Pay for all your Undocumented Procedures (PAY UP!) Act of 2011

H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011

Client expense: $695,377 · 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 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.5-Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R.157-Health Care Safety Net Enhancement Act of 2011 H.R.314-Medical Liability Procedural Reform Act of 2011 H.R.376-Volunteer Emergency Services Recruitment and Retention Act of 2011 H.R.436-Health Care Cost Reduction Act of 2012 H.R.452-Medicare Decisions Accountability Act of 2011 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.816-Provider Shield Act of 2011 H.R.896-Medical Justice Act of 2011 H.R.969- Medical Practice Freedom Act of 2011 H.R. 971-Critical Care Assessment and Improvement Act of 2011 H.R.1004-Health Flexible Spending Arrangements Improvements Act of 2012 H.R.1117-Air Ambulance Patient Safety, Protection, and Coordination Act H.R. 1063-Strengthening Medicare And Repaying Taxpayers Act of 2011 H.R. 1206- Access to Professional Health Insurance Advisors Act of 2011 H.R.1256-Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1310-To amend the Internal Revenue Code of 1986 to exempt certain emergency medical devices from the excise tax on medical devices, and for other purposes H.R.1629-Family Health Care Accessibility Act of 2011 H.R.1668-Danny McIntosh Emergency Medical Service Providers Protection Act H.R.1683-State Flexibility Act H.R.1852-Children's Hospital GME Support Reauthorization Act of 2011 H.R.1941-Hiring Heroes Act of 2011 H.R.2104-Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE) Act of 2011 H.R.2205-Ending Defensive Medicine and Encouraging Innovative Reforms Act of 2011 H.R.2353-Volunteer Responder Incentive Protection Reauthorization Act of 2011 H.R.2405-Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R.2472-Health Care Professionals Protection Act of 2011 H.R.2488-SERVE Act of 2011 H.R.2523-Physician Availability Act of 2011 H.R.2853-Emergency Medic Transition (EMT) Act of 2011 H.R.2903-Federal Emergency Management Agency (FEMA) Reauthorization Act of 2012 H.R.3000-Empowering Patients First Act H.R.3144-Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269-Diagnostic Imaging Services Protection Act of 2011 H.R.3511- Cardiac Arrest Survival Act of 2011 H.R.3586-Good Samaritans Health Professionals Act of 2011 H.R.3625-Cardiomyopathy Health Education, Awareness, Risk Assessment, and Training in the Schools (HEARTS) Act of 2011 H.R.4124-Veteran Emergency Medical Technician Support Act of 2012 H.R.4242-Ensuring Quality Health Care for All Americans Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 H.R.5842-Restoring Access to Medication Act of 2012 H.R.5858-Health Savings Accounts Improvements Act of 2012 H.R. 6079-Repeal of Obama Care Act H.R. 6142-Assuring Medicare Stability and Access for Seniors Act of 2012 H.R. 6163-National Pediatric Research Network Act of 2012 S.223-FAA Air Transportation Modernization and Safety Improvement Act S.385-Dale Long Emergency Medical Services Providers Protection Act S.668-Health Care Bureaucrats Elimination Act S.868-State Flexibility Act S.932-SERVE Act of 2011 S.933-Volunteer Responder Incentive Protection Reauthorization Act of 2011 S.951-Hiring Heroes Act of 2011 S.958-Children's Hospital GME Support Reauthorization Act of 2011 S.1059-Family Health Care Accessibility Act of 2011 S.1099-Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 S.1407-Air Ambulance Medicare Accreditation and Accountability Act S.1855-Pandemic and All-Hazards Preparedness Reauthorization Act of 2011

H.R.452-Medicare Decisions Accountability Act of 2011 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1256-Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1683-State Flexibility Act H.R.1852-Children's Hospital GME Support Reauthorization Act of 2011 H.R.2104-Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE) Act of 2011 H.R.3000-Empowering Patients First Act H.R.3144-Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269-Diagnostic Imaging Services Protection Act of 2011 H.R.4242-Ensuring Quality Health Care for All Americans Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 H.R. 6142-Assuring Medicare Stability and Access for Seniors Act of 2012 H.R. 6163-National Pediatric Research Network Act of 2012 S.868-State Flexibility Act S.958-Children's Hospital GME Support Reauthorization Act of 2011

Client expense: $433,244 · Firm income: Not reported

H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011

Client expense: $433,244 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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 H.J. Res. 117-Continuing Appropriations Resolution, 2013 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1683-State Flexibility Act H.R.5652-Sequester Replacement Reconciliation Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 H.R.5872-Sequestration Transparency Act of 2012 H.R. 6142, Assuring Medicare Stability and Access for Seniors Act of 2012 S.868-State Flexibility Act S.3295-Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013

Client expense: $433,244 · 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.

