Medicare Drug Savings Act of 2013

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013, entire bill 7. S. 740, Medicare Drug Savings Act of 2013, entire bill 8. H.R. 1588, Medicare Drug Savings Act of 2013, entire bill 9. S. 1198, Medicare Fair Share Act of 2013, entire bill 10. H.R. 4015, SGR Repeal and Medicare Provider Modernization Act of 2014, entire bill 11. H.R. 4302, Protecting Access to Medicare Act of 2014, entire bill 12. H.R. 1179, Improving Access to Medicare Coverage Act of 2013, entire bill 13. S. 569, Improving Access to Medicare Coverage Act of 2013, entire bill

Client expense: $60,000 · Firm income: Not reported

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

Pub.Law 111-148 & 111-152 - Discussed implementation of health care law that would reform the health care system to provide affordable quality health care, reduce drug costs and expand access to long-term services and supports. Discussed how to implement Medicaid provisions of Affordable Care Act. (PL. 111-148)S. 374, Medicare Mental Health Inpatient Equity Act - Lobbied in support of this legislation to eliminate the 190-day lifetime limit on Medicare coverage for in-patient psychiatric hospital services (112th). Discussed improving access to care for underserved population. (no bill) Discussed importance of maintaining low income subsididies and supports in Medicare. (no bill) Discussed the importance of coordinating services for those who qualify for both Medicare and Medicaid in order to ensure that beneficiaries receive all needed benefits but there is no duplication. (no bill) Discussed whether, and under what circumstances, managed care could effectively be used to provide benefits to dual eligible beneficiaries. (no bill) Discussed additional methods for fighting fraud and waste in Health Care. (no bill) Discussed Medigap and need for guaranteed issue for all populations and need to increase medical loss ratio. Discussed durable medical equipment bidding. (no bill) Lobbied for legislation to provide Medicare beneficiaries with additional opportunities to enroll in Medicare Part B.(no bill) Lobbied against the use of the Social Security account number on Government-issued identification cards issued in connection with Medicare, Medicaid, and SCHIP benefits and for other purposes. (no bill) Discussed support to curb waste and fraud from the Medicare and Medicaid programs. (no bill) H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2012 - Discussed the legislation as it pertained to SGR. Discussed Medicare Reform. (no bill) H.R. 2305/S. 1123, PRIME ACT (Preventing and Reducing Improper Medicare Expenditures) - Discussed support for bill and urged cosponsorship. Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs. (no bill) H.R. 1588/S. 740, Medicare Drug Savings Act - Discussed the Medicare Drug Savings Act to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed potential improvements to the Medicare Savings Programs for low-income befeficiaries. (no bill) Discussed proposals that would establish per-capita caps under Medicaid as well as other Medicaid financing proposals including block grants and changes to the current FMAP structure. (no bill) H.R. 1717 - Discussed Medicare DMEPOS Market Pricing Program Act. Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H.R.3830/S.1900 - Discussed pending U.S. trade agreement negotiations and trade promotional or "fast track" authority legislation and their potential impact on Medicare and Medicaid prescription drug programs. S. 2461 - Discussed Children's Health Insurance Program (CHIP) extension and CHIP Extension Act of 2014. Discussed Part D Payment for Drugs for Beneficiaries Enrolled in Hospice - Final 2014 CMS Guidance. H.R.5294, Health Equity & Accountability Act of 2014 - Addresses health care disparities; no endorsement due to budget impact. Medicare Advantage- Answered questions from some Hill offices. (no bill) Medicare Supplemental Insurance - Stated opposition to the elimination of first dollar coverage. (no bill) Discussed LTSS issues, including financing. (no bill)Discussed Medicare Graduate Nursing Education pilot design. (no bill) Discussed Prescription Drug Affordability. (no bill) Discussed Prescription Drug Shortages. (no bill) H.R. 3342, Affordable Medicines Utilization Act of 2011 - Lobbied to encourage state Medicaid programs to use safe, effective generic medications. H.R. 2576 - Discussion to amend the Internal Revenue Code of 1986 to modify the calculation of modified adjusted gross income for purposes of determining eligibility for certain healthcare-related programs. Discussed opposition to caps on dual eligibles; discussed managed care and dual eligibles. (no bill) Discussed with CMS demonstration programs for dual eligibles and process related to the demonstrations, as well as other work of the Medicare-Medicaid Coordination Office, discussed consumer choice and continuity of care in Medicaid managed long-term services and supports programs, discussed focus groups on dual eligibles. Discussed Hospital & Critical Access Hospitals Conditions of Participation proposed regulations; requested that advanced practice registered nurses and physicians assistants be allowed the full scope of services in hospital admitting and visiting privileges. (no bill) Discussed Hospital Outpatient Therapeutic Services Final Rule underscoring that advanced practice registered nurses and physicians should be allowed to supervise such outpatient service clinics without physician oversight as long as in line with state scope of practice laws. (no bill) Discussed health disparities. (no bill) Discussed Medicaid reform, Medicare/Medicaid "dual eligibles" integration efforts and financial alignment demonstrations; and other CMS demonstration initiatives. (no bill) S. 3586, Recruiting Individuals to Drive Elders (RIDE) Act - Discussed Medicaid non-emergency transportation bill (112th). Discussed proposals that would establish per-capita caps under Medicaid as well as other Medicaid financing proposals including block grants and changes to the current FMAP structure. (no bill) Discussed extension of funding originally provided under the Medicare Improvement for Patients and Providers Act (P.L. 110-275) to State Health Insurance Assistance Programs (SHIPs), Aging and Disability Resource Centers (ADRICs), and Area Agencies on Aging (AAAs) for Medicare outreach and enrollment counseling. (no bill) Discussed the prevention of cuts to beneficiaries in the Medicare program. (no bill) Discussed the prevention of an increase in the age of eligibility in the Medicare program. (no bill) Discussed the patch to the Sustainable Growth Rate (SGR) in the Medicare program. (no bill) Discussed concerns of block granting Medicaid. (no bill) Discussed the Kansas managed long-term services and supports waiver proposals and related implementation issues. (no bill). H.R.928/S.408, the Medicare Drug Savings Act - Discussed requirement for drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed Health Disparities. (no bill) Discussed medicare demonstration project replacing standard medicare cards with Smart Card technology. (no bill) H.R. 574 - The Medicare Physician Payment Innovation Act of 2013. Discussed Medicaid expansion and estate recovery. (no bill) S. 2491, Discussed Medicare Protection Act. Discussed concern about CMS guidance on prescription drugs for medicare beneficiaries receiving hospice and coordination between hospice providers and medicare Part D sponsors. (no bill) Discussed long-term services and supports in Hill briefings. (no bill) H.R. 1173 - Discussed advance care planning, CMS payment for advance care planning, advanced illness, and Personalize Your Care Act.H.R. 1179/S.569, Improving Access to Medicare Act - Discussed support of Improving Access to Medicare Coverage Act and urged cosponsorship and advancement of the bill. Discussed CMS information regarding healthcare marketplaces. H.R. 2305/S.1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act. Bill reduces waste, fraud, and abuse in Medicare and Medicaid programs. Discussed Competitive bidding of durable medical equipment, prosthetics, orthotics, and supplies. (no bill) Discussed repeal of Affordable Care Act provision making prescriptions necessary for over-the-counter drugs purchased with flexible spending accounts. (no bill) Discussed Medicare supplemental coverage. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug cost. (no bill) Discussed potential improvements to the Medicare Savings Programs for low-income beneficiaries. (no bill) H.R. 83, Consolidated and Further Continuing Appropriations, 2015 - Lobbied to protect vital health and social services programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation.(no bill) Discussed potential improvements to the Medicare Savings Programs for low-income beneficiares. (no bill) Discussed pending U.S. trade agreement negotiations, including trade promotional or 'fast track' authority, and their potential impact on Medicare and Medicaid prescription drug programs. (no bill) Discussed fraud, Medicare home healthcare, ways to find savings in Medicare without harming Medicare beneficiaries (care coordination, prescription drugs, waste, fraud and abuse). Discussed You've Earned A Say, ways to find savings in medicare without harming medicare beneficiaries (care coordination, prescription drugs, waste, fraud and abuse). PL.111-148 - Discussed implementation of provision to require reporting of nursing home staffing data based on payroll data and executive actions related to nursing homes, IMPACT Act, PL 113-185).. Discussed the draft legislation on Medicare fraud and abuse. Protecting the Integrity of Medicare Act. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H.R. 1588/S.740 - Discussed the Medicare Drug Savings Act to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. H.R. 3830/S. 1900 - Discussed pending U.S. trade agreement negotiations and trade promotional or "fast track" authority legislation and their potential impact on Medicare and Medicaid prescription drug programs. S. 2461 - Discussed Children's Health Insurance Program (CHIP) Extension Act of 2014. Discussed Part D Payment for Drugs for Beneficiaries Enrolled in Hospice-Final 2014 CMS Guidance. Discussed the Protecting Integrity of Medicare Act. (no bill) H.R.5435, Home Infusion Site of Care Act - Sent letter of endorsement H.R. 5958 - Discussed the ACO Improvement Act. H.J. Res. 124, Continuing Appropriations Resolution - Lobbied to protect funding levels for CMS program management under Continuing Resolution. H.R. 1179/S. 569 - Discussed observation impace on Medicare beneficiaries, counting time in observation toward Medicare's three-day inpatient hospital stay requirement for Medicare skilled nursing facility coverage, and the Improving Access to Medicare Coverage Act (CMS & MedPAC). PL. 113-295 - Responded to inquiry about Medicare offsets on Achieving a Better Life Expense Act.Discussed Medicare Advantage. (no bill) Discussed H.R. 3616, Protecting Seniors from Healthcare Fraud Act. Discussed observation care and "two-midnight rule". (no bill) H.R. 1070, the Removing Barriers to Colorectal Cancer Screening Act - Discussed and sent letter of endorsement to bill. Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H.R. 1588/S.740, Medicaid Drug Savings Act - Discussed the requirement for drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed potential improvements to the Medicare Savings Programs for low-income beneficiaries. (no bill) Discussed pending U.S. Trade agreement negotiations, including trade promotional or "fast track" authority, and their potential impact on Medicare and Medicaid prescription drug programs. (no bill) H.R. 2810/S.1871/H.R. 4015/S.2110 - Discussed SGR repeal and health care extender provisions, including the Qualified Individual low-income Medicare beneficiary assistance program. H.R. 4418, The Expanding Availability of Medicare Data Act - Sent letter of endorsement. Discussed Medicare data and billing transparency. (no bill) Discussed socio-economic risk adjustment. (no bill) S. 2240 - Discussed Medicare Choices Empowerment and Protection Act. H.R. 3024 - Discussed the Medicare Common Access Card Act. Discussed Medicare expansion. (no bill) Discussed Medicaid Labs Spousal Impoverishment provisions (PL. 111-198). Discussed transparency in healthcare. (no bill) Discussed Medicaid managed care regulations. (CMS, no bill) PL.111-148 - Discussed long-term services and supports broadly and Older Americans Act. Submitted comments on Medicare Physician fee schedule final rule and advance care planning (CMS - 1612-FC). Discussed Medicare enrollment and notification of eligibility. (no bill) Discussed Medicare in-office ancillary services exception. (no bill)

