Empowering States to Innovate Act

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act H.R.451, Healthcare Truth and Transparency Act of 2011 H.R.751, Mental Health in Schools Act of 2011 H.R. 831/S 483, To amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program S.483, Medicare Mental Health Access Act S.37, Autonomy for Psychologists and Social Workers Act of 2011 S.40, Graduate Psychology Education Act of 2011 S.43, Psychologists in the Service of the Public Act of 2011 S.539, Behavioral Health Information Technology Act of 2011 S 248/ HR 844, Empowering States to Innovate Act S. 525, Positive Aging Act of 2011 S 650/HR 1184, Health Care Waiver Transparency Act S. 374, Medicare Mental Health Inpatient Equity Act S. 1627, Resident Physician Shortage Reduction Act of 2011, A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes. HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H Res 92, Providing for consideration of the bill (H.R. 1) making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011, and for other purposes, and waiving a requirement of clause 6(a) of rule XIII with respect to consideration of certain resolutions reported from the Committee on Rules. S. 1542, H.R. 2883, Child and Family Services Improvement and Innovation Act S. 1925, H.R. 4970 Violence against Women Act Reauthorization Act S. 3604, A bill to amend title XVIII of the Social Security Act to provide for the implementation of prescriber education programs and to establish requirements relating to the administration of antipsychotics to residents of skilled nursing facilities and nursing facilities under the Medicare and Medicaid programs, and for other purposes. H.R. 6043, the Behavioral Health Information Technology Act of 2012 H.R. 5989, the Excellence in Mental Health Act of 2012 H.R. 5996, the Mental Health First Aid Higher Education Act of 2012 H.R. 5707, the Medicare Physician Payment Innovation Act of 2012 H. R. 6562, the Resident Physician Shortage Act of 2012 H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act of 2012 H.R. 6079, the Repeal of Obamacare Act H.R. 8, American Taxpayer Relief Act H.R. 6645, Save and Stregthen Medicare Act of 2012 H.R. 6598, Electronic Health Records Improvement Act Proposed Rule on the Patient Protection and Affordable Care Act: Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation. CMS-2012-0142-0001.

Client expense: $122,658 · Firm income: Not reported

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

HR 1213 - To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges: entire bill HR 1216 - To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations: entire bill HR 1213 To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges: entire bill HR 1216 To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations: entire bill HR 2 Repealing the Job-Killing Health Care Law Act: entire bill S 192 Repealing the Job-Killing Health Care Law Act: entire bill S 248 Empowering States to Innovate Act: entire bill HR 844 Empowering States to Innovate Act: entire bill Public Law No. 111-148 Patient Protection and Affordable Care Act: entire law Public Law No. 111-152 Health Care and Education Reconciliation Act of 2010: entire law HR 3587 Fair Pay to Medicaid Providers Act of 2011: entire bill HR 6079 Repeal of Obamacare Act: entire bill HR 6138 Ending the HIV/AIDS Epidemic Act of 2012: entire bill Ryan White HIV/AIDS Program Reauthorization (no number; not up until 2013): entire bill HR 2543 Stop Deceptive Advertising for Women's Services Act: entire bill S 1374 Stop Deceptive Advertising for Women's Services Act: entire bill S 1415 Access to Birth Control Act: entire bill HR 2659 Access to Birth Control Act: entire bill HR 2678 Communities of Color Teenage Pregnancy Prevention Act of 2011: provisions related to family planning and reproductive health: entire bill S 1437 Communities of Color Teenage Pregnancy Prevention Act of 2011: provisions related to family planning and reproductive health: entire bill HR 1085 Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act of 2011: entire bill S 578 Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act of 2011: entire bill HR 2954 Health Equity and Accountability Act of 2011: entire bill S 2474 Health Equity and Accountability Act of 2012: entire bill S 1782 Real Education for Healthy Youth Act of 2011: entire bill HR 3324 Real Education for Healthy Youth Act of 2011: entire bill HR 4271 Violence Against Women Reauthorization Act of 2012: entire bill HR 4970 Violence Against Women Reauthorization Act of 2012: entire bill HR 4982 Violence Against Women Reauthorization Act of 2012: entire bill S 1925 Violence Against Women Reauthorization Act of 2011: entire bill S 2338 Violence Against Women Reauthorization Act of 2012: entire bill HR 5650 Protecting Women's Access to Health Care Act: entire bill

HR 1213 - To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges: entire bill HR 1216 - To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations: entire bill HR 1213 To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges: entire bill HR 1216 To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations: entire bill HR 2 Repealing the Job-Killing Health Care Law Act: entire bill S 192 Repealing the Job-Killing Health Care Law Act: entire bill S 248 Empowering States to Innovate Act: entire bill HR 844 Empowering States to Innovate Act: entire bill Public Law No. 111-148 Patient Protection and Affordable Care Act: entire law Public Law No. 111-152 Health Care and Education Reconciliation Act of 2010: entire law HR 3587 Fair Pay to Medicaid Providers Act of 2011: entire bill HR 6079 Repeal of Obamacare Act: entire bill HR 6138 Ending the HIV/AIDS Epidemic Act of 2012: entire bill Ryan White HIV/AIDS Program Reauthorization (no number; not up until 2013): entire bill HR 2543 Stop Deceptive Advertising for Women's Services Act: entire bill S 1374 Stop Deceptive Advertising for Women's Services Act: entire bill S 1415 Access to Birth Control Act: entire bill HR 2659 Access to Birth Control Act: entire bill HR 2678 Communities of Color Teenage Pregnancy Prevention Act of 2011: provisions related to family planning and reproductive health: entire bill S 1437 Communities of Color Teenage Pregnancy Prevention Act of 2011: provisions related to family planning and reproductive health: entire bill HR 1085 Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act of 2011: entire bill S 578 Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act of 2011: entire bill HR 2954 Health Equity and Accountability Act of 2011: entire bill S 2474 Health Equity and Accountability Act of 2012: entire bill S 1782 Real Education for Healthy Youth Act of 2011: entire bill HR 3324 Real Education for Healthy Youth Act of 2011: entire bill HR 4271 Violence Against Women Reauthorization Act of 2012: entire bill HR 4970 Violence Against Women Reauthorization Act of 2012: entire bill HR 4982 Violence Against Women Reauthorization Act of 2012: entire bill S 1925 Violence Against Women Reauthorization Act of 2011: entire bill S 2338 Violence Against Women Reauthorization Act of 2012: entire bill S 3539 Medicaid Information Technology to Enhance Community Health Act of 2012: entire bill HR 5650 Protecting Women's Access to Health Care Act: entire bill