H.R.5-Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R.157-Health Care Safety Net Enhancement Act of 2011 H.R.314-Medical Liability Procedural Reform Act of 2011 H.R.376-Volunteer Emergency Services Recruitment and Retention Act of 2011 H.R.436-Health Care Cost Reduction Act of 2012 H.R.452-Medicare Decisions Accountability Act of 2011 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.816-Provider Shield Act of 2011 H.R.896-Medical Justice Act of 2011 H.R.969- Medical Practice Freedom Act of 2011 H.R. 971-Critical Care Assessment and Improvement Act of 2011 H.R.1004-Health Flexible Spending Arrangements Improvements Act of 2012 H.R.1117-Air Ambulance Patient Safety, Protection, and Coordination Act H.R.1256-Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1310-To amend the Internal Revenue Code of 1986 to exempt certain emergency medical devices from the excise tax on medical devices, and for other purposes H.R.1629-Family Health Care Accessibility Act of 2011 H.R.1668-Danny McIntosh Emergency Medical Service Providers Protection Act H.R.1683-State Flexibility Act H.R.1852-Children's Hospital GME Support Reauthorization Act of 2011 H.R.1941-Hiring Heroes Act of 2011 H.R.2104-Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE) Act of 2011 H.R.2205-Ending Defensive Medicine and Encouraging Innovative Reforms Act of 2011 H.R.2353-Volunteer Responder Incentive Protection Reauthorization Act of 2011 H.R.2405-Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R.2472-Health Care Professionals Protection Act of 2011 H.R.2488-SERVE Act of 2011 H.R.2523-Physician Availability Act of 2011 H.R.2853-Emergency Medic Transition (EMT) Act of 2011 H.R.3000-Empowering Patients First Act H.R.3144-Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269-Diagnostic Imaging Services Protection Act of 2011 H.R.3511- Cardiac Arrest Survival Act of 2011 H.R.3586-Good Samaritans Health Professionals Act of 2011 H.R.3625-Cardiomyopathy Health Education, Awareness, Risk Assessment, and Training in the Schools (HEARTS) Act of 2011 H.R.4124-Veteran Emergency Medical Technician Support Act of 2012 H.R.4242-Ensuring Quality Health Care for All Americans Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 H.R.5842-Restoring Access to Medication Act of 2012 H.R.5858-Health Savings Accounts Improvements Act of 2012 S.223-FAA Air Transportation Modernization and Safety Improvement Act S.385-Dale Long Emergency Medical Services Providers Protection Act S.668-Health Care Bureaucrats Elimination Act S.868-State Flexibility Act S.932-SERVE Act of 2011 S.933-Volunteer Responder Incentive Protection Reauthorization Act of 2011 S.951-Hiring Heroes Act of 2011 S.958-Children's Hospital GME Support Reauthorization Act of 2011 S.1059-Family Health Care Accessibility Act of 2011 S.1099-Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 S.1407-Air Ambulance Medicare Accreditation and Accountability Act S.1855-Pandemic and All-Hazards Preparedness Reauthorization Act of 2011

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 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1683-State Flexibility Act H.R.5652-Sequester Replacement Reconciliation Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 S.868-State Flexibility Act S.3295-Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013

Client expense: $891,775 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.452-Medicare Decisions Accountability Act of 2011 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1256-Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1683-State Flexibility Act H.R.1852-Children's Hospital GME Support Reauthorization Act of 2011 H.R.2104-Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE) Act of 2011 H.R.3000-Empowering Patients First Act H.R.3144-Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269-Diagnostic Imaging Services Protection Act of 2011 H.R.4242-Ensuring Quality Health Care for All Americans Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 S.868-State Flexibility Act S.958-Children's Hospital GME Support Reauthorization Act of 2011

Client expense: $891,775 · Firm income: Not reported

H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011

Client expense: $891,775 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011

