Medicare Advantage Program Integrity Act of 2012

Benefit Redesign. (No Bill): proposals for providing a catastrophic cap on Medicare out-of-pocket spending to be paid for by a surcharge on private Medigap policies and employer-provided retiree health benefits. Independent Payment Advisory Board. H.R. 1: provisions to repeal or modify P.L. 111-148/P.L. 111-152 authorizing the creation of an independent commission to promulgate Medicare policies designed to reduce Medicare spending growth. Medicare Drug Savings. S. 1206, H.R. 2190: provisions extending the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Home Health Benefits. (No bill): proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Income-relating. (No bill): proposals to increase the cost of Medicare to higher-income beneficiaries. Medicare Part A Hospital Inpatient Status. S. 818, H.R. 1543: provisions ensuring beneficiaries receiving hospital services are designated as inpatients, thereby assuring coverage of prescription drugs and post-acute care under Part A following a three-day hospitalization. Medicare Parts C and D. P.L. 110-275, P.L. 108-173: implementation of regulations and issuance of guidance relating to beneficiary eligibility, enrollment, and effectiveness of exceptions and the appeals processes under Medicare Parts C and D. Medicare Part D Negotiation of Drug Prices. S. 31, S. 44, S. 560, H.R. 999, H.R. 6392: provisions creating a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Managed Care. H.R. 4254: provisions pertaining to revisions to the coding intensity adjustment factor in the formula for the demographic adjustment used in calculating payments to Medicare Advantage organizations for 2015 and subsequent years and setting the timing of prepayments to January 2013. Medicare Supplemental Health Insurance. (No bill): proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Physician Fees. (No bill): proposals to maintain current levels of physician fees under Part B. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: provisions related to reducing Medicare Advantage plan payments; reducing the Part D coverage gap; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); improving the process for reassigning LIS beneficiaries to new plans; expanding coverage of prevention services; establishing a Medicare Commission; providing expanded Medicaid coverage for home and community-based services; authorizing the collection of data regarding disparities in the provision of care; providing safeguards and subsidies to assure affordability of health coverage for seniors. Center for Medicare and Medicaid Innovation. (No bill): proposals related to the planning for the Center for Medicare and Medicaid Innovations, and the approach this office will take to test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care for Medicare, Medicaid and CHIP beneficiaries. Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill): proposals related to activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients who receive benefits from both Medicare and Medicaid, e.g, dual-eligibles. Long-term Services and Supports/Repeal of CLASS Act. S. 720, H.R. 1173: provisions repealing expanded support for long-term supports and services through the Community Living Assistance Services and Supports (CLASS) Act.

Client expense: $310,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Employment & Training Administration, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Vice President of the U.S.

Implementation of Affordable Care Act HR 452 - Medicare Decisions Accountability Act of 2011 HR 5 - Protecting Access to Health Care Act and Help Efficient, Accessible Low Cost Timely Healthcare Act of 2012 HR 4254 - Medicare Advantage Program Integrity Act HR 3840 - Narrowing Exceptions for Withholding Taxes (NEWT) Act Proposals to cut Medicare and Medicaid HConRes 112 and amendments - Budget for FY 2013

