Negotiating for Seniors Act

Medicare 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. 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. Medicare 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 Eligibility Age (No Bill): proposals to increase the Medicare eligibility age. 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: proposals to create 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 Supplemental Health Insurance. (No bill): proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Physician Fees. (P.L. 112-240): proposal to maintain current levels of physician fees under Part B. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: implementation of the provisions 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 the Center 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 the 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.

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

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

HR 891 and S 274 - legislation that would expand the existing medication therapy management program in Medicare Part D; S 31 and S 44 and HR 2248 and HR 3638 - legislation that would require or allow the federal government to negotiate prescription drug prices on behalf of Medicare Part D plan sponsors; HR 999 and S 560 - legislation that would establish a nationwide Part D plan administered by the federal government; HR 1055 - legislation that would allow Part D plan sponsors to offer "off-label" coverage HR 2190 and S 1206 - legislation that would require prescription drug manufacturers to pay Medicaid "best price" rebates for covered prescription drugs purchased by dual eligibles under Medicare Part D; HR 3613 - legislation that would require Medicare Part D plans to establish an exceptions process for patient cost-sharing amounts; HR 4215 - legislation that would establish audit requirements and other transparency requirements for Medicare part D plan sponsors; HR 6392 - legislation that would allow the federal government to negotiate prescription drug prices on behalf of Medicare Part D plan sponsors; Worked on proposed legislative language, work which included consultation with Senate committee staff, that would amend the current prompt payment rules in Medicare Part D in the interest of preventing fraud.

Client expense: $170,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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.