Client expense: $891,775 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1683-State Flexibility Act H.R.5652-Sequester Replacement Reconciliation Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 S.868-State Flexibility Act S.3295-Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013

Client expense: $891,775 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.452-Medicare Decisions Accountability Act of 2011 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1256-Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1683-State Flexibility Act H.R.1852-Children's Hospital GME Support Reauthorization Act of 2011 H.R.2104-Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE) Act of 2011 H.R.3000-Empowering Patients First Act H.R.3144-Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269-Diagnostic Imaging Services Protection Act of 2011 H.R.4242-Ensuring Quality Health Care for All Americans Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 S.868-State Flexibility Act S.958-Children's Hospital GME Support Reauthorization Act of 2011

Client expense: $891,775 · Firm income: Not reported

H.R.5-Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R.157-Health Care Safety Net Enhancement Act of 2011 H.R.314-Medical Liability Procedural Reform Act of 2011 H.R.376-Volunteer Emergency Services Recruitment and Retention Act of 2011 H.R.436-Health Care Cost Reduction Act of 2012 H.R.452-Medicare Decisions Accountability Act of 2011 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.816-Provider Shield Act of 2011 H.R.896-Medical Justice Act of 2011 H.R.969- Medical Practice Freedom Act of 2011 H.R. 971-Critical Care Assessment and Improvement Act of 2011 H.R.1004-Health Flexible Spending Arrangements Improvements Act of 2012 H.R.1117-Air Ambulance Patient Safety, Protection, and Coordination Act H.R.1256-Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1310-To amend the Internal Revenue Code of 1986 to exempt certain emergency medical devices from the excise tax on medical devices, and for other purposes H.R.1629-Family Health Care Accessibility Act of 2011 H.R.1668-Danny McIntosh Emergency Medical Service Providers Protection Act H.R.1683-State Flexibility Act H.R.1852-Children's Hospital GME Support Reauthorization Act of 2011 H.R.1941-Hiring Heroes Act of 2011 H.R.2104-Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE) Act of 2011 H.R.2205-Ending Defensive Medicine and Encouraging Innovative Reforms Act of 2011 H.R.2353-Volunteer Responder Incentive Protection Reauthorization Act of 2011 H.R.2405-Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R.2472-Health Care Professionals Protection Act of 2011 H.R.2488-SERVE Act of 2011 H.R.2523-Physician Availability Act of 2011 H.R.2853-Emergency Medic Transition (EMT) Act of 2011 H.R.3000-Empowering Patients First Act H.R.3144-Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269-Diagnostic Imaging Services Protection Act of 2011 H.R.3511- Cardiac Arrest Survival Act of 2011 H.R.3586-Good Samaritans Health Professionals Act of 2011 H.R.3625-Cardiomyopathy Health Education, Awareness, Risk Assessment, and Training in the Schools (HEARTS) Act of 2011 H.R.4124-Veteran Emergency Medical Technician Support Act of 2012 H.R.4242-Ensuring Quality Health Care for All Americans Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 H.R.5842-Restoring Access to Medication Act of 2012 H.R.5858-Health Savings Accounts Improvements Act of 2012 S.223-FAA Air Transportation Modernization and Safety Improvement Act S.385-Dale Long Emergency Medical Services Providers Protection Act S.668-Health Care Bureaucrats Elimination Act S.868-State Flexibility Act S.932-SERVE Act of 2011 S.933-Volunteer Responder Incentive Protection Reauthorization Act of 2011 S.951-Hiring Heroes Act of 2011 S.958-Children's Hospital GME Support Reauthorization Act of 2011 S.1059-Family Health Care Accessibility Act of 2011 S.1099-Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 S.1407-Air Ambulance Medicare Accreditation and Accountability Act S.1855-Pandemic and All-Hazards Preparedness Reauthorization Act of 2011