Client expense: $2,180,000 · Firm income: Not reported

Government targets: Administration on Aging, Agriculture, Dept of (USDA), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Congressional Budget Office (CBO), Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Comptroller of the Currency (OCC), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style "rebate"). S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential programmatic offsets).Potential deficit reduction legislation that might include provisions to reduce Medicare Part B reimbursements for drugs and biologics. H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential programmatic offsets) H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013 H.R. 83, Consolidated and Further Continuing Appropriations Act, 2015 (potential programmatic offsets)

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style "rebate"). S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential programmatic offsets).Potential deficit reduction legislation that might include provisions to reduce Medicare Part B reimbursements for drugs and biologics. H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential programmatic offsets). H.R. 4187, Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms Act of 2014 H.R. 83, Consolidated and Further Continuing Appropriations Act, 2015 (potential programmatic offsets).

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs) S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential programmatic offsets). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential programmatic offsets).H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style rebate). H.R. 83, Consolidated and Further Continuing Appropriations Act, 2015 (potential programmatic offsets).

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to the Independent Payment Advisory Board H.R. 460, Patients Access to Treatments Act: Provisions related to cost sharing in the specialty tier H.R. 928, Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to Part D issues H.R. 1024, Medication Therapy Management Empowerment Act of 2013: Provisions related to medication therapy management in Part D H.R. 1102, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference H.R. 1588, Medicare Drug Savings Act of 2013: Provisions related to Part D issues H.R. 2753 Securing Care for Seniors Act: Provisions related to Value Based Insurance Design H.R. 2810, Medicare Patient Access and Quality Improvement Act: Provisions related to SGR reform H.R. 2827, To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D: Provisions related to Medicare Part D Drug Tier Formularies H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013: Provisions related to Office of Inspector General (OIG) enforcement of fraud and abuse laws H.R. 3392, Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013: Provisions related to lock-in programs H.R. 3796, Comprehensive Care Payment Innovation Act: Provisions related to alternative payment models H.R. 3890 Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to sustainable growth rate (SGR) and Medicare provider payment reform H.R. 4160, Keep the Promise to Seniors Act of 2014: Provisions related to Part D issues H.R. 4302, Protecting Access to Medicare Act of 2014: Provisions related to the biopharmaceutical industry H.R. 4577, Ensuring Seniors Access to Local Pharmacies Act of 2014: Provisions related to Part D preferred pharmacy networks H.R. 5183, Value Based Insurance Design for Better Care Act of 2014: Provisions related to valued base insurance design demonstration program H.R. 5558 ACO Improvement Act: Provisions related to alternate payment models H.R. 5780, Protecting Integrity in Medicare Act of 2014: Provisions related to addressing fraud and prescription drug abuse S. 117, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference S. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to Independent Payment Advisory Board S. 408, Medicare Prescription Drug Savings and Choice Act of 2013: Provision related to Part D issues S. 557, Medication Therapy Management Empowerment Act of 2013: Provisions related to Part D and medication therapy management S. 740, Medicare Drug Savings Act of 2013: Provisions related to Part D issues Deficit reduction policy issues S. 882, Stop Trafficking of Pills (STOP) Act: Provisions related to lock-in programs (112th Congress) S. 1365, Part D Beneficiary Appeals Fairness Act: Provisions related to the specialty tier in Part D S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013: Provisions related to reforming Medicare physician payments S. 1932, Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to SGR reform S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014: Provisions related to SGR reform Hospital Improvements for Payment (HIP) Act of 2014: Provisions related to Medicare reform (no bill number) Medicare Prescription Drug Diversion and Abuse Prevention Act: Provisions related to diversion and abuse (no bill number) Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs: Provisions related to Part D Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy Medicaid Program, Covered Outpatient Drugs rulemaking Medicare sustainable growth rate policy issues Implementation issues relating to the Physician Payment Sunshine Act, including Medicare, Medicaid, Childrens Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests rulemaking Issues related to better use of medicine and adherence

Client expense: $3,960,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Medicare Payment Advisory Commission (MedPAC), Patent & Trademark Office (PTO), SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

FY 2014 Omnibus HR 3547 FY 2014 Continuing Resolution H J Res 106 PL 113-73 FY 2014 Continuing Resolution H J Res 59 PL 113-67 HR 4302 SGR Patch Protecting Access to Medicare Act of 2014 - Public Law No: 113-93 In all of the above the specific issues included potential Medicare offsets that might be applied to prescription drugs HR 962/S 452 - Medicare Diabetes Prevention Act of 2013 HR 1257 Prevent Diabetes Medicare Act of 2013 HR 1274/S 945 Access to Quality Diabetes Education Act of 2013; HR 1588/ S 740 -- Medicare Drug Savings Act of 2013 HR 2415/ S 1184 - Treat and Reduce Obesity Act of 2013; HR 2663/S 1422 - Scoring of Preventive Health Savings Medicare diabetes screening and self management

Client expense: Not reported · Firm income: $27,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

CY 2015 Medicare proposed rule for hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system: Provisions related to packaging of drugs and biologicals.Comprehensive Care Payment Innovation Act (H.R. 3796). Protecting Access to Medicare Act of 2014 (H.R. 4302), in regard to ICD-10. Issues related to Medicare coverage and payment for durable medical equipment. SGR Repeal and Medicare Beneficiary Access Act (S. 1871) Medicare Drug Savings Act (H.R. 1588, S. 740) Protecting the Integrity of Medicare Act of 2014 (H.R. 5780)

Client expense: $415,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 962 and S. 452, the Medicare Diabetes Prevention Act of 2013; Issues related to Medicare Part D and Medicaid rebates as contained in Pub. L. 112-25, the Budget Control Act of 2011 and H.R. 8, the American Taxpayer Relief Act of 2012; H.R. 1588 and S. 740, the Medicare Drug Savings Act of 2013; H.R. 1257, the Preventing Diabetes in Medicare Act of 2013 and prediabetes generally; H.R. 1274 and S. 945, the Access to Quality Diabetes Education Act of 2013 (Diabetes Self-Management Training in Medicare); Medicare diabetes screening generally; diabetes screening recommendations under USPSTF.