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; Nursing provisions in potential job creation legislation; Anti-competitive barriers to practice; Negotiated Rulemaking on Designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; Prevention and Public Health Fund; Definition of essential health benefits; Health information technology and electronic health records; HRSA nurse practitioner national sample survey; Amendments to the Consumer Product Safety Improvement Act; Menu and Nutrition Labeling; Draft legislation to reauthorize the Prescription Drug User Fee Act (PDUFA); Draft legislation on Congressional Budget Office scoring of preventive health services; Draft legislation on voluntary tandem licensing and credentialing for federal telemedicine services; Draft legislation on reauthorization of the National Quality Forum; H.R. 5/S. 218/S. 1099 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R. 5 - Protecting Access to Healthcare (PATH) Act; H.R. 451 - Healthcare Truth and Transparency Act of 2011; S. 248/H.R. 844 - Empowering States to Innovate Act; S. 174 - Healthy Lifestyles and Prevention Act; H.R. 10/S. 299/S. 1720/S. 1786 - Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 - to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 - State Flexibility Act; H.R. 2465 - Federal Workers' Compensation Modernization and Improvement Act; S. 261 - Federal Employees' Compensation Reform Act; H.R. 469 - Protecting Student Athletes from Concussions Act; S. 601/H.R. 1127 - Childrens Sports Athletic Equipment Safety Act; Concussion Treatment and Care Tools (ConTACT) Act; S. 54 - Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act; S. 55 - Nursing School Clinics Act; H.R. 157 - Health Care Safety Net Enhancement Act; H.R. 227 - Child Gun Safety and Gun Access Prevention Act; H.R. 338 - Protecting Our Kids' Medicine Act; H.R. 469 - Protecting Student Athletes from Concussions Act; H.R. 576 - Healthy Children Through School Nutrition Education Act; H.R. 713 - Keeping Families Together Act; H.R. 751 - Mental Health in Schools Act; H.R. 1214 - to repeal mandatory funding for school-based health center construction; S. 961 - Reconnecting Youth to Prevent Homelessness Act; S. 1165, Button Cell Battery Safety Act; H.R. 1852/S. 958 - Childrens Hospital GME Support Reauthorization Act; H.R. 115 - CHAMPVA Childrens Protection Act; H.R. 364 - Common Sense Health Reform Americans Actually Want Act; H.R. 614 - Post 9/11 G.I. Bill Dependent Coverage Improvement Act; H.R. 978 - Seniors Identity Protection Act; H.R. 989 - Voluntary State Discount Prescription Drug Plan Act; H.R. 1035/S. 1504 - Medicaid Coverage for Citizens of Freely Associated States Act; H.R. 2029/S. 1131 - Birth Defects Prevention, Risk Reduction, and Awareness Act; H.R. 2758/S. 1463 - Breastfeeding Promotion Act; H.R. 2229 - Student-to-School Nurse Ratio Improvement Act. H.R. 3679 - National Nurse Act; H.R. 4274 - BPCA and PREA Reauthorization Act; S. 2289 - Better Pharmaceuticals and Devices for Children Act; H.R. 5651 - Food and Drug Administration Reform Act; H.R. 5842 - Restoring Access to Medication Act; S. 3187 - FDA Safety and Innovation Act; S. 2474 - Health Equity and Accountability Act; S. 1789 - 21st Century Postal Service Act; S. 847 - Safe Chemicals Act; H.R. 2405/S. 1855 - Pandemic and All-Hazards Preparedness Act (PAHPA); H.R. 2359 - Safe Cosmetics Act; H.R. 6482 - Preventive Health Savings Act; Supplemental Nutrition Assistance Program (SNAP) provisions of H.R. 6083, Federal Agriculture Reform and Risk Management (FARRM) Act, and S.3240, Agriculture Reform, Food, and Jobs Act.

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; Nursing provisions in potential job creation legislation; Anti-competitive barriers to practice; Negotiated Rulemaking on Designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; Prevention and Public Health Fund; Definition of essential health benefits; Health information technology and electronic health records; HRSA nurse practitioner national sample survey; Draft legislation to reauthorize the Prescription Drug User Fee Act (PDUFA); Draft legislation on Congressional Budget Office scoring of preventive health services; Draft legislation on voluntary tandem licensing and credentialing for federal telemedicine services; Draft legislation on reauthorization of the National Quality Forum; H.R. 5/S. 218/S. 1099 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R. 5 - Protecting Access to Healthcare (PATH) Act; H.R. 451 - Healthcare Truth and Transparency Act of 2011; S. 248/H.R. 844 - Empowering States to Innovate Act; S. 174 - Healthy Lifestyles and Prevention Act; H.R. 10/S. 299/S. 1720/S. 1786 - Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 - to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 - State Flexibility Act; H.R. 2465 - Federal Workers' Compensation Modernization and Improvement Act; S. 261 - Federal Employees' Compensation Reform Act; H.R. 469 - Protecting Student Athletes from Concussions Act; S. 601/H.R. 1127 - Childrens Sports Athletic Equipment Safety Act; Concussion Treatment and Care Tools (ConTACT) Act; H.R. 3679 - National Nurse Act; H.R. 4274 - BPCA and PREA Reauthorization Act; S. 2289 - Better Pharmaceuticals and Devices for Children Act; H.R. 5651 - Food and Drug Administration Reform Act; H.R. 5842 - Restoring Access to Medication Act; S. 3187 - FDA Safety and Innovation Act S. 2474 - Health Equity and Accountability Act; S. 1789 - 21st Century Postal Service Act; H.R. 6482 - Preventive Health Savings Act; Supplemental Nutrition Assistance Program (SNAP) provisions of H.R. 6083, Federal Agriculture Reform and Risk Management (FARRM) Act, and S.3240, Agriculture Reform, Food, and Jobs Act.

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act H.R.451, Healthcare Truth and Transparency Act of 2011 H.R.751, Mental Health in Schools Act of 2011 H.R. 831/S 483, To amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program S.483, Medicare Mental Health Access Act S.37, Autonomy for Psychologists and Social Workers Act of 2011 S.40, Graduate Psychology Education Act of 2011 S.43, Psychologists in the Service of the Public Act of 2011 S.539, Behavioral Health Information Technology Act of 2011 S 248/ HR 844, Empowering States to Innovate Act S. 525, Positive Aging Act of 2011 S 650/HR 1184, Health Care Waiver Transparency Act S. 374, Medicare Mental Health Inpatient Equity Act S. 1627, Resident Physician Shortage Reduction Act of 2011, A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes. HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H Res 92, Providing for consideration of the bill (H.R. 1) making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011, and for other purposes, and waiving a requirement of clause 6(a) of rule XIII with respect to consideration of certain resolutions reported from the Committee on Rules. S. 1542, H.R. 2883, Child and Family Services Improvement and Innovation Act S. 1925, H.R. 4970 Violence against Women Act Reauthorization Act S. 3604, A bill to amend title XVIII of the Social Security Act to provide for the implementation of prescriber education programs and to establish requirements relating to the administration of antipsychotics to residents of skilled nursing facilities and nursing facilities under the Medicare and Medicaid programs, and for other purposes. H.R. 6043, the Behavioral Health Information Technology Act of 2012 H.R. 5989, the Excellence in Mental Health Act of 2012 H.R. 5996, the Mental Health First Aid Higher Education Act of 2012 H.R. 5707, the Medicare Physician Payment Innovation Act of 2012 H. R. 6562, the Resident Physician Shortage Act of 2012 H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act of 2012 H.R. 6079, the Repeal of Obamacare Act Proposed Rule on Patient Protection and Affordable Care Act; Data Collection To Support Standards Related to Essential Health Benefits; Recognition of Entities for the Accreditation of Qualified Health. Posted June 6, 2012. (CMS-2012-0071-0001)

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act HR 896, Medical Justice Act of 2011 HR 1256, Medicare Physician Payment Transparency and Assessment Act of 2011 S 248 / HR 844, Empowering States to Innovate Act S 650/HR 1184, Health Care Waiver Transparency Act S 374, Medicare Mental Health Inpatient Equity Act S 539, Behavioral Health Information Technology Act of 2011 S.365, the Budget Control Act of 2011 Proposed Rule on Patient Protection and Affordable Care Act; Data Collection To Support Standards Related to Essential Health Benefits; Recognition of Entities for the Accreditation of Qualified Health. Posted June 6, 2012. (CMS-2012-0071-0001)