H.R.5-Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R.157-Health Care Safety Net Enhancement Act of 2011 H.R.314-Medical Liability Procedural Reform Act of 2011 H.R.376-Volunteer Emergency Services Recruitment and Retention Act of 2011 H.R.452-Medicare Decisions Accountability Act of 2011 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.658-FAA Air Transportation Modernization and Safety Improvement Act H.R.816-Provider Shield Act of 2011 H.R.896-Medical Justice Act of 2011 H.R.971-Critical Care Assessment and Improvement Act of 2011 H.R.969-Medical Practice Freedom Act of 2011 H.R.1117-Air Ambulance Patient Safety, Protection, and Coordination Act H.R.1256-Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1310-To amend the Internal Revenue Code of 1986 to exempt certain emergency medical devices from the excise tax on medical devices, and for other purposes H.R.1629-Family Health Care Accessibility Act of 2011 H.R.1668-Danny McIntosh Emergency Medical Service Providers Protection Act H.R.1683-State Flexibility Act H.R.1852-Children's Hospital GME Support Reauthorization Act of 2011 H.R.1941-Hiring Heroes Act of 2011 H.R.2205-Ending Defensive Medicine and Encouraging Innovative Reforms Act of 2011 H.R.2353-Volunteer Responder Incentive Protection Reauthorization Act of 2011 H.R.2405-Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R.2472-Health Care Professionals Protection Act of 2011 H.R.2488-SERVE Act of 2011 H.R.2523-Physician Availability Act of 2011 (7/13/2011) H.R.2853-Emergency Medic Transition (EMT) Act of 2011 H.R.3000-Empowering Patients First Act H.R.3144-Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269-Diagnostic Imaging Services Protection Act of 2011 H.R.3511-Cardiac Arrest Survival Act of 2011 H.R.3586-Good Samaritans Health Professionals Act of 2011 H.R.3625-Cardiomyopathy Health Education, Awareness, Risk Assessment, and Training in the Schools (HEARTS) Act of 2011 H.R.3630 (P.L. 112-96)-Temporary Payroll Tax Cut Continuation Act of 2011 H.R.3765 (P.L. 112-78)-Temporary Payroll Tax Cut Continuation Act of 2011 H.R.4242-Ensuring Quality Health Care for All Americans Act of 2012 S.223-FAA Air Transportation Modernization and Safety Improvement Act S.385-Dale Long Emergency Medical Services Providers Protection Act S.668-Health Care Bureaucrats Elimination Act S.868-State Flexibility Act S.932-SERVE Act of 2011 S.933-Volunteer Responder Incentive Protection Reauthorization Act of 2011 S.951-Hiring Heroes Act of 2011 S.958-Children's Hospital GME Support Reauthorization Act of 2011 S.1059-Family Health Care Accessibility Act of 2011 S.1099-Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 S.1407-Air Ambulance Medicare Accreditation and Accountability Act S.1855-Pandemic and All-Hazards Preparedness Reauthorization Act of 2011

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. H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1683-State Flexibility Act H.R.3630 (P.L. 112-96)-Temporary Payroll Tax Cut Continuation Act of 2011 H.R.3765 (P.L. 112-78)-Temporary Payroll Tax Cut Continuation Act of 2011 S.868-State Flexibility Act

Client expense: $508,199 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011

Client expense: $508,199 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.452-Medicare Decisions Accountability Act of 2011 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1256-Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1683-State Flexibility Act H.R.1852-Children's Hospital GME Support Reauthorization Act of 2011 H.R.3000-Empowering Patients First Act H.R.3144-Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269-Diagnostic Imaging Services Protection Act of 2011 H.R.3630 (P.L. 112-96)-Temporary Payroll Tax Cut Continuation Act of 2011 H.R.3765 (P.L. 112-78)-Temporary Payroll Tax Cut Continuation Act of 2011 H.R.4242-Ensuring Quality Health Care for All Americans Act of 2012 S.668-Health Care Bureaucrats Elimination Act S.868-State Flexibility Act S.958-Children's Hospital GME Support Reauthorization Act of 2011

Client expense: $508,199 · Firm income: Not reported

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

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

H.R.541 - Pay for all your Undocumented Procedures (PAY UP) Act of 2011

Client expense: $605,518 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.541 - Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1683 - State Flexibility Act H.R.2055 (P.L.112-74) - Consolidated Appropriations Act, 2012 H.R.3070 - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2012 H.R.3630 - Temporary Payroll Tax Cut Continuation Act of 2011 H.R.3765 (P.L112-78) - Temporary Payroll Tax Cut Continuation Act of 2011 S.868 - State Flexibility Act S.1599 - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2012