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE, U.S. Trade Representative (USTR)

H.R. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board H.R. 928 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D H.R. 1024 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues H.R. 1102 - Medicare Prescription Drug Price Negotiation Act of 2013; Provisions related to Part D issues and non-interference H.R. 1588 - Medicare Drug Savings Act of 2013; provisions related to Part D issues H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013; Provisions related to SGR reform H.R. 2827 - To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D; provisions related to Medicare Part D Drug Tier Formularies H.R. 3890 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease H.R 4160 - Keep the Promise to Seniors Act of 2014; provisions related to Part D H.R. 4187 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 4302 - Protecting Access to Medicare Act of 2014; provisions related to the biopharmaceutical industry S. 117 - Medicare Prescription Drug Price Negotiation Act of 2013; provisions related to Part D issues S. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board S. 408 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D S. 557 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues S. 740 - Medicare Drug Savings Act of 2013; provisions related to Part D issues S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013; Provisions related to reforming Medicare physician payments S. 1932 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014; Provisions related to SGR reform S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014; Provisions related to SGR reform No bill # assigned - Contract Year 2015 Policy and Technical Cganges to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs; Provisions related to Part D No bill # assigned - Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy No bill # assigned - Issues related to better use of medicines and comprehensive medication management No bill # assigned - Medicaid Program, Covered Outpatient Drugs rulemaking No bill # assigned - Implementation Issues relating to the Physician Payment Sunshine ActNo bill # assigned - Vaccine access and coverage issues

Client expense: $580,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, U.S. Trade Representative (USTR)

H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style "rebate"). S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential programmatic offsets).Potential deficit reduction legislation that might include provisions to reduce Medicare Part B reimbursements for drugs and biologics. H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential programmatic offsets). H.R. 83, Consolidated and Further Continuing Appropriations Act, 2015 (potential programmatic offsets)

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 962 and S. 452 Medicare Diabetes Prevention Act of 2013; Issues related to Medicare Part D and Medicaid rebates as contained in P.L. 112-25 Budget Control Act of 2011 and H.R. 8 American Taxpayer Relief Actof 2012; H.R. 1588 & S. 740 Medicare Drug Savings Act of 2013; H.R. 1257 Preventing Diabetes in Medicare Act of 2013 and prediabetes generally; H.R. 1274 and S 945 Access to Quality Diabetes Education Act of 2013 (Diabetes Self-Management Training in Medicare);Medicare diabetes screening generally; S. 1184 and H.R. 2415 Treat and Reduce Obesity Act of 2013 and obesity medication coverage generally; Diabesity amendment to S. 1871 SGR Repeal and Medicare Beneficiary Access; Physician Quality and Reporting System (PQRS)

Client expense: $280,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA)

Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill.) Proposals related to the activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients receiving benefits from both Medicare and Medicaid, i.e., dual-eligibles. Medicare Advantage. S. 2552, H.R.4998, Medicare Advantage Participant Bill of Rights Act of 2014: provisions to establish necessary protections for seniors enrolled in Medicare Advantage plans. Medicare Benefit Redesign. S. 11, Fiscal Sustainability Act of 2013: provisions pertaining to Parts A and B deductibles; premiums, including means-testing; a catastrophic cap on out-of-pocket spending; the eligibility age; and proposals to privatize Medicare. Medicare Drug Savings. S. 740, H.R. 1588, Medicare Drug Savings Act of 2013: provisions to extend the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Part D Negotiation of Drug Prices. S. 408, H.R. 928, Medicare Prescription Drug Savings and Choice Act of 2013: proposals to create a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Physician Fees and Extenders. H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014; S. 2157, Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014: provisions relating to a permanent fix of the sustainable growth rate (SGR) formula used to determine physician fees under Part B; the extension of the Qualified Individual (QI) program; and the therapy caps. Medicare Supplemental Health Insurance. (No bill.) Proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Observation Status. S. 569, H.R. 1179, Improving Access to Medicare Coverage Act of 2013: legislation to count days in the hospital in observation status toward meeting the three-day prior hospitalization requirement for skilled nursing facility (SNF) care eligibility. Nursing Home Staffing. H.R. 5373, Put A Registered Nurse in the Nursing Home Act of 2014: legislation to require nursing homes and skilled nursing facilities that receive Medicare and/or Medicaid reimbursement to have at least one direct care registered nurse on duty at all times. Comprehensive Health Care Reform. P.L. 111-148, Patient Protection and Affordable Care Act; P.L. 111-152, Health Care and Education Reconciliation Act of 2010: implementation of provisions reducing Medicare Advantage plan payments; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); expanding coverage of prevention services; testing payment and delivery system reforms; and providing expanded Medicaid coverage.

Client expense: $230,000 · Firm income: Not reported

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

Medicare medicaid legislationH.R. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board H.R. 928 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D H.R. 1024 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues H.R. 1102 - Medicare Prescription Drug Price Negotiation Act of 2013; Provisions related to Part D issues and non-interference H.R. 1588 - Medicare Drug Savings Act of 2013; provisions related to Part D issues H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013; Provisions related to SGR reform H.R. 2827 - To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D; provisions related to Medicare Part D Drug Tier Formularies H.R. 3890 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease H.R 4160 - Keep the Promise to Seniors Act of 2014; provisions related to Part D H.R. 4187 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 4302 - Protecting Access to Medicare Act of 2014 - provisions related to the biopharmaceutical industry S. 117 - Medicare Prescription Drug Price Negotiation Act of 2013; provisions related to Part D issues S. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board S. 408 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D S. 557 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues S. 740 - Medicare Drug Savings Act of 2013; provisions related to Part D issues S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013; Provisions related to reforming Medicare physician payments S. 1932 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014; Provisions related to SGR reform S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014; Provisions related to SGR reform

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

CY 2015 Medicare proposed rule for hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system: (1) Provisions related to reassignment of disposable negative pressure wound therapy to APC 0015; (2) Provisions related to packaging of drugs and biologicals.Comprehensive Care Payment Innovation Act (H.R. 3796). Protecting Access to Medicare Act of 2014 (H.R. 4302), in regard to ICD-10. Issues related to Medicare coverage and payment for durable medical equipment. SGR Repeal and Medicare Beneficiary Access Act (S. 1871) Medicare Drug Savings Act (H.R. 1588, S. 740)

Client expense: $375,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

H.R. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to the Independent Payment Advisory Board H.R. 460, Patients Access to Treatments Act: Provisions related to cost sharing in the specialty tier H.R. 928, Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to Part D issues H.R. 1024, Medication Therapy Management Empowerment Act of 2013: Provisions related to medication therapy management in Part D H.R. 1102, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference H.R. 1588, Medicare Drug Savings Act of 2013: Provisions related to Part D issues H.R. 2753 Securing Care for Seniors Act: Provisions related to Value Based Insurance Design H.R. 2810, Medicare Patient Access and Quality Improvement Act: Provisions related to SGR reform H.R. 2827, To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D: Provisions related to Medicare Part D Drug Tier Formularies H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013: Provisions related to fraud and abuse H.R. 3392, Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013: Provisions related to lock-in programs H.R. 3796, Comprehensive Care Payment Innovation Act: Provisions related to alternative payment models H.R. 3890 Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to sustainable growth rate (SGR) and Medicare provider payment reform H.R. 4160, Keep the Promise to Seniors Act of 2014: Provisions related to Part D issues H.R. 4302, Protecting Access to Medicare Act of 2014: Provisions related to the biopharmaceutical industry H.R. 4577, Ensuring Seniors Access to Local Pharmacies Act of 2014: Provisions related to Part D preferred pharmacy networks H.R. 5183, Value Based Insurance Design for Better Care Act of 2014: Provisions related to valued base insurance design demonstration program H.R. 5558 ACO Improvement Act: Provisions related to alternate payment models S. 117, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference S. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to Independent Payment Advisory Board S. 408, Medicare Prescription Drug Savings and Choice Act of 2013: Provision related to Part D issues S. 557, Medication Therapy Management Empowerment Act of 2013: Provisions related to Part D and medication therapy management S. 740, Medicare Drug Savings Act of 2013: Provisions related to Part D issues Deficit reduction policy issues S. 882, Stop Trafficking of Pills (STOP) Act: Provisions related to lock-in programs (112th Congress) S. 1365, Part D Beneficiary Appeals Fairness Act: Provisions related to the specialty tier in Part D S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013: Provisions related to reforming Medicare physician payments S. 1932, Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to SGR reform S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014: Provisions related to SGR reform Medicare Prescription Drug Diversion and Abuse Prevention Act: Provisions related to diversion and abuse (no bill number) Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs: Provisions related to Part D Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy Medicaid Program, Covered Outpatient Drugs rulemaking Medicare sustainable growth rate policy issues Implementation issues relating to the Physician Payment Sunshine Act, including Medicare, Medicaid, Childrens Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests rulemaking Issues related to better use of medicine and adherence Protecting Integrity in Medicare Act of 2014 (no bill number): Provisions related to addressing fraud, prescription drug abuse, and other issues Lock-in concepts generally

Client expense: $3,680,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Patent & Trademark Office (PTO), SENATE, U.S. Trade Representative (USTR)

H.R. 962 and S. 452 Medicare Diabetes Prevention Act of 2013; Issues related to Medicare Part D and Medicaid rebates as contained in P.L. 112-25 Budget Control Act of 2011 and H.R. 8 American Taxpayer Relief Act of 2012; H.R. 1588 & S. 740 Medicare Drug Savings Act of 2013; H.R. 1257 Preventing Diabetes in Medicare Act of 2013 and prediabetes generally; H.R. 1274 and S 945 Access to Quality Diabetes Education Act of 2013 (Diabetes Self-Management Training in Medicare);Medicare diabetes screening generally; S. 1184 and H.R. 2415 Treat and Reduce Obesity Act of 2013; Physician Quality and Reporting System (PQRS). Diabesity amendment to S. 1871 SGR Repeal and Medicare Beneficiary Access.

