Registered Nurse Safe Staffing Act of 2011

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

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

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

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

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

H.R. 876/S. 58; Registered Nurse Safe Staffing Act of 2011. S. 56/H.R. 2134: Medicaid Advanced Practice Nurses and Physicians Assistants Access Act. S. 277/H.R. 2267; Home Health Care Planning Improvement Act of 2011 Provider Neutral Language - HHS Provisions related to dual eligibles living with mental illness and their providers and the current process of state demonstration proposals to integrate care for beneficiaries that are concurrently eligible for Medicare and Medicaid. HR 6079- Patients Rights Repeal Act. HR 6176 Aligning Incentives for Better Patient Care Act of 2011.

Client expense: $547,767 · Firm income: Not reported

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

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

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

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

See addendum page. Food and Drug Administration Safety and Innovation Act (S.3187): lobbied in support of the drug shortages bill included in S.3187. Lobbied on changes to the National Childrens Study recruitment procedures and to ask for Congressional review. Lobbied in support of Accelerating the End of Breast Cancer Act of 2011 (H.R. 3067). Lobbied in opposition to Registered Nurse Safe Staffing Act of 2011 (H.R. 876). Reviewed Home Health Care Planning Improvement Act of 2011 (H.R. 2267). CU is neutral on this bill. Reviewed Medicare Cost Contract Extension Act of 2011 (H.R. 2770). CU is neutral on this bill. Reviewed Health Care Cost Reduction Act of 2012 (H.R. 436) and the Protect Medical Innovation Act of 2011 contained therein. CU is neutral on this bill. Reviewed the Quality Health Care Coalition Act of 2011 (H.R. 1409). CU is neutral on this bill.

Client expense: $124,204 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), Patent & Trademark Office (PTO), SENATE

H.R. 876/S. 58; Registered Nurse Safe Staffing Act of 2011. S. 56/H.R. 2134: Medicaid Advanced Practice Nurses and Physicians Assistants Access Act. S. 277/H.R. 2267; Home Health Care Planning Improvement Act of 2011 Provider Neutral Language - HHS As organizations representing dual eligibles living with mental illness and their providers, we are writing to share our views on the current process of state demonstration proposals to integrate care for beneficiaries that are concurrently eligible for Medicare and Medicaid.

Client expense: $318,625 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

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

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

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

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

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

H.R. 876/S. 58; Registered Nurse Safe Staffing Act of 2011 S. 56/H.R. 2134, Medicaid Advanced Practice Nurses and Physicians Assistants Access Act S. 227/H.R. 2267; Home Health Care Planning Improvement Act of 2011 Provider Neutral Language- HHS

Client expense: $454,438 · Firm income: Not reported

Government targets: Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

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

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

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

Legislation and issues related to: Physician/nurse reimbursement; Medicare Medical Home; Medicaid Health Home; Medicare-Medicaid Advanced Primary Care demonstration; Accountable Care Organizations; provisions of the Patient Protection & Affordable Care Act (P.L. 111-148); Graduate Nurse Education demonstration; home health face-to-face examination requirements; Independent Payment Advisory Board (IPAB); Medicare/Medicaid hospital conditions of participation; draft legislation on admission of advanced practice registered nurses to hospital medical staff, granting of clinical privileges; H.R. 2 Repealing the Job-Killing Health Care Law Act; S. 16 Patient Choice Restoration Act; S. 56/H.R. 2134 Medicaid Advanced Practice Nurses and Physician Assistants Access Act; S. 58/H.R. 876 Registered Nurse Safe Staffing Act; S. 227/H.R. 2267 Home Health Care Planning Improvement Act; S. 244/H.R. 782 State Health Care Flexibility Act; H.R. 560 Rural Representation and Transparency Improvement Act; H.R. 452 Medical Decisions Accountability Act; S. 668 Health Care Bureaucrats Elimination Act; S. 1680 Craig Thomas Rural Hospital and Provider Equity Act; H.R. 3630/H.R. 3743/H.R. 3765 Temporary Payroll Tax Cut Continuation Act; H.R. 3326/S. 1587 Medicaid Flexibility for States Act.

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

H.R. 876/S. 58; Registered Nurse Safe Staffing Act of 2011 S. 56/H.R. 2134, Medicaid Advanced Practice Nurses and Physicians Assistants Access Act S. 227/H.R. 2267; Home Health Care Planning Improvement Act of 2011 Letters to Joint Select Committee related to funding cuts for FY 2012 and changes to the entitlement programs. Provider Neutral Language- HHS Letters to Joint Select Committee related to Protection of Dual Eligibles. Letter to Joint Select Commiteee related to eligibility of the Independence at Home Program Provisions related to Medical Checklist Legislation. H.R. 2465, The Federal Workers Compensation Modernization and Improvement Act.