Client expense: $143,731 · Firm income: Not reported

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost;. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. In July 2012 testimony; advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentivesboth non-financial and financialfor engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013; Urged Congress not to terminate the Agency for Healthcare Research and Quality. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Hospital Outpatient Proposed Rule/August 2012: ACP expressed concern to CMS of the increased frequency of beneficiaries in hospital settings being categorized as outpatients receiving observation services rather than regular inpatient admissions; recommended current general admission criteria be replaced or at least clarified through the use of the large number of evidence based guidelines covering a variety of conditions frequently involved in the hospitalization decision-making process (e.g., chest pain, heart failure, chronic obstructive pulmonary disease) offered through the Agency for Healthcare Research and Quality (AHRQ) National Guidelines Clearinghouse, the opinion of the admitting physician be given increased weight in the coverage determination process, prior to any denial of admission by a Medicare contractor, the denial should be reviewed and confirmed by a physician, need improved clear and transparent inpatient admission criteria. Health Information Technology/August 2012: Provided suggestions on Stage 3 of Meaningful Use, including: Refine and evolve existing measures rather than add new measures; do not introduce new functions without appropriate testing; choose additional documentation requirements wisely and seek to reduce existing requirements that do not add value to the patient record; require usability testing with a specific focus on reducing data collection burdens; do not add functional requirements that have not been adequately defined; understand the implications of intensively focusing vendors programming capacity on Meaningful Use requirements. Physician Fee Schedule/August 2012: Advocated that policies to improve payment for undervalued evaluation and management services should not be restricted to a designated subset of specialties (as defined by their self-designation) or impose other restrictive criteria that could exclude physicians who legitimately and appropriately provide such services to their patients. Rather, the objective should be to pay more appropriately for evaluation and care coordination services that bring value to the patient, no matter the specialty of the physician who is billing for the service. Sequestration: Opposed automatic across-the-board cuts (known as sequestration) scheduled to hit federal agencies in January 2013 to the tune of $100 billion. Across-the-board cuts, which do not take into consideration the importance or effectiveness of any particular program or activity, are not an appropriate method of governing. Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs. They should work to improve the effectiveness of care provided, make necessary and appropriate changes in entitlement programs, including Medicare cost-sharing, reform payment and delivery systems, and support the proven value of primary care.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. In July 2012 testimony; advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentivesboth non-financial and financialfor engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013; Urged Congress not to terminate the Agency for Healthcare Research and Quality. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Hospital Outpatient Proposed Rule/August 2012: ACP expressed concern to CMS of the increased frequency of beneficiaries in hospital settings being categorized as outpatients receiving observation services rather than regular inpatient admissions; recommended current general admission criteria be replaced or at least clarified through the use of the large number of evidence based guidelines covering a variety of conditions frequently involved in the hospitalization decision-making process (e.g., chest pain, heart failure, chronic obstructive pulmonary disease) offered through the Agency for Healthcare Research and Quality (AHRQ) National Guidelines Clearinghouse, the opinion of the admitting physician be given increased weight in the coverage determination process, prior to any denial of admission by a Medicare contractor, the denial should be reviewed and confirmed by a physician, need improved clear and transparent inpatient admission criteria. Health Information Technology/August 2012: Provided suggestions on Stage 3 of Meaningful Use, including: Refine and evolve existing measures rather than add new measures; do not introduce new functions without appropriate testing; choose additional documentation requirements wisely and seek to reduce existing requirements that do not add value to the patient record; require usability testing with a specific focus on reducing data collection burdens; do not add functional requirements that have not been adequately defined; understand the implications of intensively focusing vendors programming capacity on Meaningful Use requirements. Physician Fee Schedule/August 2012: Advocated that policies to improve payment for undervalued evaluation and management services should not be restricted to a designated subset of specialties (as defined by their self-designation) or impose other restrictive criteria that could exclude physicians who legitimately and appropriately provide such services to their patients. Rather, the objective should be to pay more appropriately for evaluation and care coordination services that bring value to the patient, no matter the specialty of the physician who is billing for the service. Sequestration: Opposed automatic across-the-board cuts (known as sequestration) scheduled to hit federal agencies in January 2013 to the tune of $100 billion. Across-the-board cuts, which do not take into consideration the importance or effectiveness of any particular program or activity, are not an appropriate method of governing. Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs. They should work to improve the effectiveness of care provided, make necessary and appropriate changes in entitlement programs, including Medicare cost-sharing, reform payment and delivery systems, and support the proven value of primary care.

HR 1213 - To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges: entire bill HR 1216 - To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations: entire bill HR 1213 To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges: entire bill HR 1216 To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations: entire bill HR 2 Repealing the Job-Killing Health Care Law Act: entire bill S 192 Repealing the Job-Killing Health Care Law Act: entire bill S 248 Empowering States to Innovate Act: entire bill HR 844 Empowering States to Innovate Act: entire bill Public Law No. 111-148 Patient Protection and Affordable Care Act: entire law Public Law No. 111-152 Health Care and Education Reconciliation Act of 2010: entire law HR 3587 Fair Pay to Medicaid Providers Act of 2011: entire bill HR 6079 Repeal of Obamacare Act: entire bill HR 6138 Ending the HIV/AIDS Epidemic Act of 2012: entire bill Ryan White HIV/AIDS Program Reauthorization (no number; not up until 2013): entire bill HR 2543 Stop Deceptive Advertising for Women's Services Act: entire bill S 1374 Stop Deceptive Advertising for Women's Services Act: entire bill S 1415 Access to Birth Control Act: entire bill HR 2659 Access to Birth Control Act: entire bill HR 2678 Communities of Color Teenage Pregnancy Prevention Act of 2011: provisions related to family planning and reproductive health: entire bill S 1437 Communities of Color Teenage Pregnancy Prevention Act of 2011: provisions related to family planning and reproductive health: entire bill HR 1085 Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act of 2011: entire bill S 578 Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act of 2011: entire bill HR 2954 Health Equity and Accountability Act of 2011: entire bill S 2474 Health Equity and Accountability Act of 2012: entire bill S 1782 Real Education for Healthy Youth Act of 2011: entire bill HR 3324 Real Education for Healthy Youth Act of 2011: entire bill HR 4271 Violence Against Women Reauthorization Act of 2012: entire bill HR 4970 Violence Against Women Reauthorization Act of 2012: entire bill HR 4982 Violence Against Women Reauthorization Act of 2012: entire bill S 1925 Violence Against Women Reauthorization Act of 2011: entire bill S 2338 Violence Against Women Reauthorization Act of 2012: entire bill

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; Nursing provisions in potential job creation legislation; Negotiated Rulemaking on Designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; Prevention and Public Health Fund; Definition of essential health benefits; Health information technology and electronic health records; HRSA nurse practitioner national sample survey; Amendments to the Consumer Product Safety Improvement Act; Menu and Nutrition Labeling; Draft legislation to reauthorize the Prescription Drug User Fee Act (PDUFA); Draft legislation on Congressional Budget Office scoring of preventive health services; Draft legislation on voluntary tandem licensing and credentialing for federal telemedicine services; H.R. 5/S. 218/S. 1099 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R. 5 - Protecting Access to Healthcare (PATH) Act; H.R. 451 - Healthcare Truth and Transparency Act of 2011; S. 248/H.R. 844 - Empowering States to Innovate Act; S. 174 - Healthy Lifestyles and Prevention Act; H.R. 10/S. 299/S. 1720/S. 1786 - Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 - to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 - State Flexibility Act; H.R. 2465 - Federal Workers' Compensation Modernization and Improvement Act; S. 261 - Federal Employees' Compensation Reform Act; H.R. 469 - Protecting Student Athletes from Concussions Act; S. 601/H.R. 1127 - Childrens Sports Athletic Equipment Safety Act; Concussion Treatment and Care Tools (ConTACT) Act; S. 54 - Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act; S. 55 - Nursing School Clinics Act; H.R. 157 - Health Care Safety Net Enhancement Act; H.R. 227 - Child Gun Safety and Gun Access Prevention Act; H.R. 338 - Protecting Our Kids' Medicine Act; H.R. 469 - Protecting Student Athletes from Concussions Act; H.R. 576 - Healthy Children Through School Nutrition Education Act; H.R. 713 - Keeping Families Together Act; H.R. 751 - Mental Health in Schools Act; H.R. 1214 - to repeal mandatory funding for school-based health center construction; S. 961 - Reconnecting Youth to Prevent Homelessness Act; S. 1165, Button Cell Battery Safety Act. H.R. 1852/S. 958 - Childrens Hospital GME Support Reauthorization Act; H.R. 115 - CHAMPVA Childrens Protection Act; H.R. 364 - Common Sense Health Reform Americans Actually Want Act; H.R. 614 - Post 9/11 G.I. Bill Dependent Coverage Improvement Act; H.R. 978 - Seniors Identity Protection Act; H.R. 989 - Voluntary State Discount Prescription Drug Plan Act; H.R. 1035/S. 1504 - Medicaid Coverage for Citizens of Freely Associated States Act; H.R. 2029/S. 1131 - Birth Defects Prevention, Risk Reduction, and Awareness Act; H.R. 2758/S. 1463 - Breastfeeding Promotion Act; H.R. 2229 - Student-to-School Nurse Ratio Improvement Act. H.R. 3679 - National Nurse Act; H.R. 4274 - BPCA and PREA Reauthorization Act; S. 2289 - Better Pharmaceuticals and Devices for Children Act; H.R. 5651 - Food and Drug Administration Reform Act; H.R. 5842 - Restoring Access to Medication Act; S. 3187 - FDA Safety and Innovation Act S. 2474 - Health Equity and Accountability Act; S. 1789 - 21st Century Postal Service Act.