Client expense: $605,518 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.5 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R.157 - Health Care Safety Net Enhancement Act of 2011 H.R.314 - Medical Liability Procedural Reform Act of 2011 H.R.376 - Volunteer Emergency Services Recruitment and Retention Act of 2011 H.R.452 - Medicare Decisions Accountability Act of 2011 H.R.541 - Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.658 - FAA Air Transportation Modernization and Safety Improvement Act H.R.816 - Provider Shield Act of 2011 H.R.896 - Medical Justice Act of 2011 H.R.969 - Medical Practice Freedom Act of 2011 H.R.971 - Critical Care Assessment and Improvement Act of 2011 H.R.1005 - Medicare Ambulance Access Preservation Act of 2011 H.R.1117 - Air Ambulance Patient Safety, Protection, and Coordination Act H.R.1256 - Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1310 - To amend the Internal Revenue Code of 1986 to exempt certain emergency medical devices from the excise tax on medical devices, and for other purposes H.R.1629 - Family Health Care Accessibility Act of 2011 H.R.1668 - Danny McIntosh Emergency Medical Service Providers Protection Act H.R.1683 - State Flexibility Act H.R.1852 - Children's Hospital GME Support Reauthorization Act of 2011 H.R.1941 - Hiring Heroes Act of 2011 H.R.2205 - Ending Defensive Medicine and Encouraging Innovative Reforms Act of 2011 H.R. 2353 - Volunteer Responder Incentive Protection Reauthorization Act of 2011 H.R.2405 - Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R.2472 - Health Care Professionals Protection Act of 2011 H.R. 2488 - SERVE Act of 2011 H.R.3000 - Empowering Patients First Act H.R.3144 - Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269 - Diagnostic Imaging Services Protection Act of 2011 H.R.3586 - Good Samaritans Health Professionals Act of 2011 H.R.3630 - Temporary Payroll Tax Cut Continuation Act of 2011 H.R.3765 (P.L112-78) - Temporary Payroll Tax Cut Continuation Act of 2011 S.223 - FAA Air Transportation Modernization and Safety Improvement Act S.385 - Dale Long Emergency Medical Services Providers Protection Act S.424 - Medicare Ambulance Access Preservation Act of 2011 S.868 - State Flexibility Act S.932 - SERVE Act of 2011 S.933 - Volunteer Responder Incentive Protection Reauthorization Act of 2011 S.951 - Hiring Heroes Act of 2011 S.958 - Children's Hospital GME Support Reauthorization Act of 2011 S.1059 - Family Health Care Accessibility Act of 2011 S.1099 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 S.1407 - Air Ambulance Medicare Accreditation and Accountability Act S.1855 - Pandemic and All-Hazards Preparedness Reauthorization Act of 2011

H.R.452 - Medicare Decisions Accountability Act of 2011 H.R.541 - Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1005 - Medicare Ambulance Access Preservation Act of 2011 H.R.1256 - Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1683 - State Flexibility Act H.R.1852 - Children's Hospital GME Support Reauthorization Act of 2011 H.R.3000 - Empowering Patients First Act H.R.3144 - Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269 - Diagnostic Imaging Services Protection Act of 2011 H.R.3630 - Temporary Payroll Tax Cut Continuation Act of 2011 H.R.3765 (P.L112-78) - Temporary Payroll Tax Cut Continuation Act of 2011 S.424 - Medicare Ambulance Access Preservation Act of 2011 S.668 - Health Care Bureaucrats Elimination Act S.868 - State Flexibility Act S.958 - Children's Hospital GME Support Reauthorization Act of 2011