Client expense: Not reported · Firm income: $30,000

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA)

Pub.Law 111-148 & 111-152 - Discussed implementation of health care law that would reform the health care system to provide affordable quality health care, reduce drug costs and expand access to long-term services and supports. Discussed how to implement Medicaid provisions of Affordable Care Act. (PL. 111-148)S. 374, Medicare Mental Health Inpatient Equity Act - Lobbied in support of this legislation to eliminate the 190-day lifetime limit on Medicare coverage for in-patient psychiatric hospital services (112th). Discussed improving access to care for underserved population. (no bill) Discussed importance of maintaining low income subsididies and supports in Medicare. (no bill) Discussed the importance of coordinating services for those who qualify for both Medicare and Medicaid in order to ensure that beneficiaries receive all needed benefits but there is no duplication. (no bill) Discussed whether, and under what circumstances, managed care could effectively be used to provide benefits to dual eligible beneficiaries. (no bill) Discussed additional methods for fighting fraud and waste in Health Care. (no bill) Discussed Medigap and need for guaranteed issue for all populations and need to increase medical loss ratio. Discussed durable medical equipment bidding. (no bill) Lobbied for legislation to provide Medicare beneficiaries with additional opportunities to enroll in Medicare Part B.(no bill) Lobbied against the use of the Social Security account number on Government-issued identification cards issued in connection with Medicare, Medicaid, and SCHIP benefits and for other purposes. (no bill) Discussed support to curb waste and fraud from the Medicare and Medicaid programs. (no bill) H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2012 - Discussed the legislation as it pertained to SGR. Discussed Medicare Reform. (no bill) H.R. 2305/S. 1123, PRIME ACT (Preventing and Reducing Improper Medicare Expenditures) - Discussed support for bill and urged cosponsorship. Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs. (no bill) H.R. 1588/S. 740, Medicare Drug Savings Act - Discussed the Medicare Drug Savings Act to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed potential improvements to the Medicare Savings Programs for low-income befeficiaries. (no bill) Discussed proposals that would establish per-capita caps under Medicaid as well as other Medicaid financing proposals including block grants and changes to the current FMAP structure. (no bill) H.R. 1717 - Discussed Medicare DMEPOS Market Pricing Program Act. Discussed implementation of regulations regarding minimum wage and overtime for home care workers and consumer-directed care. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H. R. 1588/S.740 - Discussed the Medicare Drug Savings Act to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. H.R.3830/S.1900 - Discussed pending U.S. trade agreement negotiations and trade promotional or "fast track" authority legislation and their potential impact on Medicare and Medicaid prescription drug programs. S. 2461 - Discussed Children's Health Insurance Program (CHIP) extension and CHIP Extension Act of 2014. Discussed Part D Payment for Drugs for Beneficiaries Enrolled in Hospice - Final 2014 CMS Guidance. H.R.5294, Health Equity & Accountability Act of 2014 - Addresses health care disparities; no endorsement due to budget impact. Medicare Advantage- Answered questions from some Hill offices. (no bill) Medicare Supplemental Insurance - Stated opposition to the elimination of first dollar coverage. (no bill)Discussed Medicare Graduate Nursing Education pilot design. (no bill) Discussed Prescription Drug Affordability. (no bill) Discussed Prescription Drug Shortages. (no bill) H.R. 3342, Affordable Medicines Utilization Act of 2011 - Lobbied to encourage state Medicaid programs to use safe, effective generic medications. H.R. 2576 - Discussion to amend the Internal Revenue Code of 1986 to modify the calculation of modified adjusted gross income for purposes of determining eligibility for certain healthcare-related programs. Discussed opposition to caps on dual eligibles; discussed managed care and dual eligibles. (no bill) Discussed with CMS demonstration programs for dual eligibles and process related to the demonstrations, as well as other work of the Medicare-Medicaid Coordination Office, discussed consumer choice and continuity of care in Medicaid managed long-term services and supports programs, discussed focus groups on dual eligibles. Discussed Hospital & Critical Access Hospitals Conditions of Participation proposed regulations; requested that advanced practice registered nurses and physicians assistants be allowed the full scope of services in hospital admitting and visiting privileges. (no bill) Discussed Hospital Outpatient Therapeutic Services Final Rule underscoring that advanced practice registered nurses and physicians should be allowed to supervise such outpatient service clinics without physician oversight as long as in line with state scope of practice laws. (no bill) Discussed health disparities. (no bill) Discussed Medicaid reform, Medicare/Medicaid "dual eligibles" integration efforts and financial alignment demonstrations; and other CMS demonstration initiatives. (no bill) S. 3586, Recruiting Individuals to Drive Elders (RIDE) Act - Discussed Medicaid non-emergency transportation bill (112th). Discussed proposals that would establish per-capita caps under Medicaid as well as other Medicaid financing proposals including block grants and changes to the current FMAP structure. (no bill) Discussed extension of funding originally provided under the Medicare Improvement for Patients and Providers Act (P.L. 110-275) to State Health Insurance Assistance Programs (SHIPs), Aging and Disability Resource Centers (ADRICs), and Area Agencies on Aging (AAAs) for Medicare outreach and enrollment counseling. (no bill) Discussed the prevention of cuts to beneficiaries in the Medicare program. (no bill) Discussed the prevention of an increase in the age of eligibility in the Medicare program. (no bill) Discussed the patch to the Sustainable Growth Rate (SGR) in the Medicare program. (no bill) Discussed concerns of block granting Medicaid. (no bill) Discussed the Kansas managed long-term services and supports waiver proposals and related implementation issues. (no bill). H.R.928/S.408, the Medicare Drug Savings Act - Discussed requirement for drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed Health Disparities. (no bill) Discussed medicare demonstration project replacing standard medicare cards with Smart Card technology. (no bill) H.R. 574 - The Medicare Physician Payment Innovation Act of 2013. Discussed Medicaid expansion and estate recovery. (no bill) Discussed Medicaid and asset transfers. (no bill) H.R.4994/S. 2553, Improving Medicare Post-Acute Care Transformation Act of 2014 - Discussed the bill and AARP support for the bill. Shared our letter of support. S. 2491, Discussed Medicare Protection Act. Discussed concern about CMS guidance on prescription drugs for medicare beneficiaries receiving hospice and coordination between hospice providers and medicare Part D sponsors. (no bill) H.R. 1179/S.569 - Submitted statement for the record for Senate Aging Committee hearing on Observation Improving Access to Medicare Coverage Act and Notice of Observation Treatment and Implication for Care Eligibility Act (H.R. 5232). Discussed aging in place, HCBS, family caregiving. (no bill)H.R. 1179/S.569, Improving Access to Medicare Act - Discussed support of Improving Access to Medicare Coverage Act and urged cosponsorship and advancement of the bill. Discussed CMS information regarding healthcare marketplaces. H.R. 2305/S.1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act. Bill reduces waste, fraud, and abuse in Medicare and Medicaid programs. Discussed Competitive bidding of durable medical equipment, prosthetics, orthotics, and supplies. (no bill) Discussed repeal of Affordable Care Act provision making prescriptions necessary for over-the-counter drugs purchased with flexible spending accounts. (no bill) Discussed Medicare supplemental coverage. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug cost. (no bill) Discussed potential improvements to the Medicare Savings Programs for low-income beneficiaries. (no bill) Discussed Recruiting Individuals to Drive Our Elders Act (RIDE) would increase state flexibility by giving states the option to receive federal assistance to reimburse their volunteer drivers for no-load miles. (no bill) Labor, Health and Human Services Appropriations Act, 2015 - Lobbied to protect vital health and social services programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation.(no bill) Discussed potential improvements to the Medicare Savings Programs for low-income beneficiares. (no bill) Discussed pending U.S. trade agreement negotiations, including trade promotional or 'fast track' authority, and their potential impact on Medicare and Medicaid prescription drug programs. (no bill) Discussed fraud, Medicare home healthcare, ways to find savings in Medicare without harming Medicare beneficiaries (care coordination, prescription drugs, waste, fraud and abuse). Discussed You've Earned A Say, ways to find savings in medicare without harming medicare beneficiaries (care coordination, prescription drugs, waste, fraud and abuse). PL.111-148 - Discussed implementation of provision to require reporting of nursing home staffing data based on payroll data. Discussed the draft legislation on Medicare fraud and abuse. Protecting the Integrity of Medicare Act. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H.R. 1588/S.740 - Discussed the Medicare Drug Savings Act to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. H.R. 3830/S. 1900 - Discussed pending U.S. trade agreement negotiations and trade promotional or "fast track" authority legislation and their potential impact on Medicare and Medicaid prescription drug programs. S. 2461 - Discussed Children's Health Insurance Program (CHIP) Extension Act of 2014. Discussed Part D Payment for Drugs for Beneficiaries Enrolled in Hospice-Final 2014 CMS Guidance. Discussed the Protecting Integrity of Medicare Act. (no bill) H.R.5435, Home Infusion Site of Care Act - Sent letter of endorsement H.R. 5958 - Discussed the ACO Improvement Act. H.R. 5232 - Discussed and sent letter on the Notice of Observation Treatment and Implication for Care Eligibility Act. Met with Centers for Medicare and medicaid services to discuss three-day stay requirement for medicare skilled nursing coverage. H.J. Res. 124, Continuing Appropriations Resolution - Lobbied to protect funding levels for CMS program management under Continuing Resolution. Discussed coordination with hospice providers and Medicare Part D plans guidance for Medicare beneficiaries receiving hospice. (no bill) H.R. 1179/S. 569 - Discussed observation impace on Medicare beneficiaries, counting time in observation toward Medicare's three-day inpatient hospital stay requirement for Medicare skilled nursing facility coverage, and the Improving Access to Medicare Coverage Act (CMS & MedPAC). Discussed caucus for military/veteran family caregivers and support for family caregivers. (no bill) Discussed draft working paper on impact of observation on Medicare beneficiary out of pocket. (no bill)Discussed District of Columbia EPD Medicaid HCBS waiver. (no bill) H.R. 5232 - Discussed legislation and shared letter of support for the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act of 2014. Discussed Medicare Advantage. (no bill) Discussed H.R. 3616, Protecting Seniors from Healthcare Fraud Act. Discussed observation care and "two-midnight rule". (no bill) H.R. 1070, the Removing Barriers to Colorectal Cancer Screening Act - Discussed and sent letter of endorsement to bill. Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H.R. 1588/S.740, Medicaid Drug Savings Act - Discussed the requirement for drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed potential improvements to the Medicare Savings Programs for low-income beneficiaries. (no bill) Discussed pending U.S. Trade agreement negotiations, including trade promotional or "fast track" authority, and their potential impact on Medicare and Medicaid prescription drug programs. (no bill) H.R. 2810/S.1871/H.R. 4015/S.2110 - Discussed SGR repeal and health care extender provisions, including the Qualified Individual low-income Medicare beneficiary assistance program. H.R. 4418, The Expanding Availability of Medicare Data Act - Sent letter of endorsement. Discussed Medicare data and billing transparency. (no bill) Discussed socio-economic risk adjustment. (no bill) S. 2240 - Discussed Medicare Choices Empowerment and Protection Act. H.R. 3024 - Discussed the Medicare Common Access Card Act. H.R. 4673-Discussed the Bundling and Coordinating Post Acute Care (BACPAC) Act and shared views on post-acute care return. Discussed Medicare expansion. (no bill) Discussed Medicaid Labs Spousal Impoverishment provisions (PL. 111-198). S. 2361, Discussed Stop Schemes and cons against Medicare and seniors. Discussed transparency in healthcare. (no bill) Discussed LTSS Hill briefing series. (no bill) Met with CMS on observation status. (no bill) Submitted comment letter to CMS on the FY2015 Medicare Hospice proposed regulation. Shared comment letter with some Hill staff. H.R. 4994/S.2553 - Shared letter of support for Improving Medicare Post-Acute Care Transformation Act and discussed the status of the bill. Discussed long-term survey and supports Hill briefings. (no bill) Submitted comment letter to CMS on the FY 2015 Medicare Home Health proposed regulation. Shared draft working paper on impact of observation on Medicare beneficiary out of pocket cost. (no bill) Responded to inquiry on observation. (no bill)