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; Nursing provisions in potential job creation legislation; Negotiated Rulemaking on Designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; Prevention and Public Health Fund; Definition of essential health benefits; Health information technology and electronic health records; HRSA nurse practitioner national sample survey; Draft legislation to reauthorize the Prescription Drug User Fee Act (PDUFA); Draft legislation on Congressional Budget Office scoring of preventive health services; Draft legislation on voluntary tandem licensing and credentialing for federal telemedicine services; H.R. 5/S. 218/S. 1099 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R. 5 - Protecting Access to Healthcare (PATH) Act; H.R. 451 - Healthcare Truth and Transparency Act of 2011; S. 248/H.R. 844 - Empowering States to Innovate Act; S. 174 - Healthy Lifestyles and Prevention Act; H.R. 10/S. 299/S. 1720/S. 1786 - Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 - to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 - State Flexibility Act; H.R. 2465 - Federal Workers' Compensation Modernization and Improvement Act; S. 261 - Federal Employees' Compensation Reform Act; H.R. 469 - Protecting Student Athletes from Concussions Act; S. 601/H.R. 1127 - Childrens Sports Athletic Equipment Safety Act; Concussion Treatment and Care Tools (ConTACT) Act; H.R. 3679 - National Nurse Act; H.R. 4274 - BPCA and PREA Reauthorization Act; S. 2289 - Better Pharmaceuticals and Devices for Children Act; H.R. 5651 - Food and Drug Administration Reform Act; H.R. 5842 - Restoring Access to Medication Act; S. 3187 - FDA Safety and Innovation Act S. 2474 - Health Equity and Accountability Act; S. 1789 - 21st Century Postal Service Act.

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act HR 896, Medical Justice Act of 2011 HR 1256, Medicare Physician Payment Transparency and Assessment Act of 2011 S 248 / HR 844, Empowering States to Innovate Act S 650/HR 1184, Health Care Waiver Transparency Act S 374, Medicare Mental Health Inpatient Equity Act S 539, Behavioral Health Information Technology Act of 2011 S.365, the Budget Control Act of 2011 Establishment of Exchanges and Qualified Health Plans, and Standards Related to Reinsurance, Risk Corridors and Risk Adjustment (HHS-0S-2011-0022-0001)

Client expense: $277,532 · Firm income: Not reported

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 4274, the Better Pharmaceuticals for Children ACT and Pediatric Research Reauthorization Act of 2012 Draft, Senate HELP, drug shortage legislation and Prescription Drug User Fee Act (PDUFA) reauthorization S. 3187, Food and Drug Administration Safety and Innovation Act of 2012 H. R. 2245, S. 296, Preserving Access to Life-Saving Medications Act of 2011 S.1584 , Drug Safety and Accountability Act of 2011 HR 439/S 73, State Leadership in Health Care Act H.R.451, Healthcare Truth and Transparency Act of 2011 H.R.751, Mental Health in Schools Act of 2011 H.R. 831/S 483, To amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program S.483, Medicare Mental Health Access Act S.37, Autonomy for Psychologists and Social Workers Act of 2011 S.40, Graduate Psychology Education Act of 2011 S.43, Psychologists in the Service of the Public Act of 2011 S.539, Behavioral Health Information Technology Act of 2011 S 248/ HR 844, Empowering States to Innovate Act S. 525, Positive Aging Act of 2011 S 650/HR 1184, Health Care Waiver Transparency Act S. 374, Medicare Mental Health Inpatient Equity Act S. 1627, Resident Physician Shortage Reduction Act of 2011, A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes. HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H Res 92, Providing for consideration of the bill (H.R. 1) making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011, and for other purposes, and waiving a requirement of clause 6(a) of rule XIII with respect to consideration of certain resolutions reported from the Committee on Rules. S. 1542, H.R. 2883, Child and Family Services Improvement and Innovation Act S. 1925, H.R. 4970 Violence against Women Act Reauthorization Act H.R. 6043, the Behavioral Health Information Technology Act of 2012 H.R. 5989, the Excellence in Mental Health Act of 2012 H.R. 5996, the Mental Health First Aid Higher Education Act of 2012 H.R. 5707, the Medicare Physician Payment Innovation Act of 2012 Nationwide Health Information Network: Conditions for Trusted Exchange (HHS-OS-2012-0006) HHS Bulletin on Federally-Facilitated Exchanges

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost; Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost; Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians.

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; Nursing provisions in potential job creation legislation; Negotiated Rulemaking on Designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; Health information technology and electronic health records; Repeal of Medicaid maintenance of effort requirements; HRSA nurse practitioner national sample survey; Amendments to the Consumer Product Safety Improvement Act; Menu and Nutrition Labeling; Draft legislation to reauthorize the Prescription Drug User Fee Act (PDUFA); H.R. 5/S. 218/S. 1099 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R. 5 - Protecting Access to Healthcare (PATH) Act; H.R. 451 - Healthcare Truth and Transparency Act of 2011; S. 248/H.R. 844 - Empowering States to Innovate Act; S. 174 - Healthy Lifestyles and Prevention Act; H.R. 10/S. 299/S. 1720/S. 1786 - Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 - to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 - State Flexibility Act; H.R. 2465 - Federal Workers' Compensation Modernization and Improvement Act; S. 261 - Federal Employees' Compensation Reform Act; H.R. 469 - Protecting Student Athletes from Concussions Act; S. 601/H.R. 1127 - Childrens Sports Athletic Equipment Safety Act; Concussion Treatment and Care Tools (ConTACT) Act; H.R. 4160 - State Health Flexibility Act; H.R. 3679 - National Nurse Act; H.R. 4274 - BPCA and PREA Reauthorization Act; S. 54 - Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act; S. 55 - Nursing School Clinics Act; H.R. 157 - Health Care Safety Net Enhancement Act; H.R. 227 - Child Gun Safety and Gun Access Prevention Act; H.R. 338 - Protecting Our Kids' Medicine Act; H.R. 469 - Protecting Student Athletes from Concussions Act; H.R. 576 - Healthy Children Through School Nutrition Education Act; H.R. 713 - Keeping Families Together Act; H.R. 751 - Mental Health in Schools Act; H.R. 1214 - to repeal mandatory funding for school-based health center construction; S. 961 - Reconnecting Youth to Prevent Homelessness Act; S. 1165, Button Cell Battery Safety Act; H.R. 1852/S. 958 - Childrens Hospital GME Support Reauthorization Act; H.R. 115 - CHAMPVA Childrens Protection Act; H.R. 364 - Common Sense Health Reform Americans Actually Want Act; H.R. 614 - Post 9/11 G.I. Bill Dependent Coverage Improvement Act; H.R. 978 - Seniors Identity Protection Act; H.R. 989 - Voluntary State Discount Prescription Drug Plan Act; H.R. 1035/S. 1504 - Medicaid Coverage for Citizens of Freely Associated States Act; H.R. 2029/S. 1131 - Birth Defects Prevention, Risk Reduction, and Awareness Act; H.R. 2758/S. 1463 - Breastfeeding Promotion Act; H.R. 2229 - Student-to-School Nurse Ratio Improvement Act.

