Act of 2011, entire bill. S. 1734, Generating Antibiotic Incentives Now Act of 2011, entire bill. H.R. 5, Protecting Access to Healthcare Act, entire bill. Senate HELP and House Energy & Commerce discussion drafts regarding drug shortages and FDA reauthorization legislation. H.R. 3630, The Middle Class Tax Relief and Job Creation Act of 2012, entire bill. 2011-12 Outpatient Prospective Payment System rules, focusing on provisions affecting physicians and hospitals including: policies related to the physician supervision of outpatient therapeutic services and physician self-referral prohibition; hospital value-based purchasing program. 2011 and 2012 Inpatient prospective payment system rules: entire rules. 2012 Physician Fee Schedule rule, entire rule. 2012 Hospice wage index proposed rule, entire rule. Changes to Hospital CoPs, entire rule. Reporting and Returning Medicare Overpayments, entire rule. Other issues: "Super Committee" deliberations related to S. 365, Budget Control Act of 2012. Proposals involving the Sustainable Growth Rate (SGR) formula. The Deficit Commission Report and President's 2013 budget proposal, including proposals that involve Medicare and Medicaid payments to hospitals. 2011 March CBO proposal to eliminate the CAH, SCH, MDH programs. Accountable Care Organizations regulations and the Innovation Center's demonstration programs. Medicare and Medicaid Recovery Audit Contractor programs. Telemedicine and radiology issues affecting hospitals and physicians, including the credentialing and privileging process for Telemedicine services. Geographic Variation in Medicare spending, IOM studies on high value and Medicare geographic adjusters. Medical Liability Reform. Medicare and Medicaid Electronic Health Record Payment Incentive Programs (Meaningful Use), including the release of the Stage 2 Meaningful Use regulation. Hospital wage index reform, including Section 3137(b) of the Affordable Care Act. State health insurance exchanges. Hospital Part A and Part B Rebilling demonstration program. ICD-10 implementation issues. Transmittal 72 involving rehabilitation and respiratory care services under the hospital conditions of participation.

Client expense: $55,681 · Firm income: Not reported

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

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

Client expense: $3,970,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Equal Employment Opportunity Commission (EEOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE, White House Office

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

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

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

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

Client expense: Not reported · Firm income: Not reported

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

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

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

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