Client expense: $2,380,000 · Firm income: Not reported

Government targets: Administration on Aging, Agriculture, Dept of (USDA), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Congressional Budget Office (CBO), Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Comptroller of the Currency (OCC), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs) S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential revenue raising provisions). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential revenue raising provisions).H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style rebate).

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013, entire bill 7. S. 740, Medicare Drug Savings Act of 2013, entire bill 8. H.R. 1588, Medicare Drug Savings Act of 2013, entire bill 9. S. 1198, Medicare Fair Share Act of 2013, entire bill 10. H.R. 4015, SGR Repeal and Medicare Provider Modernization Act of 2014, entire bill 11. H.R. 4302, Protecting Access to Medicare Act of 2014, entire bill 12. H.R. 1179, Improving Access to Medicare Coverage Act of 2013, entire bill 13. S. 569, Improving Access to Medicare Coverage Act of 2013, entire bill

Client expense: $60,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Social Security Administration (SSA)

FY 2014 Omnibus HR 3547 FY 2014 Continuing Resolution H J Res 106 PL 113-73 FY 2014 Continuing Resolution H J Res 59 PL 113-67 HR 4302 SGR Patch Protecting Access to Medicare Act of 2014 - Public Law No: 113-93 H Con Res 96 Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024/no Senate companion yet, HJ Res 124 Continuing Appropriations Resolution, 2015 In all of the above the specific issues included potential Medicare offsets that might be applied to prescription drugs HR 962/S 452 - Medicare Diabetes Prevention Act of 2013 HR 1257 Prevent Diabetes Medicare Act of 2013 HR 1274/S 945 Access to Quality Diabetes Education Act of 2013; HR 1588/ S 740 -- Medicare Drug Savings Act of 2013 HR 2415/ S 1184 - Treat and Reduce Obesity Act of 2013; HR 2663/S 1422 - Scoring of Preventive Health Savings Medicare diabetes screening and self management

Client expense: Not reported · Firm income: $27,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 962 and S. 452, the Medicare Diabetes Prevention Act of 2013; Issues related to Medicare Part D and Medicaid rebates as contained in Pub. L. 112-25, the Budget Control Act of 2011 and H.R. 8, the American Taxpayer Relief Act of 2012; H.R. 1588 and S. 740, the Medicare Drug Savings Act of 2013; H.R. 1257, the Preventing Diabetes in Medicare Act of 2013 and prediabetes generally; H.R. 1274 and S. 945, the Access to Quality Diabetes Education Act of 2013 (Diabetes Self-Management Training in Medicare); Medicare diabetes screening generally; diabetes screening recommendations under USPSTF.

Client expense: Not reported · Firm income: $70,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Policies to enhance patient access to medicines in Medicare; Medicare payment proposals, S. 117 / H.R. 1102, Medicare Prescription Drug Price Negotiation Act of 2013; S. 740 / H.R. 1588, Medicare Drug Savings Act of 2013; H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013;

Client expense: $1,600,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, U.S. Trade Representative (USTR)

H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style "rebate"). S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential revenue raising provisions).Potential deficit reduction legislation that might include provisions to reduce Medicare Part B reimbursements for drugs and biologics. H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential revenue raising provisions). H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board H.R. 928 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D H.R. 1024 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues H.R. 1102 - Medicare Prescription Drug Price Negotiation Act of 2013; Provisions related to Part D issues and non-interference H.R. 1588 - Medicare Drug Savings Act of 2013; provisions related to Part D issues H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013; Provisions related to SGR reform H.R. 2827 - To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D; provisions related to Medicare Part D Drug Tier Formularies H.R. 3890 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease H.R 4160 - Keep the Promise to Seniors Act of 2014; provisions related to Part D H.R. 4187 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 4302 - Protecting Access to Medicare Act of 2014 - provisions related to the biopharmaceutical industry S. 117 - Medicare Prescription Drug Price Negotiation Act of 2013; provisions related to Part D issues S. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board S. 408 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D S. 557 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues S. 740 - Medicare Drug Savings Act of 2013; provisions related to Part D issues S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013; Provisions related to reforming Medicare physician payments S. 1932 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014; Provisions related to SGR reform S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014; Provisions related to SGR reform No bill # assigned - Contract Year 2015 Policy and Technical Cganges to the Medicare Advantage and the Medicare Prescription Drug Benefits ProgramsProvisions related to Part D No bill # assigned - Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy No bill # assigned - Issues related to better use of medicines and comprehensive medication management No bill # assigned - Medicaid Program, Covered Outpatient Drugs rulemaking No bill # assigned - Implementation Issues relating to the Physician Payment Sunshine Act No bill # assigned - Vaccine access and coverage issues

Client expense: $1,140,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, U.S. Trade Representative (USTR)

H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style "rebate"). S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential revenue raising provisions).Potential deficit reduction legislation that might include provisions to reduce Medicare Part B reimbursements for drugs and biologics. H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential revenue raising provisions). H.R. 4187, Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms Act of 2014

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style "rebate"). S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential revenue raising provisions).Potential deficit reduction legislation that might include provisions to reduce Medicare Part B reimbursements for drugs and biologics. H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential revenue raising provisions).