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; Nursing provisions in potential job creation legislation; Negotiated Rulemaking on Designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; Health information technology and electronic health records; Repeal of Medicaid maintenance of effort requirements; HRSA nurse practitioner national sample survey; State of Florida Section 1115 Medicaid waiver application on managed medical assistance program; Draft legislation to reauthorize the Prescription Drug User Fee Act (PDUFA); H.R. 5/S. 218/S. 1099 - Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R. 5 - Protecting Access to Healthcare (PATH) Act; H.R. 451 - Healthcare Truth and Transparency Act of 2011; S. 248/H.R. 844 - Empowering States to Innovate Act; S. 174 - Healthy Lifestyles and Prevention Act; H.R. 10/S. 299/S. 1720/S. 1786 - Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 - to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 - State Flexibility Act; H.R. 2465 - Federal Workers' Compensation Modernization and Improvement Act; S. 261 - Federal Employees' Compensation Reform Act; H.R. 469 - Protecting Student Athletes from Concussions Act; S. 601/H.R. 1127 - Childrens Sports Athletic Equipment Safety Act; Concussion Treatment and Care Tools (ConTACT) Act; H.R. 4160 - State Health Flexibility Act; H.R. 3679 - National Nurse Act; H.R. 4274 - BPCA and PREA Reauthorization Act.

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

HR 1213 To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges: entire bill HR 1216 To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations: entire bill HR 2 Repealing the Job-Killing Health Care Law Act: entire bill S 192 Repealing the Job-Killing Health Care Law Act: entire bill S 248 Empowering States to Innovate Act: entire bill HR 844 Empowering States to Innovate Act: entire bill Public Law No. 111-148 Patient Protection and Affordable Care Act: entire bill S 2002 Online Pharmacy Safety Act: entire bill HR 4095 Online Pharmacy Safety Act: entire bill

Client expense: $68,486 · Firm income: Not reported

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act HR 896, Medical Justice Act of 2011 HR 1256, Medicare Physician Payment Transparency and Assessment Act of 2011 S 248 / HR 844, Empowering States to Innovate Act S 650/HR 1184, Health Care Waiver Transparency Act S 374, Medicare Mental Health Inpatient Equity Act S 539, Behavioral Health Information Technology Act of 2011 S.365, the Budget Control Act of 2011 HHS-0S-2011-0022-0001 Establishment of Exchanges and Qualified Health Plans, and Standards Related to Reinsurance, Risk Corridors and Risk Adjustment

Client expense: $135,786 · Firm income: Not reported

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act H.R.451, Healthcare Truth and Transparency Act of 2011 H.R.751, Mental Health in Schools Act of 2011 H.R. 831/S 483, To amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program S.483, Medicare Mental Health Access Act S.37, Autonomy for Psychologists and Social Workers Act of 2011 S.40, Graduate Psychology Education Act of 2011 S.43, Psychologists in the Service of the Public Act of 2011 S.539, Behavioral Health Information Technology Act of 2011 S 248 / HR 844, Empowering States to Innovate Act S. 525, Positive Aging Act of 2011 S 650/HR 1184, Health Care Waiver Transparency Act S. 374, Medicare Mental Health Inpatient Equity Act S. 1627, Resident Physician Shortage Reduction Act of 2011, A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes. HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H Res 92, Providing for consideration of the bill (H.R. 1) making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011, and for other purposes, and waiving a requirement of clause 6(a) of rule XIII with respect to consideration of certain resolutions reported from the Committee on Rules. S. 1542, H.R. 2883, Child and Family Services Improvement and Innovation Act HR 4274, the Better Pharmaceuticals for Children ACT and Pediatric Research Reauthorization Act of 2012 Draft, Senate HELP, drug storage legislation and Prescription Drug User Fee Act (PDUFA) reauthorization HR 2245/S 296 Prserving Access to Life-Saving Medications Act of 2011 S. 1584, Drug safety and Accountablity Act of 2011 HR 3765, Temporary Payroll Tax Cut Continuation Act of 2011 HR 3630, Temporary Payroll Tax Cut Continuation Act of 2011 S. 1925 Violence against Women Act Reauthorization HHS Secretary's Bulletin on Essential Health Benefits Final Rule on Medicare Part B Physician Fee Schedules for CY 2012 The use of restraint and seculsion in psychiatric residential treatment facilities providing services to persons under 21 years of age (CMS-2012-0005-0001) Medicare Program; Payment Policies Under the Physician Fee Schedule, Five-Year Review of Work Relative Value Units, Clinical Laboratory Fee Schedule: Signature on Requisition, and Other Revisions to Part B for CY 2012 [CMS1524FC and CMS1436F]

State Innovation Waivers Legislation (S 248, HR 844), grants services

Client expense: Not reported · Firm income: $22,500

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1213 - To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges: entire bill HR 1216 - To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations: entire bill HR 2 Repealing the Job-Killing Health Care Law Act: entire bill S 192 Repealing the Job-Killing Health Care Law Act: entire bill S 248 Empowering States to Innovate Act: entire bill HR 844 Empowering States to Innovate Act: entire bill Public Law No. 111-148 Patient Protection and Affordable Care Act: provisions related to reproductive health coverage and women's health care providers and issues regarding contraception coverage under the law

Client expense: $559,808 · Firm income: Not reported

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; nursing provisions in potential job creation legislation; Negotiated Rulemaking on Designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; health information technology and electronic health records; repeal of Medicaid maintenance of effort requirements; HRSA NP national sample survey; H.R. 5/S. 218/S. 1099 Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R. 451 Healthcare Truth and Transparency Act of 2011; S. 248/H.R. 844 Empowering States to Innovate Act; S. 174 Healthy Lifestyles and Prevention Act; H.R. 10/S. 299/S. 1720/S. 1786 Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 State Flexibility Act; H.R. 2465 Federal Workers' Compensation Modernization and Improvement Act; S. 261 Federal Employees' Compensation Reform Act; H.R. 469 Protecting Student Athletes from Concussions Act; S. 601/H.R. 1127 Childrens Sports Athletic Equipment Safety Act; Concussion Treatment and Care Tools (ConTACT) Act; Amendments to the Consumer Product Safety Improvement Act; Menu and Nutrition Labeling; S. 54 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act; S. 55 Nursing School Clinics Act; H.R. 157 Health Care Safety Net Enhancement Act; H.R. 227 Child Gun Safety and Gun Access Prevention Act; H.R. 338 Protecting Our Kids' Medicine Act; H.R. 469 Protecting Student Athletes from Concussions Act; H.R. 576 Healthy Children Through School Nutrition Education Act; H.R. 713 Keeping Families Together Act; H.R. 751 Mental Health in Schools Act; H.R. 1214 to repeal mandatory funding for school-based health center construction; S. 961 Reconnecting Youth to Prevent Homelessness Act; S. 1165, Button Cell Battery Safety Act; H.R. 1852/S. 958 Childrens Hospital GME Support Reauthorization Act; H.R. 115 CHAMPVA Childrens Protection Act; H.R. 364 Common Sense Health Reform Americans Actually Want Act; H.R. 614 Post 9/11 G.I. Bill Dependent Coverage Improvement Act; H.R. 978 Seniors Identity Protection Act; H.R. 989 Voluntary State Discount Prescription Drug Plan Act; H.R. 1035/S. 1504 Medicaid Coverage for Citizens of Freely Associated States Act; H.R. 2029/S. 1131 Birth Defects Prevention, Risk Reduction, and Awareness Act; H.R. 2758/S. 1463 Breastfeeding Promotion Act; H.R. 2229 Student-to-School Nurse Ratio Improvement Act.

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; nursing provisions in potential job creation legislation; Negotiated Rule-making on Designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; health information technology and electronic health records; repeal of Medicaid maintenance of effort requirements; HRSA NP national sample survey; H.R. 5/S. 218/S. 1099 Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R. 451 Healthcare Truth and Transparency Act of 2011; S. 248/H.R. 844 Empowering States to Innovate Act; S. 174 Healthy Lifestyles and Prevention Act; H.R. 10/S. 299/S. 1720/S. 1786 Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 State Flexibility Act; H.R. 2465 Federal Workers' Compensation Modernization and Improvement Act; S. 261 Federal Employees' Compensation Reform Act; H.R. 469 Protecting Student Athletes from Concussions Act; S. 601/H.R. 1127 Childrens Sports Athletic Equipment Safety Act; Concussion Treatment and Care Tools (ConTACT) Act.