Client expense: $730,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

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

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

Medicare Dental Benefits. S. 3272, H.R. 5909: provisions creating a Medicare Part B dental benefit. Medigap Benefits. S. 3271: provisions expanding access to Medicare supplemental insurance. Benefit Redesign. (No Bill): proposal to provide a catastrophic cap on Medicare out-of-pocket spending funded by a surcharge on private Medigap policies and employer-provided retiree health benefits. Independent Payment Advisory Board. H.R. 452, S. 668, H.R. 1 (Sec. 4050): proposals to repeal or modify the provisions of P.L. 111-148 and P.L. 111-152 reducing Medicare spending growth through an independent commission. Medicare Drug Savings. S. 1206, H.R. 2190: provisions extending Medicaid drug rebates to prescription drugs paid for by Medicare on behalf of Medicare-Medicaid dual-eligibles, and by Medicare Part D Low-Income Subsidy beneficiaries. Home Health Benefits. (No bill): proposal to require copayments from people receiving the Medicare home health benefit. Medicare Income-relating. (No bill): proposals to increase the percent of Medicare beneficiaries paying higher income-related premiums. Medicare Part A Hospital Inpatient Status. S. 818, H.R. 1543: provisions ensuring beneficiaries receiving hospital services are designated as inpatients, thereby assuring coverage of prescription drugs and post-acute care under Part A following a three-day hospitalization. Medicare Parts C and D. P.L. 110-275, P.L. 108-173: implementation of regulations and the issuance of guidance relating to beneficiary eligibility, enrollment, and effectiveness of exceptions and the appeals processes under Medicare Parts C and D. Medicare Part D Negotiation of Drug Prices. S. 31, S. 44, S. 560, H.R. 999, H.R. 3638: provisions creating a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Managed Care. H.R. 4254: provisions pertaining to revising the coding intensity adjustment factor in the demographic adjustment formula (used in calculating payments to Medicare Advantage organizations) for 2015 and subsequent years and setting the timing of prepayments beginning with January 2013. Medicare Supplemental Health Insurance. (No bill): proposals to increase costs for Medicare supplemental insurance. Medicare Physician Fees. P.L. 112-96, (H.R. 3630): provisions maintaining current levels of physician fees under Part B; extending the therapy caps exceptions process; and extending the Qualified Individual program. Medicare Privatization/Premium Support. (H. Con. Res. 112 and S. Con. Res. 37): provisions to convert Medicare from a defined benefit plan to a premium support/voucher system. Raising Medicare Eligibility Age. (H. Con. Res. 112 and S. Con. Res. 37): provisions to raise the Medicare eligibility age from 65 to 67. Prescription Drug Safety. P.L.112-144 (S. 3187, H.R. 3988, H.R. 4087, H.R. 5334, S. 2236, S. 2289 and S. 2516): provisions facilitating the importation of prescription drugs; preventing pharmaceutical fraud by requiring good corporate behavior; facilitating the adoption of modern information technology; and prohibiting brand name drug companies from compensating generic drug companies to delay the entry of a generic drug into the market. Public Health Service Act Dental Care. S. 1878, H.R. 4091: provisions pertaining to offering grant support to national dental programs that provide pro-bono dental care to Medicare and Medicaid eligible low-income children and adults. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: provisions related to reducing Medicare Advantage plan payments; reducing the Part D coverage gap; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); improving the process for reassigning LIS beneficiaries to new plans; expanding coverage of prevention services; establishing a Medicare Commission; providing expanded Medicaid coverage for home and community-based services; authorizing the collection of data regarding disparities in the provision of care; providing safeguards and subsidies to assure affordability of health coverage for seniors. Center for Medicare and Medicaid Innovations. (No bill): proposals related to planning for the Center for Medicare and Medicaid Innovations, and the approach this entity will take to test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care for Medicare, Medicaid and CHIP beneficiaries. Federal Coordinated Health Care Office/Medicare-Medicaid Coordination Office. (No bill): proposals related to activities of the Federal Coordinated Health Care Office intended to improve the quality of care for Medicare and Medicaid dual-eligibles. Long-term Care Financing. (No bill): proposals to amend the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums; to permit the use of qualified long-term care insurance under cafeteria plans and flexible spending arrangements; and to provide a tax credit for individuals with long-term care needs. Long-term Services and Supports/Repeal of CLASS. S. 720, H.R. 1173: provisions repealing the Community Living Assistance Services and Supports (CLASS) Act.

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

Supported all provisions: S. 1878/H.R. 4091, Coordination of Pro Bono Medically Recommended Dental Care Act H.R. 4254, Medicare Advantage Program Integrity Act of 2012

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Payroll Tax Cut Continuation Act (Camp) Medicare physician payment, extension of QI and TMA programs, budget offsets H.R. 4254, Medicare Advantage Program Integrity Act (Stark) MA payment changes S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation 16. Specific Lobbying Issues (continued) S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans S. 1931, Temporary Tax Holiday and Government Reduction Act (Heller) budget offsets S. 1944, Middle Class Tax Cut Act (Casey) budget offsets S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) incentives for wellness and prevention Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including; risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to Medigap coverage. 18. Lobbyists (continued): K. Callahan: Ross (March 2005- January 2012); Research Assistant, Senator Tim Johnson (October 2001 March 2005). D. Mott-Bronson: (June 1998 - September 2002); Democratic Professional Staff Member, House International Relations Committee, Representative McKinney (September 2002 December 2002).