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 962 and S. 452 Medicare Diabetes Prevention Act of 2013; Issues related to Medicare Part D and Medicaid rebates as contained in P.L. 112-25 Budget Control Act of 2011 and H.R. 8 American Taxpayer Relief Actof 2012; H.R. 1588 & S. 740 Medicare Drug Savings Act of 2013; H.R. 1257 Preventing Diabetes in Medicare Act of 2013 and prediabetes generally; H.R. 1274 and S 945 Access to Quality Diabetes Education Act of 2013 (Diabetes Self-Management Training in Medicare);Medicare diabetes screening generally; S. 1184 and H.R. 2415 Treat and Reduce Obesity Act of 2013 and obesity medication coverage generally; Diabesity amendment to S. 1871 SGR Repeal and Medicare Beneficiary Access; Physician Quality and Reporting System (PQRS)

Client expense: $910,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA)

Medicare Advantage. S. 2552: provisions to establish necessary protections for seniors enrolled in Medicare Advantage plans. Medicare Protection Act. S. 2087, S. 2491: provisions protecting Medicare beneficiaries from changes that would reduce benefits or restrict eligibility. Medicare Benefit Redesign. (No bill.) Proposals to combine Part A and B deductibles along with a catastrophic cap on Medicare out-of-pocket spending to be paid for by increased out-of-pocket costs for Medicare beneficiaries. Medicare Drug Savings. S. 740, H.R. 1588: provisions to extend the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Equality. H.R. 5182: provisions to require recognition of same-sex marriage for the purposes of Medicare benefits eligibility. Medicare Fraud, Waste and Abuse. S. 2361: provisions to require the Centers for Medicare and Medicaid Services (CMS) to verify that health care providers wishing to participate in Medicare have not owned a company that previously defrauded the government, allow private insurers to share information about potentially fraudulent providers with Medicare and require new medical coding systems to be tested before they are deployed to ensure Medicares fraud prevention systems function properly. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Premium Support. H. Con. Res. 96: proposals to privatize Medicare. Medicare Income-Relating. H. Con. Res. 96: proposals to increase the cost of Medicare to higher-income beneficiaries. Medicare Eligibility Age. H. Con. Res. 96: proposals to increase the Medicare eligibility age. Medicare Part D Negotiation of Drug Prices. S. 117, S. 408, H.R. 1102, H.R. 928: proposals to create a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Physician Fees and Extenders. H.R. 4015, S. 2157: provisions relating to a permanent fix of the sustainable growth rate (SGR) formula used to determine physician fees under Part B; the extension the Qualified Individual (QI) program; and the therapy caps. Medicare Supplemental Health Insurance. (No bill.) Proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Observation Status. S. 569, H.R. 1179: legislation to count days in the hospital in observation status toward meeting the three-day prior hospitalization requirement for skilled nursing facility (SNF) care eligibility. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: implementation of provisions reducing Medicare Advantage plan payments; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); expanding coverage of prevention services; testing payment and delivery system reforms; and providing expanded Medicaid coverage. Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill.) Proposals related to the activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients receiving benefits from both Medicare and Medicaid, i.e., dual-eligibles. Registered Nurses. H.R. 5373: provisions to require nursing homes and skilled nursing facilities that receive Medicare and/or Medicaid reimbursement to have at least one direct care registered nurse (RN) on duty 24 hours a day, 7 days per week. The Commission on Long-Term Care. (No bill). Proposals and recommendations made to Congress by the Long-Term Care Commission, established under Section 643 of the American Taxpayer Relief Act of 2012 (P.L. 112-240).

Client expense: $210,000 · Firm income: Not reported

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

H.R. 962 and S. 452 Medicare Diabetes Prevention Act of 2013; Issues related to Medicare Part D and Medicaid rebates as contained in P.L. 112-25 Budget Control Act of 2011 and H.R. 8 American Taxpayer Relief Act of 2012; H.R. 1588 & S. 740 Medicare Drug Savings Act of 2013; H.R. 1257 Preventing Diabetes in Medicare Act of 2013 and prediabetes generally; H.R. 1274 and S 945 Access to Quality Diabetes Education Act of 2013 (Diabetes Self-Management Training in Medicare);Medicare diabetes screening generally.

Client expense: Not reported · Firm income: $70,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provisions related to packaging of drugs and biologicals in the Medicare proposed rule for hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system (CMS-1601-P), published on July 8, 2013 SGR Repeal and Medicare Beneficiary Access Act (S. 1871) Medicare Drug Savings Act (H.R. 1588, S. 740)Comprehensive Care Payment Innovation Act (H.R. 3796). Protecting Access to Medicare Act of 2014 (H.R. 4302), in regard to ICD-10.

Client expense: $430,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Part D Program and Generic Drugs, H.R. 1588, Medicare Drug Savings Act of 2013, S. 740, Medicare Drug Savings Act of 2013

Client expense: $655,940 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office

Policies to enhance patient access to medicines in Medicare; Medicare payment proposals, S. 117 / H.R. 1102, Medicare Prescription Drug Price Negotiation Act of 2013; S. 740 / H.R. 1588, Medicare Drug Savings Act of 2013; H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013;

Client expense: $880,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, U.S. Trade Representative (USTR)