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

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

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act HR 896, Medical Justice Act of 2011 HR 1256, Medicare Physician Payment Transparency and Assessment Act of 2011 S 248 / HR 844, Empowering States to Innovate Act S 650/HR 1184, Health Care Waiver Transparency Act S 374, Medicare Mental Health Inpatient Equity Act S 539, Behavioral Health Information Technology Act of 2011 S.365, the Budget Control Act of 2011 HHS-0S-2011-0022-0001 Establishment of Exchanges and Qualified Health Plans, and Standards Related to Reinsurance, Risk Corridors and Risk Adjustment

Client expense: $126,533 · Firm income: Not reported

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act H.R.451, Healthcare Truth and Transparency Act of 2011 H.R.751, Mental Health in Schools Act of 2011 H.R. 831/S 483, To amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program S.483, Medicare Mental Health Access Act S.37, Autonomy for Psychologists and Social Workers Act of 2011 S.40, Graduate Psychology Education Act of 2011 S.43, Psychologists in the Service of the Public Act of 2011 S.539, Behavioral Health Information Technology Act of 2011 S 248 / HR 844, Empowering States to Innovate Act S. 525, Positive Aging Act of 2011 S 650/HR 1184, Health Care Waiver Transparency Act S. 374, Medicare Mental Health Inpatient Equity Act S. 1627, Resident Physician Shortage Reduction Act of 2011, A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes. HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 1830 Service members' Telemedicine and E-Health Portability Act of 2011 H Res 92, Providing for consideration of the bill (H.R. 1) making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011, and for other purposes, and waiving a requirement of clause 6(a) of rule XIII with respect to consideration of certain resolutions reported from the Committee on Rules. HR 1473, Department of Defense and Full-Year Continuing Appropriations Act, 2011 S. 1542, H.R. 2883, Child and Family Services Improvement and Innovation Act S.365, the Budget Control Act of 2011 Payment Policies Under the Physician Fee Schedule, Five-Year Review of Work Relative Value Units, Clinical Laboratory Fee Schedule: Signature on Requisition, and Other(CMS-2011-0131-1045) Requirements for History and Physical Examinations; Authentication of Verbal Orders; Securing Medications; and Postanesthesia Evaluations (CMS-2006-0232-0001) H.R. 3630, HR 3765, Temporary Payroll Tax Cut Continuation Action of 2011 CLIA Program and HIPAA Privacy; Patients Access to Laboratory Test Reports (CMS-2011-0145-0001) Proposed Changes to the Medicare Advantage and the Medicare (CMS-2010-0258-0001) FDAs Education Blueprint for Prescriber Education for the Long-Acting/Extended Release Opioid Classes (FDA-2011-D-0771-0001) Proposed Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (CMS-2010-0258-0001)

State Innovation Waivers Legislation (S 248, HR 844); FY12 Labor/HHS/Education Appropriations (S 1599), grants services

Client expense: Not reported · Firm income: $22,500

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1213 - To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges: entire bill HR 2 - Repealing the Job-Killing Health Care Law Act: entire bill S 192 - Repealing the Job-Killing Health Care Law Act: entire bill S 248 Empowering States to Innovate Act: entire bill HR. 844 Empowering States to Innovate Act: entire bill

Client expense: $51,861 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID)

HR 1213 To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges: entire bill HR 2 Repealing the Job-Killing Health Care Law Act: entire bill S 192 Repealing the Job-Killing Health Care Law Act: entire bill S 248 Empowering States to Innovate Act: entire bill HR 844 Empowering States to Innovate Act: entire bill H.R. 2954 Health Equity and Accountability Act of 2011: provisions related to family planning and reproductive health HR 1216 To amend the Public Health Service Act to convert funding for graduate medical education in qualified teaching health centers from direct appropriations to an authorization of appropriations: provisions related to family planning and reproductive health

Client expense: $164,581 · Firm income: Not reported

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act H.R.451, Healthcare Truth and Transparency Act of 2011 H.R.751, Mental Health in Schools Act of 2011 H.R. 831/S 483, To amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program S.483, Medicare Mental Health Access Act S.37, Autonomy for Psychologists and Social Workers Act of 2011 S.40, Graduate Psychology Education Act of 2011 S.43, Psychologists in the Service of the Public Act of 2011 S.539, Behavioral Health Information Technology Act of 2011 S 248 / HR 844, Empowering States to Innovate Act S. 525, Positive Aging Act of 2011 S 650/HR 1184, Health Care Waiver Transparency Act S. 374, Medicare Mental Health Inpatient Equity Act S. 1627, Resident Physician Shortage Reduction Act of 2011, A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes. HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 1830 Service members' Telemedicine and E-Health Portability Act of 2011 H Res 92, Providing for consideration of the bill (H.R. 1) making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011, and for other purposes, and waiving a requirement of clause 6(a) of rule XIII with respect to consideration of certain resolutions reported from the Committee on Rules. HR 1473, Department of Defense and Full-Year Continuing Appropriations Act, 2011 S. 1542, H.R. 2883, Child and Family Services Improvement and Innovation Act S.365, the Budget Control Act of 2011 Medicare Program; Proposed Changes to the Electronic Prescribing (eRx) Incentive Program CMS-2011-0108-0001 Medicare Program: Conditions of Participation for Community Mental Health Centers CMS-2011-0123-0001 Medicare and Medicaid Programs: Opportunities for Alignment under Medicaid and Medicare CMS-2011-0080-0002 HIPAA Privacy Rule Accounting of Disclosures under the Health Information Technology for Economic and Clinical Health Act HHS-OCR-2011-0011-0001 Proposed Rules for Screening for Depression in Adults (CAG-00425N) and Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse (CAG-00427N)

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act HR 896, Medical Justice Act of 2011 HR 1256, Medicare Physician Payment Transparency and Assessment Act of 2011 S 248 / HR 844, Empowering States to Innovate Act S 650/HR 1184, Health Care Waiver Transparency Act S 374, Medicare Mental Health Inpatient Equity Act S 539, Behavioral Health Information Technology Act of 2011 S.365, the Budget Control Act of 2011 HHS-0S-2011-0022-0001 Establishment of Exchanges and Qualified Health Plans, and Standards Related to Reinsurance, Risk Corridors and Risk Adjustment

Client expense: $118,117 · Firm income: Not reported

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; nursing provisions in potential job creation legislation; Negotiated Rule-making on Designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; health information technology and electronic health records; repeal of Medicaid maintenance of effort requirements; H.R. 5/S. 218 Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R. 451 Healthcare Truth and Transparency Act of 2011; S. 248/H.R. 844 Empowering States to Innovate Act; S. 174 Healthy Lifestyles and Prevention Act; H.R. 10/S. 299 Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 State Flexibility Act; H.R. 2465 Federal Workers' Compensation Modernization and Improvement Act; S. 261 Federal Employees' Compensation Reform Act; Amendments to the Consumer Product Safety Improvement Act; Menu and Nutrition Labeling; S. 54 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act; S. 55 Nursing School Clinics Act; H.R. 157 Health Care Safety Net Enhancement Act; H.R. 227 Child Gun Safety and Gun Access Prevention Act; H.R. 338 Protecting Our Kids' Medicine Act; H.R. 469 Protecting Student Athletes from Concussions Act; H.R. 576 Healthy Children Through School Nutrition Education Act; H.R. 713 Keeping Families Together Act; H.R. 751 Mental Health in Schools Act; H.R. 1214 to repeal mandatory funding for school-based health center construction; S. 961 Reconnecting Youth to Prevent Homelessness Act; S. 1165, Button Cell Battery Safety Act; H.R. 1852/S. 958 Childrens Hospital GME Support Reauthorization Act; H.R. 115 CHAMPVA Childrens Protection Act; H.R. 364 Common Sense Health Reform Americans Actually Want Act; H.R. 614 Post 9/11 G.I. Bill Dependent Coverage Improvement Act; H.R. 978 Seniors Identity Protection Act; H.R. 989 Voluntary State Discount Prescription Drug Plan Act; H.R. 1035/S. 1504 Medicaid Coverage for Citizens of Freely Associated States Act; H.R. 2029/S. 1131 Birth Defects Prevention, Risk Reduction, and Awareness Act; H.R. 2758/S. 1463 Breastfeeding Promotion Act; H.R. 2229 Student-to-School Nurse Ratio Improvement Act; S. 601, Childrens Sports Athletic Equipment Safety Act; Concussion Treatment and Care Tools (ConTACT) Act.