Client expense: $464,666 · Firm income: Not reported

H.R. 876/S. 58; Registered Nurse Safe Staffing Act of 2011 H.R. 999/S. 560; Prescription Drug Savings and Choice Act S. 374; Medicare Mental Health Impatient Equity Act S. 56/H.R. 2134, Medicaid Advanced Practice Nurses and Physicians Assistants Access Act S. 227/H.R. 2267; Home Health Care Planning Improvement Act of 2011 Proposals related to funding the Medicaid Program H.R. 1683; State Flexibility Act of 2011 S. 778; Protecting Access to Rural Therapy Services (PARTS) Act of 2011 Issues related to value-based purchasing programs for Medicare providers and professionals. Letters to Joint Select Committee related to funding cuts for FY 2012 and changes to the entitlement programs.

Client expense: $486,520 · Firm income: Not reported

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

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

Impact of Registered Nurse Safe Staffing Act of 2011, HR876. Impact of proposed Vascularized Composite Allograft (VCA) rule, reclassifying VCAs as organs and not tissues.

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

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

H.R. 876/S. 58; Registered Nurse Safe Staffing Act of 2011 H.R. 999/S.560; Prescription Drug Savings and Choice Act S. 374; Medicare Mental Health Inpatient Equity Act S. 56H.R. 2134; Medicaid Advanced Practice Nurses and Physicians Assistants Access Act S. 227/H.R. 2267; Home Health Care Planning Improvement Act of 2011 Proposals related to funding the Medicaid program. H.R. 1683; State Flexibility Act of 2011 S. 778; Protecting Access to Rural Therapy Services (PARTS) Act of 2011 Issues related to value-based purchasing programs for Medicare porviders and professionals.

Client expense: $376,148 · Firm income: Not reported

Funding for academic medical centers, Childrens Hospital Graduate Medical Education programs, Graduate Medical Education programs, National Institutes of Health, and Medicare and Medicaid programs, and related provisions of H.R. 1 (and continuing appropriations measures H.J.Res. 48 and H.J.Res. 44). Childrens athletic helmet safety and the Childrens Sports Athletic Equipment Safety Act (S. 601, H.R. 1127). Registered Nurse Safe Staffing Act of 2011 (H.R. 876) provisions relating to hospital nurse staffing. Health and wellness promotion and prevention provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA; P.L. 111-148).

Client expense: $90,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Patient Protection and Affordable Care Act, Maintain the Medicaid maintenance of effort (MOE) provisions; HR 452 Medicare Decisions Accountability Act of 2011, to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; HR 541 Pay for all your Undocumented Procedures (PAY UP!) Act of 2011, amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens. Requires a re-allotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state; HR 876 and S 58 The Registered Nurse Safe Staffing Act of 2011, to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers; HR 1159, to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests; HR 1186, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals; S 374 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; Legislation which would amend the Social Security Act to ensure that the full cost of certain provider taxes are considered allowable costs for purposes of Medicare reimbursements to CAHs; Urging congress to establish patient and facility criteria to distinguish LTACHs from other care settings; Raising concerns about CMS flawed methodology that overstate the effect of the documentation and coding changes to PPS payments, ensuring that CMS does not go beyond its charge of ensuring budget-neutral implementation of MS-DRGs; Working with CMS to clarify requirements and ensure that the systems to register for the meaningful use incentives and attest to meeting the requirements are useable, including ensuring that hospitals can, with permission, help their physicians sign up for the program and attest to meeting the requirements; Worked with ONC to modify the certification requirements for EHRs to allow the flexibility promised in the rules for meaningful use; Worked to get legislative fix introduced for ACA provision related to readmission policy to eliminate a computation error and ensure that unrelated and planned readmissions are excluded from the policy; Worked to structure the development of the regulation to implement ACOs prior to release of the proposed rule; Obtaining change in language for Medicare conditions of participation related to governing board requirements to eliminate an unnecessary requirement for separate boards or separate meetings of the board for individual hospitals that are part of a system; Urging CMS not to adopt a burdensome notice requirement in the Medicare conditions of participation related to the grievance process; Urging CMS to update, streamline, and modernize the Medicare conditions of participation.

H.R. 876/S. 58; Registered Nurse Safe Staffing Act of 2011 S. 56;; Medicaid Advanced Practice Nurses and Physicians Assistants Access Act S. 374; Medicare Health in Schools Act of 2011 H.R. 999/S. 560; Prescription Drug Savings and Choice Act Medicare Mental Health Modernization Act of 2011 Any provisions related to efforts which aim to weaken stability protections in Medicaid and CHIP

Client expense: $418,215 · Firm income: Not reported

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), SENATE