Client expense: $605,518 · Firm income: Not reported

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

H.R. 1 - Full-year continuing Appropriations Act of 2011 (2/11/11) H.R.5 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R.157 - Health Care Safety Net Enhancement Act of 2011 H.R.314 - Medical Liability Procedural Reform Act of 2011 H.R.376 - Volunteer Emergency Services Recruitment and Retention Act of 2011 H.R.452 - Medicare Decisions Accountability Act of 2011 H.R.541 - Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.658 - FAA Air Transportation Modernization and Safety Improvement Act H.R.816 - Provider Shield Act of 2011 H.R.896 - Medical Justice Act of 2011 H.R.969 - Medical Practice Freedom Act of 2011 H.R.971 - Critical Care Assessment and Improvement Act of 2011 H.R.1005 - Medicare Ambulance Access Preservation Act of 2011 H.R.1065 - Pill Mill Crackdown Act of 2011 H.R.1117 - Air Ambulance Patient Safety, Protection, and Coordination Act H.R.1213 - To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges H.R.1214 - To repeal mandatory funding for school-based health center construction H.R.1254 - Synthetic Drug Control Act of 2011 H.R.1256 - Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1310 - To amend the Internal Revenue Code of 1986 to exempt certain emergency medical devices from the excise tax on medical devices, and for other purposes H.R.1363 - Further Additional Continuing Appropriations Amendments, 2011 H.R.1473 - Department of Defense and Full-Year Continuing Appropriations Act of 2011 H.R.1571 - Combating Dangerous Synthetic Stimulants Act of 2011 H.R.1622 - Spectrum Innovation Act H.R.1668 - Danny McIntosh Emergency Medical Service Providers Protection Act H.R.1683 - State Flexibility Act H.R.1852 - Children's Hospital GME Support Reauthorization Act of 2011 H.R.1925 - Prescription Drug Abuse Prevention and Treatment Act of 2011 H.R.1941 - Hiring Heroes Act of 2011 H.R.2205 - Ending Defensive Medicine and Encouraging Innovative Reforms Act of 2011 H.R.2324 - Research of Alcohol Detection Systems (ROADS) for Stopping Alcohol-related Fatalities Everywhere Act of 2011 H.R.2353 - Volunteer Responder Incentive Protection Reauthorization Act of 2011 H.R.2405 - Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R.2472 - Health Care Professionals Protection Act of 2011 H.R.2488 - SERVE Act of 2011 H.R.2523 - Physician Availability Act of 2011 S.12 - Job Creation Act of 2011 S.197 - Medical Care Access Protection (MCAP) Act of 2011 S.223 - FAA Air Transportation Modernization and Safety Improvement Act S.296 - Preserving Access to Life-Saving Medications Act S.385 - Dale Long Emergency Medical Services Providers Protection Act S.409 - Combating Dangerous Synthetic Stimulants Act of 2011 S.424 - Medicare Ambulance Access Preservation Act of 2011 S.507 - Prescription Drug Abuse Prevention and Treatment Act of 2011 S.510 - Research of Alcohol Detection Systems (ROADS) for Stopping Alcohol-related Fatalities Everywhere Act of 2011 S.605 - Dangerous Synthetic Drug Control Act of 2011 S.668 - Health Care Bureaucrats Elimination Act S.868 - State Flexibility Act S.911 - SPECTRUM Act S.932 - SERVE Act of 2011 S.933 - Volunteer Responder Incentive Protection Reauthorization Act of 2011 S.951 - Hiring Heroes Act of 2011 S.958 - Children's Hospital GME Support Reauthorization Act of 2011 S.1059 - Family Health Care Accessibility Act of 2011 S.1099 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011

H.R.5 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R.157 - Health Care Safety Net Enhancement Act of 2011 H.R.314 - Medical Liability Procedural Reform Act of 2011 H.R.376 - Volunteer Emergency Services Recruitment and Retention Act of 2011 H.R.452 - Medicare Decisions Accountability Act of 2011 H.R.541 - Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.816 - Provider Shield Act of 2011 H.R.896 - Medical Justice Act of 2011 H.R.969 - Medical Practice Freedom Act of 2011 H.R.971 - Critical Care Assessment and Improvement Act of 2011 H.R.1005 - Medicare Ambulance Access Preservation Act of 2011 H.R.1065 - Pill Mill Crackdown Act of 2011 H.R.1117 - Air Ambulance Patient Safety, Protection, and Coordination Act H.R.1213 - To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges H.R.1214 - To repeal mandatory funding for school-based health center construction H.R.1254 - Synthetic Drug Control Act of 2011 H.R.1256 - Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1363 - Further Additional Continuing Appropriations Amendments, 2011 H.R.1622 - Spectrum Innovation Act H.R.1629 - Family Health Care Accessibility Act of 2011 H.R.1668 - Danny McIntosh Emergency Medical Service Providers Protection Act H.R.1683 - State Flexibility Act H.R.1852 - Children's Hospital GME Support Reauthorization Act of 2011 H.R.1941 - Hiring Heroes Act of 2011 H.R.2205 - Ending Defensive Medicine and Encouraging Innovative Reforms Act of 2011 H.R.2245 - Preserving Access to Life-Saving Medications Act of 2011 was it introduced in July 1 H.R.2353 - Volunteer Responder Incentive Protection Reauthorization Act of 2011 H.R.2405 - Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 S.12 - Job Creation Act of 2011 S.197 - Medical Care Access Protection (MCAP) Act of 2011 S.296 - Preserving Access to Life-Saving Medications Act S.385 - Dale Long Emergency Medical Services Providers Protection Act S.409 - Combating Dangerous Synthetic Stimulants Act of 2011 S.424 - Medicare Ambulance Access Preservation Act of 2011 S.507 - Prescription Drug Abuse Prevention and Treatment Act of 2011 S.605 - Dangerous Synthetic Drug Control Act of 2011 S.668 - Health Care Bureaucrats Elimination Act S.868 - State Flexibility Act S.911 - SPECTRUM Act S.932 - SERVE Act of 2011 S.933 - Volunteer Responder Incentive Protection Reauthorization Act of 2011 S.951 - Hiring Heroes Act of 2011 S.958 - Children's Hospital GME Support Reauthorization Act of 2011 S.1099 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011

HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 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, lgislation 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; Urging congress to establish patient and facility criteria to distinguish LTACHs from other care settings; Raising concerns about CMS flawed methodology that overstate the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to improve the regulation to implement ACOs; Urging CMS to update, streamline, and modernize the Medicare conditions of participation; Sessions Crowley and Stabenow Murkowski IPPS letter requesting fixes to the coding offset circulated for signature; HR 1852/ S 950 Children's Hospital GME Support Reauthorization Act of 2011, the current CHGME authorization expires in September, and the bills would reauthorize the CHGME program for an additional five years, through fiscal year (FY) 2016, at the current authorization level of up to $330 million a year; HR 1683/ S 868 Medicaid MOE, strikes provisions of ACA related to maintaining Medicaid eligibility levels; HR 1543 Improving Access to Medicare Coverage Act of 2011, to amend title XVIII of the Social Security Act to count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare; Worked on legislation related to HIT payments for hospitals in multi-campus systems.

Patient Protection and Affordable Care Act, Maintain the Medicaid maintenance of effort (MOE) provisions; 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 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; 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; Urging congress to establish patient and facility criteria to distinguish LTACHs from other care settings; Raising concerns about CMS flawed methodology that overstate the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to structure the development of the regulation to implement ACOs prior to release of the proposed rule; Obtaining change in language for Medicare conditions of participation related to governing board requirements to eliminate an unnecessary requirement for separate boards or separate meetings of the board for individual hospitals that are part of a system; Urging CMS not to adopt a burdensome notice requirement in the Medicare conditions of participation related to the grievance process; Urging CMS to update, streamline, and modernize the Medicare conditions of participation.

H.R.1 - Full-Year Continuing Appropriations Act of 2011 H.R.5 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R.452 - Medicare Decisions Accountability Act of 2011 H.R.541 - Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1005 - Medicare Ambulance Access Preservation Act of 2011 H.R.1256 - Medicare Physician Payment Transparency and Assessment Act of 2011 S.218 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 S.296 - Preserving Access to Life-Saving Medications Act S.424 - Medicare Ambulance Access Preservation Act of 2011 S.507 - Prescription Drug Abuse Prevention and Treatment Act of 2011

Client expense: $440,609 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1 - Full-Year Continuing Appropriations Act of 2011 H.R.5 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R.157 - Health Care Safety Net Enhancement Act of 2011 H.R.314 - Medical Liability Procedural Reform Act of 2011 H.R.376 - Volunteer Emergency Services Recruitment and Retention Act of 2011 H.R.452 - Medicare Decisions Accountability Act of 2011 H.R.541 - Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.816 - Provider Shield Act of 2011 H.R.896 - Medical Justice Act of 2011 H.R.1005 - Medicare Ambulance Access Preservation Act of 2011 H.R.1065 - Pill Mill Crackdown Act of 2011 H.R.1256 - Medicare Physician Payment Transparency and Assessment Act of 2011 S.197 - Medical Care Access Protection (MCAP) Act of 2011 S.218 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 S.296 - Preserving Access to Life-Saving Medications Act S.409 - Combating Dangerous Synthetic Stimulants Act of 2011 S.424 - Medicare Ambulance Access Preservation Act of 2011 S.507 - Prescription Drug Abuse Prevention and Treatment Act of 2011

Client expense: $440,609 · Firm income: Not reported