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; nursing provisions in potential job creation legislation; Negotiated Rule-making on Designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; health information technology and electronic health records; repeal of Medicaid maintenance of effort requirements; H.R. 5/S. 218 Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R.451 Healthcare Truth and Transparency Act of 2011; S. 248/H.R. 844 Empowering States to Innovate Act; S. 174 Healthy Lifestyles and Prevention Act; H.R. 10/S. 299 Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 State Flexibility Act; H.R. 2465 Federal Workers' Compensation Modernization and Improvement Act; S. 261 Federal Employees' Compensation Reform Act; H.R. 469, Protecting Student Athletes from Concussions Act; S. 601, Childrens Sports Athletic Equipment Safety Act; Concussion Treatment and Care Tools (ConTACT) Act.

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

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

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011. Medicare Payment Advisory Commission (MedPAC) Recommendations on the SGR: Commented on MedPACs September 2011 comprehensive proposal to eliminate the SGR with the intent of protecting access to primary care for Medicare beneficiaries, outlined substantial concerns that preclude the College from supporting it. The Joint Select Committee on Deficit Reduction: Urged Congress to repeal the SGR formula and permanently reform the Medicare physician payment system as part of any final agreement between Congress, the Administration and the Joint Select Committee (JSC) on Deficit Reduction. In addition to repeal of the SGR, urged the JSC to establish a national, multi-stakeholder initiative to reduce marginal and ineffective care and promote high value care as well as preserve and broaden financing for Graduate Medical Education and allocate GME funding more strategically, based on an assessment of national workforce priorities and goals; urged members of Congress to sign on to a letter sponsored by Rep. Allyson Schwartz that asks the JSC to include a long term solution to the broken SGR formula in its recommendations to Congress; urged the JSC to include medical liability reform in its recommendations to Congress. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care. Healthcare in the FY2012 Budget: Recommend funding of $65 billion for discretionary public health programs (Function 550) in the FY 2012 budget resolution; sent letter urging the House Labor-HHS-Education Appropriations Subcommittee to provide $762.5 million for the Title VII and VIII programs in FY 2012, sent letter to appropriators asking them to increase the allocation for the Labor-HHS-Education appropriations bill. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268 (in the 110th Congress), to provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage: Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Empowering States to Innovate Act (S. 248, H.R. 844): Supported this legislation, which will allow states to seek waivers three years earlier than the Affordable Care Act to design their own plans to provide comparable levels of coverage to their residents. The Patients Freedom to Choose Act (S. 312, H.R. 605): Supported this legislation, which will repeal a provision in the Affordable Care Act that requires that physicians provide written authorization for over-the-counter drugs reimbursed by a Flexible Spending Account or Health Savings Account.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011. Medicare Payment Advisory Commission (MedPAC) Recommendations on the SGR: Commented on MedPACs September 2011 comprehensive proposal to eliminate the SGR with the intent of protecting access to primary care for Medicare beneficiaries, outlined substantial concerns that preclude the College from supporting it. The Joint Select Committee on Deficit Reduction: Urged Congress to repeal the SGR formula and permanently reform the Medicare physician payment system as part of any final agreement between Congress, the Administration and the Joint Select Committee (JSC) on Deficit Reduction. In addition to repeal of the SGR, urged the JSC to establish a national, multi-stakeholder initiative to reduce marginal and ineffective care and promote high value care as well as preserve and broaden financing for Graduate Medical Education and allocate GME funding more strategically, based on an assessment of national workforce priorities and goals; urged members of Congress to sign on to a letter sponsored by Rep. Allyson Schwartz that asks the JSC to include a long term solution to the broken SGR formula in its recommendations to Congress; urged the JSC to include medical liability reform in its recommendations to Congress. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care. Healthcare in the FY2012 Budget: Recommend funding of $65 billion for discretionary public health programs (Function 550) in the FY 2012 budget resolution; sent letter urging the House Labor-HHS-Education Appropriations Subcommittee to provide $762.5 million for the Title VII and VIII programs in FY 2012, sent letter to appropriators asking them to increase the allocation for the Labor-HHS-Education appropriations bill.. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268 (in the 110th Congress), to provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage: Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Empowering States to Innovate Act (S. 248, H.R. 844): Supported this legislation, which will allow states to seek waivers three years earlier than the Affordable Care Act to design their own plans to provide comparable levels of coverage to their residents. The Patients Freedom to Choose Act (S. 312, H.R. 605): Supported this legislation, which will repeal a provision in the Affordable Care Act that requires that physicians provide written authorization for over-the-counter drugs reimbursed by a Flexible Spending Account or Health Savings Account.

State Innovation Waivers Legislation (S 248, HR 844)

Client expense: Not reported · Firm income: $22,500

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; nursing provisions in potential job creation legislation; Negotiated Rule-making on designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; health information technology and electronic health records; repeal of Medicaid maintenance of effort requirements; H.R. 5/S.218 Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R.451 Healthcare Truth and Transparency Act of 2011; S.248/H.R. 844 Empowering States to Innovate Act; S. 174 Healthy Lifestyles and Prevention Act; H.R 10/S. 299 Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 State Flexibility Act; H.R. 2465 Federal Workers' Compensation Modernization and Improvement Act; S. 261 Federal Employees' Compensation Reform Act; Amendments to the Consumer Product Safety Improvement Act; Menu and Nutrition Labeling; S.54 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act; S.55 Nursing School Clinics Act; H.R.157 Health Care Safety Net Enhancement Act; H.R.227 Child Gun Safety and Gun Access Prevention Act; H.R.338 Protecting Our Kids' Medicine Act; H.R.469 Protecting Student Athletes from Concussions Act; H.R.576 Healthy Children Through School Nutrition Education Act; H.R.713 Keeping Families Together Act; H.R.751 Mental Health in Schools Act; H.R.1214 to repeal mandatory funding for school-based health center construction; S. 961 Reconnecting Youth to Prevent Homelessness Act; S. 1165, Button Cell Battery Safety Act.

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

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; nursing provisions in potential job creation legislation; Negotiated Rule-making on designation of Medically Underserved and Health Professional Shortage Areas; Administration review of current regulations; health information technology and electronic health records; repeal of Medicaid maintenance of effort requirements; H.R. 5/S.218 Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R.451 Healthcare Truth and Transparency Act of 2011; S.248/H.R. 844 Empowering States to Innovate Act; S. 174 Healthy Lifestyles and Prevention Act; H.R 10/S. 299 Regulations From the Executive in Need of Scrutiny (REINS) Act; H.R. 1217 to repeal the Prevention and Public Health Fund; H.R. 1683/S. 868 State Flexibility Act; H.R. 2465 Federal Workers' Compensation Modernization and Improvement Act; S. 261 Federal Employees' Compensation Reform Act.