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

Implementation of Affordable Care Act HR 452 - Medicare Decisions Accountability Act of 2011 HR 5 - Protecting Access to Health Care Act and Help Efficient, Accessible Low Cost Timely Healthcare Act of 2012 HR 4254 - Medicare Advantage Program Integrity Act HR 3840 - Narrowing Exceptions for Withholding Taxes (NEWT) Act Proposals to cut Medicare and Medicaid HConRes 112 and amendments - Budget for FY 2013

Client expense: $720,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

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

Supported all provisions, unless indicated otherwise H.R. 4254, Medicare Advantage Program Integrity Act of 2012 H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2012 - supported extending the Qualified Individual (QI) program

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare/Commission. P.L. 111-148, P.L. 111-152 (Sec. 4050): provisions pertaining to the repeal or modification of provisions creating an independent commission authorized to establish Medicare payment and policy designed to reduce Medicare spending growth. Medicare Drug Savings. S. 1206, H.R. 2190: provisions extending Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare/Home Health Benefits. (No bill): proposals regarding potential copayments for beneficiaries receiving the Medicare home health benefit. Medicare/Income-relating. (No bill): proposals to increase costs for higher-income Medicare beneficiaries. Medicare/Part A Hospital Inpatient Status. S. 818, H.R. 1543: provisions ensuring beneficiaries receiving hospital services are designated as inpatients, thereby assuring coverage of prescription drugs and post-acute care under Part A following a three-day hospitalization. Medicare Part B Drug Savings. S. 1699: provisions pertaining to provisions that reduce the cost of prescription drugs paid for under Medicare Part B. Medicare/Parts C and D. P.L. 110-275, P.L. 108-173: provisions pertaining to the implementation of regulations and issuance of guidance relating to beneficiary eligibility, enrollment, and effectiveness of exceptions and the appeals processes under Medicare Parts C and D. Medicare/Part D plan, Negotiation of Part D Drug Prices. S. 31, S. 44, S. 560, H.R. 999: provisions creating a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare/Managed Care. Medicare Advantage Program Integrity Act of 2012. H.R. 4254: provisions pertaining to revisions of the coding intensity adjustment factor in the formula for the demographic adjustment used in calculating payments to Medicare Advantage organizations for 2015 and subsequent years and sets the timing of prepayments to beginning with January 2013. Medicare/Medicare Supplemental Health Insurance. (No bill): proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare/Physician Fees. P.L. 112-96, (H.R. 3630): provisions pertaining to provisions that maintain current levels of physician fees under Medicare Part B; extending the therapy caps exceptions process; extending the Qualified Individual program. Medicare/Premium Support/Privatization. (No bill): proposals to convert Medicare from a defined benefit plan to a premium support/voucher system. Medicare/Raising Eligibility Age. (No bill): proposals to raise the Medicare eligibility age from 65 to 67. Medicare/Medicaid. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: provisions related to reducing Medicare Advantage plan payments; reducing the Part D coverage gap; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); improving the process for reassigning LIS beneficiaries to new plans; expanding coverage of prevention services; establishing a Medicare Commission; providing expanded Medicaid coverage for home and community-based services; authorizing the collection of data regarding disparities in the provision of care; providing safeguards and subsidies to assure affordability of health coverage for seniors. Medicare and Medicaid/Center for Medicare and Medicaid Innovations. (No bill): proposals related to the planning for the Center for Medicare and Medicaid Innovations, and the approach this office will take to test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care for Medicare, Medicaid and CHIP beneficiaries. Medicare and Medicaid/Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill): proposals related to activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients who receive benefits from both Medicare and Medicaid, i.e., dual-eligibles. Long-term Care Financing via Tax Deduction. (No bill): provisions amending the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long -term care needs. Long-term Services and Supports/Community Living Assistance Services and Supports (CLASS) Act. S. 720, H.R. 1173: provisions repealing previously enacted expanded support for long-term supports and services.