Pub.Law 111-148 & 111-152 - Discussed implementation of health care law that would reform the health care system to provide affordable quality health care, reduce drug costs and expand access to long-term services and supports. Discussed how to implement Medicaid provisions of Affordable Care Act. (PL. 111-148)S. 374, Medicare Mental Health Inpatient Equity Act - Lobbied in support of this legislation to eliminate the 190-day lifetime limit on Medicare coverage for in-patient psychiatric hospital services (112th). Discussed improving access to care for underserved population. (no bill) Discussed importance of maintaining low income subsididies and supports in Medicare. (no bill) Discussed the importance of coordinating services for those who qualify for both Medicare and Medicaid in order to ensure that beneficiaries receive all needed benefits but there is no duplication. (no bill) Discussed whether, and under what circumstances, managed care could effectively be used to provide benefits to dual eligible beneficiaries. (no bill) Discussed additional methods for fighting fraud and waste in Health Care. (no bill) Discussed Medigap and need for guaranteed issue for all populations and need to increase medical loss ratio. Discussed durable medical equipment bidding. (no bill) Lobbied for legislation to provide Medicare beneficiaries with additional opportunities to enroll in Medicare Part B.(no bill) Lobbied against the use of the Social Security account number on Government-issued identification cards issued in connection with Medicare, Medicaid, and SCHIP benefits and for other purposes. (no bill) Discussed support to curb waste and fraud from the Medicare and Medicaid programs. (no bill) H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2012 - Discussed the legislation as it pertained to SGR. Discussed Medicare Reform. (no bill) H.R. 2305/S. 1123, PRIME ACT (Preventing and Reducing Improper Medicare Expenditures) - Discussed support for bill and urged cosponsorship. Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs. (no bill) H.R. 1588/S. 740, Medicare Drug Savings Act - Discussed the Medicare Drug Savings Act to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed potential improvements to the Medicare Savings Programs for low-income befeficiaries. (no bill) Discussed proposals that would establish per-capita caps under Medicaid as well as other Medicaid financing proposals including block grants and changes to the current FMAP structure. (no bill) H.R. 1717 - Discussed Medicare DMEPOS Market Pricing Program Act. Discussed implementation of regulations regarding minimum wage and overtime for home care workers and consumer-directed care. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H. R. 1588/S.740 - Discussed the Medicare Drug Savings Act to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. H.R.3830/S.1900 - Discussed pending U.S. trade agreement negotiations and trade promotional or "fast track" authority legislation and their potential impact on Medicare and Medicaid prescription drug programs. S. 2461 - Discussed Children's Health Insurance Program (CHIP) extension and CHIP Extension Act of 2014. Discussed Part D Payment for Drugs for Beneficiaries Enrolled in Hospice - Final 2014 CMS Guidance.Discussed Medicare Graduate Nursing Education pilot design. (no bill) Discussed Prescription Drug Affordability. (no bill) Discussed Prescription Drug Shortages. (no bill) H.R. 3342, Affordable Medicines Utilization Act of 2011 - Lobbied to encourage state Medicaid programs to use safe, effective generic medications. H.R. 2576 - Discussion to amend the Internal Revenue Code of 1986 to modify the calculation of modified adjusted gross income for purposes of determining eligibility for certain healthcare-related programs. Discussed opposition to caps on dual eligibles; discussed managed care and dual eligibles. (no bill) Discussed with CMS demonstration programs for dual eligibles and process related to the demonstrations, as well as other work of the Medicare-Medicaid Coordination Office, discussed consumer choice and continuity of care in Medicaid managed long-term services and supports programs, discussed focus groups on dual eligibles. Discussed Hospital & Critical Access Hospitals Conditions of Participation proposed regulations; requested that advanced practice registered nurses and physicians assistants be allowed the full scope of services in hospital admitting and visiting privileges. (no bill) Discussed Hospital Outpatient Therapeutic Services Final Rule underscoring that advanced practice registered nurses and physicians should be allowed to supervise such outpatient service clinics without physician oversight as long as in line with state scope of practice laws. (no bill) Discussed health disparities. (no bill) Discussed Medicaid reform, Medicare/Medicaid "dual eligibles" integration efforts and financial alignment demonstrations; and other CMS demonstration initiatives. (no bill) S. 3586, Recruiting Individuals to Drive Elders (RIDE) Act - Discussed Medicaid non-emergency transportation bill (112th). Discussed proposals that would establish per-capita caps under Medicaid as well as other Medicaid financing proposals including block grants and changes to the current FMAP structure. (no bill) Discussed extension of funding originally provided under the Medicare Improvement for Patients and Providers Act (P.L. 110-275) to State Health Insurance Assistance Programs (SHIPs), Aging and Disability Resource Centers (ADRICs), and Area Agencies on Aging (AAAs) for Medicare outreach and enrollment counseling. (no bill) Discussed the prevention of cuts to beneficiaries in the Medicare program. (no bill) Discussed the prevention of an increase in the age of eligibility in the Medicare program. (no bill) Discussed the patch to the Sustainable Growth Rate (SGR) in the Medicare program. (no bill) Discussed concerns of block granting Medicaid. (no bill) Discussed the Kansas managed long-term services and supports waiver proposals and related implementation issues. (no bill). H.R.928/S.408, the Medicare Drug Savings Act - Discussed requirement for drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed Health Disparities. (no bill) Discussed medicare demonstration project replacing standard medicare cards with Smart Card technology. (no bill) H.R. 574 - The Medicare Physician Payment Innovation Act of 2013. H.R. 1173 - Discussed Personalize Your Care Act. Discussed Medicaid expansion and estate recovery. (no bill) Discussed Medicaid and asset transfers. (no bill) Discussed the Improving Medicare Post-Acute Care Transformation Act of 2014 and provided feedback on the draft bill. (no bill number at the time, but later bill number was H.R. 4944/S. 2553) S. 2491, Discussed Medicare Protection Act. Submitted comment letter on FYIS Medicare Skilled Nursing Facility payment rule. (no bill) Discussed concern about CMS guidance on prescription drugs for medicare beneficiaries receiving hospice and coordination between hospice providers and medicare Part D sponsors. (no bill)H.R. 1179/S.569, Improving Access to Medicare Act - Discussed support of Improving Access to Medicare Coverage Act and urged cosponsorship and advancement of the bill. Discussed comments regarding Medicare and You handbook. (no bill) Discussed CMS information regarding healthcare marketplaces. H.R. 2305/S.1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act. Bill reduces waste, fraud, and abuse in Medicare and Medicaid programs. Discussed Competitive bidding of durable medical equipment, prosthetics, orthotics, and supplies. (no bill) Discussed repeal of Affordable Care Act provision making prescriptions necessary for over-the-counter drugs purchased with flexible spending accounts. (no bill) Discussed Medicare supplemental coverage. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug cost. (no bill) Discussed potential improvements to the Medicare Savings Programs for low-income beneficiaries. (no bill) Discussed Recruiting Individuals to Drive Our Elders Act (RIDE) would increase state flexibility by giving states the option to receive federal assistance to reimburse their volunteer drivers for no-load miles. (no bill) Labor, Health and Human Services Appropriations Act, 2014 - Lobbied to protect vital health and social services programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation.(no bill) Discussed potential improvements to the Medicare Savings Programs for low-income beneficiares. (no bill) Discussed pending U.S. trade agreement negotiations, including trade promotional or 'fast track' authority, and their potential impact on Medicare and Medicaid prescription drug programs. (no bill) Discussed fraud, Medicare home healthcare, ways to find savings in Medicare without harming Medicare beneficiaries (care coordination, prescription drugs, waste, fraud and abuse). Discussed You've Earned A Say, ways to find savings in medicare without harming medicare beneficiaries (care coordination, prescription drugs, waste, fraud and abuse). PL.111-148 - Discussed implementation of provision to require reporting of nursing home staffing data based on payroll data.Discussed Medicare Advantage. (no bill) Discussed H.R. 3616, Protecting Seniors from Healthcare Fraud Act. Discussed observation care and "two-midnight rule". (no bill) H.R. 1070, the Removing Barriers to Colorectal Cancer Screening Act - Discussed and sent letter of endorsement to bill. Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H.R. 1588/S.740, Medicaid Drug Savings Act - Discussed the requirement for drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed potential improvements to the Medicare Savings Programs for low-income beneficiaries. (no bill) Discussed pending U.S. Trade agreement negotiations, including trade promotional or "fast track" authority, and their potential impact on Medicare and Medicaid prescription drug programs. (no bill) H.R. 2810/S.1871/H.R. 4015/S.2110 - Discussed SGR repeal and health care extender provisions, including the Qualified Individual low-income Medicare beneficiary assistance program. H.R. 4418, The Expanding Availability of Medicare Data Act - Sent letter of endorsement. Discussed Medicare data and billing transparency. (no bill) Discussed socio-economic risk adjustment. (no bill) Discussed nursing home staffing data in meeting with CMS. (no bill) Discussed advanced care planning, Welcome to Medicare visit, and Medicare wellness visits. Discussed language access in managed long-term services and supports in meeting with the HHS Office for Civil Rights. S. 2240, Discussed Medicare Choices Empowerment and Protection Act. S. 1439, Discussed support for Care Planning Act. Discussed LTSS Scorecard and reserving a room/logistics for Hill briefing on the LTSS Scorecard. (no bill). Discussed managed LTSS and language access. (no bill) H.R. 3024, Discussed the Medicare Common Access Card Act. H.R. 9673, Discussed the Bundling and Coordinating Post Acute Care (BACPAC) Act and shared views on post-acute care return. Discussed Medicare expansion. (no bill) H.R. 1179/S. 569, Improving Access to Medicare Coverage Act - Submitted written statement for the record for the current hospital ---in the Medicare program hearings. Shared draft witness questions with some subcommittee members and committee staff. Discussed Medicaid Labs Spousal Impoverishment provisions (PL. 111-198). S. 2361, Discussed Stop Schemes and cons against Medicare and seniors. Invited Hill staff to attend the LTSS Scorecard briefing. (no bill) Participated in a roundtable discussion on long-term services and supports. (no bill) Discussed Welcome to Medicare Visit and advance care planning. (no bill) Discussed transparency in healthcare. (no bill) Discussed New York State Community first choice option and workforce issues. (no bill)

Client expense: $2,360,000 · Firm income: Not reported

Government targets: Administration on Aging, Agriculture, Dept of (USDA), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Comptroller of the Currency (OCC), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

H.R. 962 and S. 452 Medicare Diabetes Prevention Act of 2013; Issues related to Medicare Part D and Medicaid rebates as contained in P.L. 112-25 Budget Control Act of 2011 and H.R. 8 American Taxpayer Relief Act of 2012; H.R. 1588 & S. 740 Medicare Drug Savings Act of 2013; H.R. 1257 Preventing Diabetes in Medicare Act of 2013 and prediabetes generally; H.R. 1274 and S 945 Access to Quality Diabetes Education Act of 2013 (Diabetes Self-Management Training in Medicare);Medicare diabetes screening generally; S. 1184 and H.R. 2415 Treat and Reduce Obesity Act of 2013; Physician Quality and Reporting System (PQRS). Diabesity amendment to S. 1871 SGR Repeal and Medicare Beneficiary Access.