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

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

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act H.R.451, Healthcare Truth and Transparency Act of 2011 H.R.751, Mental Health in Schools Act of 2011 H.R. 831/S 483, To amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program S.483, Medicare Mental Health Access Act S.37, Autonomy for Psychologists and Social Workers Act of 2011 S.40, Graduate Psychology Education Act of 2011 S.43, Psychologists in the Service of the Public Act of 2011 S.539, Behavioral Health Information Technology Act of 2011 S 248 / HR 844, Empowering States to Innovate Act S. 525, Positive Aging Act of 2011 S 650/HR 1184, Health Care Waiver Transparency Act S. 374, Medicare Mental Health Inpatient Equity Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 1830 Servicemembers' Telemedicine and E-Health Portability Act of 2011 H Res 92, Providing for consideration of the bill (H.R. 1) making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011, and for other purposes, and waiving a requirement of clause 6(a) of rule XIII with respect to consideration of certain resolutions reported from the Committee on Rules. HR 1473, Department of Defense and Full-Year Continuing Appropriations Act, 2011 H Res 218, Providing for consideration of the bill (H.R. 1473) making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011, and for other purposes HR 1, Full-Year Continuing Appropriations Act, 2011 Screening for Depression in Adults, National Coverage Analysis (CAG-00425N). (4/1/11) Medicare Program; Proposed Changes to the Electronic Prescribing (eRx) Incentive ProgramCMS-2011-0108-0001 Medicare Program: Conditions of Participation for Community Mental Health Centers CMS-2011-0123-0001 Medicare and Medicaid Programs: Opportunities for Alignment under Medicaid and Medicare CMS-2011-0080-0002 HIPAA Privacy Rule Accounting of Disclosures under the Health Information Technology for Economic and Clinical Health Act HHS-OCR-2011-0011-0001

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act HR 896, Medical Justice Act of 2011 HR 1256, Medicare Physician Payment Transparency and Assessment Act of 2011 S 248 / HR 844, Empowering States to Innovate Act S 650/HR 1184, Health Care Waiver Transparency Act S 374, Medicare Mental Health Inpatient Equity Act S 539, Behavioral Health Information Technology Act of 2011

Client expense: $190,234 · Firm income: Not reported

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

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Center for Medicare and Medicaid Services (CMS): Support the re-nomination of Don Berwick, MD, as the Administrator of CMS and urge the Finance Committee to approve his nomination in a timely manner; Support delaying the date from Apr. 1, 2011 to no earlier than July 1, 2011 at which CMS would fully enforce the so-called physician face-to-face encounter rule that is the outgrowth of section 6407 of the Patient Protection and Affordable Care Act (PPACA). Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Urged Congress to repeal the SGR formula and permanently reform the Medicare physician payment system as part of any final agreement between Congress and the Administration on authorizing an increase in the debt ceiling. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care; restore the 20/220 loan deferment pathway (S.646 in the 111th Congress). Advanced Care Planning: Worked with the sponsors of the Personalize Your Care Act of 2011, H.R. 1589, to modify this legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans. It would also provide states and communities with grants to create or expand programs that assist with advance care planning. ACP expressed concerns regarding section four of the bill that would require that certified electronic health records display current advance directives and physician orders for life sustaining treatment, as this provision would bypass a process, mandated by the HITECH Act, in which CMS conducts extensive consultations with stakeholders to determine the certification standards for electronic health records. Healthcare in the FY2012 Budget: recommend funding of $65 billion for discretionary public health programs (Function 550) in the FY 2012 budget resolution. Appropriations FY2011: Advocated for strong investment in Titles VII and VIII programs in FY 2011 Labor, Health & Human Services & Educations appropriations bills; these programs provide direct financial support for health care workforce development and education. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268 (in the 110th Congress), to provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation;; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act. Tanning Bed Cancer Control Act of 2011 Supported H.R. 1676, which directs the Commissioner of Food and Drugs (FDA): (1) to complete a study to examine the classification of ultraviolet tanning lamps as class I medical devices; and (2) not later than one year after completion of such study, to either issue a rule providing for the reclassification of an ultraviolet tanning lamp as a class II or class III device or submit to Congress a report providing a justification for not issuing such a rule. The Empowering States to Innovate Act (S. 248, H.R. 844): Supported this legislation, which will allow states to seek waivers three years earlier than the Affordable Care Act to design their own plans to provide comparable levels of coverage to their residents. The Patients Freedom to Choose Act (S. 312, H.R. 605): Supported this legislation, which will repeal a provision in the Affordable Care Act that requires that physicians provide written authorization for over-the-counter drugs reimbursed by a Flexible Spending Account or Health Savings Account.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Center for Medicare and Medicaid Services (CMS): Support the re-nomination of Don Berwick, MD, as the Administrator of CMS and urge the Finance Committee to approve his nomination in a timely manner; Support delaying the date from Apr. 1, 2011 to no earlier than July 1, 2011 at which CMS would fully enforce the so-called physician face-to-face encounter rule that is the outgrowth of section 6407 of the Patient Protection and Affordable Care Act (PPACA). Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Specifically, in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011; Urged Congress to repeal the SGR formula and permanently reform the Medicare physician payment system as part of any final agreement between Congress and the Administration on authorizing an increase in the debt ceiling. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care; restore the 20/220 loan deferment pathway (S.646 in the 111th Congress). Advanced Care Planning: Worked with the sponsors of the Personalize Your Care Act of 2011, H.R. 1589, to modify this legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans. It would also provide states and communities with grants to create or expand programs that assist with advance care planning. ACP expressed concerns regarding section four of the bill that would require that certified electronic health records display current advance directives and physician orders for life sustaining treatment, as this provision would bypass a process, mandated by the HITECH Act, in which CMS conducts extensive consultations with stakeholders to determine the certification standards for electronic health records. Healthcare in the FY2012 Budget: recommend funding of $65 billion for discretionary public health programs (Function 550) in the FY 2012 budget resolution. Appropriations FY2011: Advocated for strong investment in Titles VII and VIII programs in FY 2011 Labor, Health & Human Services & Educations appropriations bills; these programs provide direct financial support for health care workforce development and education. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268 (in the 110th Congress), to provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Urge enactment of H.R. 5, the HEALTH Act, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation;; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act. Tanning Bed Cancer Control Act of 2011 Supported H.R. 1676, which directs the Commissioner of Food and Drugs (FDA): (1) to complete a study to examine the classification of ultraviolet tanning lamps as class I medical devices; and (2) not later than one year after completion of such study, to either issue a rule providing for the reclassification of an ultraviolet tanning lamp as a class II or class III device or submit to Congress a report providing a justification for not issuing such a rule. The Empowering States to Innovate Act (S. 248, H.R. 844): Supported this legislation, which will allow states to seek waivers three years earlier than the Affordable Care Act to design their own plans to provide comparable levels of coverage to their residents. The Patients Freedom to Choose Act (S. 312, H.R. 605): Supported this legislation, which will repeal a provision in the Affordable Care Act that requires that physicians provide written authorization for over-the-counter drugs reimbursed by a Flexible Spending Account or Health Savings Account.

Patient Protection and Affordable Care Act, S. 248; State Innovation Waivers Legislation (S. 248, H.R. 844)

Client expense: Not reported · Firm income: $22,500

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

Health & Wellness Provisions, PPACA. ERISA Waivers, S. 248, HR 844, S 73, S244. General health issues: GINA, Mental Health Parity.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Equal Employment Opportunity Commission (EEOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

Legislation and issues relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Nurse Education, Expansion, and Development Act; nursing provisions in potential job creation legislation; Negotiated Rule-making on designation of Medically Underserved and Health Professional Shortage Areas; H.R. 5/S.218 Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act; H.R.451 Healthcare Truth and Transparency Act of 2011; S.248/H.R. 844 Empowering States to Innovate Act; S.54 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act; S.55 Nursing School Clinics Act; H.R.157 Health Care Safety Net Enhancement Act; H.R.227 Child Gun Safety and Gun Access Prevention Act; H.R.469 Protecting Student Athletes from Concussions Act; H.R.576 Healthy Children Through School Nutrition Education Act; H.R.713 Keeping Families Together Act; H.R.751 Mental Health in Schools Act; H.R.1214 to repeal mandatory funding for school-based health center construction; Reconnecting Youth to Prevent Homelessness Act.

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

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