Client expense: Not reported · Firm income: $30,000

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA)

H.R. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to the Independent Payment Advisory Board H.R. 460, Patients Access to Treatments Act: Provisions related to cost sharing in the specialty tier H.R. 928, Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to Part D issuesH.R. 1024, Medication Therapy Management Empowerment Act of 2013: Provisions related to medication therapy management in Part D H.R. 1102, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference H.R. 1588, Medicare Drug Savings Act of 2013: Provisions related to Part D issues H.R. 2810, Medicare Patient Access and Quality Improvement Act: Provisions related to SGR reform H.R. 2827, To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D: Provisions related to Medicare Part D Drug Tier Formularies H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013: Provisions related to fraud and abuse H.R. 3392, Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013: Provisions related to lock-in programs H.R. 3796, Comprehensive Care Payment Innovation Act: Provisions related to alternative payment models H.R. 4160, Keep the Promise to Seniors Act of 2014: Provisions related to Part D issues H.R. 4302, Protecting Access to Medicare Act of 2014: Provisions related to the biopharmaceutical industry S. 117, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference S. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to Independent Payment Advisory Board S. 408, Medicare Prescription Drug Savings and Choice Act of 2013: Provision related to Part D issues S. 740, Medicare Drug Savings Act of 2013: Provisions related to Part D issues Deficit reduction policy issues S. 882, Stop Trafficking of Pills (STOP) Act: Provisions related to lock-in programs (112th Congress) S. 1365, Part D Beneficiary Appeals Fairness Act: Provisions related to the specialty tier in Part D S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013: Provisions related to reforming Medicare physician payments S. 1932, Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to SGR reform S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014: Provisions related to SGR reform Medicare Prescription Drug Diversion and Abuse Prevention Act: Provisions related to diversion and abuse (no bill number) Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs: Provisions related to Part D Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy Medicaid Program, Covered Outpatient Drugs rulemaking Medicare sustainable growth rate policy issues Implementation issues relating to the Physician Payment Sunshine Act, including Medicare, Medicaid, Childrens Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests rulemaking Issues related to better use of medicine and adherence

Client expense: $4,190,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Security Council (NSC), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR), White House Office

FY 2014 Omnibus HR 3547 FY 2014 Continuing Resolution H J Res 106 PL 113-73 FY 2014 Continuing Resolution H J Res 59 PL 113-67 HR 4302 SGR Patch Protecting Access to Medicare Act of 2014 - Public Law No: 113-93 H Con Res 96 Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024/no Senate companion yetIn all of the above the specific issues included potential Medicare offsets that might be applied to prescription drugs HR 962/S 452 - Medicare Diabetes Prevention Act of 2013 HR 1257 Prevent Diabetes Medicare Act of 2013 HR 1274/S 945 Access to Quality Diabetes Education Act of 2013; HR 1588/ S 740 -- Medicare Drug Savings Act of 2013 HR 2415/ S 1184 - Treat and Reduce Obesity Act of 2013; HR 2663/S 1422 - Scoring of Preventive Health Savings Medicare diabetes screening and self management

Client expense: Not reported · Firm income: $27,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board H.R. 928 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D H.R. 1024 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues H.R. 1102 - Medicare Prescription Drug Price Negotiation Act of 2013; Provisions related to Part D issues and non-interference H.R. 1588 - Medicare Drug Savings Act of 2013; provisions related to Part D issues H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013; provisions related to SGR reform H.R. 2827 - To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D; provisions related to Medicare Part D Drug Tier Formularies H.R. 3890 - Better Care, Lower Cost Act; provisions related to Part D, value-based insurance design, and chronic disease H.R 4160 - Keep the Promise to Seniors Act of 2014; provisions related to Part D H.R. 4187 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 4302 - Protecting Access to Medicare Act of 2014; provisions related to the biopharmaceutical industry S. 117 - Medicare Prescription Drug Price Negotiation Act of 2013; provisions related to Part D issues S. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board S. 408 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D S. 557 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues S. 740 - Medicare Drug Savings Act of 2013; provisions related to Part D issues S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013; Provisions related to reforming Medicare physician payments S. 1932 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014; Provisions related to SGR reform S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014; Provisions related to SGR reform No bill # assigned - Contract Year 2015 Policy and Technical Cganges to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs; provisions related to Part D No bill # assigned - Legislative proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy No bill # assigned - Issues related to comprehensive medication management No bill # assigned - Medicaid Program, Covered Outpatient Drugs rulemaking No bill # assigned - Implementation Issues relating to the Physician Payment Sunshine Act No bill # assigned - Vaccine access and coverage issues

Client expense: $1,020,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR)

H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style "rebate"). S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential revenue raising provisions).Potential deficit reduction legislation that might include provisions to reduce Medicare Part B reimbursements for drugs and biologics. H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential revenue raising provisions). H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style "rebate"). S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential revenue raising provisions).Potential deficit reduction legislation that might include provisions to reduce Medicare Part B reimbursements for drugs and biologics. H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential revenue raising provisions). H.R. 4187, Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms Act of 2014

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style "rebate"). S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential revenue raising provisions).Potential deficit reduction legislation that might include provisions to reduce Medicare Part B reimbursements for drugs and biologics. H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential revenue raising provisions).

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1588, Medicare Drug Savings Act of 2013 (provisions relating to Medicare Part D and the establishment of a Medicaid style mandatory rebate on prescription drugs) S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act (potential revenue raising provisions). H.R. 4302, Protecting Access to Medicare Act of 2014, (potential revenue raising provisions).H. Con. Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024, (potential provisions relating to Medicare Part D and the establishment of a Medicaid style rebate).

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013, entire bill 7. S. 740, Medicare Drug Savings Act of 2013, entire bill 8. H.R. 1588, Medicare Drug Savings Act of 2013, entire bill 9. S. 1198, Medicare Fair Share Act of 2013, entire bill 10. H.R. 4015, SGR Repeal and Medicare Provider Modernization Act of 2014, entire bill 11. H.R. 4302, Protecting Access to Medicare Act of 2014

Client expense: $60,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Social Security Administration (SSA)

H.R. 962 and S. 452 Medicare Diabetes Prevention Act of 2013; Issues related to Medicare Part D and Medicaid rebates as contained in P.L. 112-25 Budget Control Act of 2011 and H.R. 8 American Taxpayer Relief Actof 2012; H.R. 1588 & S. 740 Medicare Drug Savings Act of 2013; H.R. 1257 Preventing Diabetes in Medicare Act of 2013 and prediabetes generally; H.R. 1274 and S 945 Access to Quality Diabetes Education Act of 2013 (Diabetes Self-Management Training in Medicare);Medicare diabetes screening generally; S. 1184 and H.R. 2415 Treat and Reduce Obesity Act of 2013; Diabesity amendment to S. 1871 SGR Repeal and Medicare Beneficiary Access; Physician Quality and Reporting System (PQRS)

Client expense: $440,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA)

Medicare Protection Act. S. 2087, S. 2491: provisions protecting Medicare beneficiaries from changes that would reduce benefits or restrict eligibility. Medicare Benefit Redesign. (No bill.) Proposals to combine Part A and B deductibles along with a catastrophic cap on Medicareout-of-pocket spending to be paid for by increased out-of-pocket costs for Medicare beneficiaries. Medicare Drug Savings. S. 740, H.R. 1588: provisions to extend the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Fraud, Waste and Abuse. S. 2361: provisions to require the Centers for Medicare and Medicaid Services (CMS) to verify that health care providers wishing to participate in Medicare have not owned a company that previously defrauded the government, allow private insurers to share information about potentially fraudulent providers with Medicare and require new medical coding systems to be tested before they are deployed to ensure Medicares fraud prevention systems function properly. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Premium Support. H. Con. Res. 96: proposals to privatize Medicare. Medicare Income-Relating. H. Con. Res. 96: proposals to increase the cost of Medicare to higher-income beneficiaries. Medicare Eligibility Age. H. Con. Res. 96: proposals to increase the Medicare eligibility age. Medicare Part D Negotiation of Drug Prices. S. 117, S. 408, H.R. 1102, H.R. 928: proposals to create a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Supplemental Health Insurance. (No bill.) Proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Observation Status. S. 569, H.R. 1179: legislation to count days in the hospital in observation status toward meeting the three-day prior hospitalization requirement for skilled nursing facility (SNF) care eligibility. Medicare Advantage Payment Rate. (No bill). Proposals to decrease Medicare Advantage (MA) 2015 payment rates. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: implementation of provisions reducing Medicare Advantage plan payments; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); expanding coverage of prevention services; testing payment and delivery system reforms; and providing expanded Medicaid coverage. Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill.) Proposals related to the activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients receiving benefits from both Medicare and Medicaid, i.e., dual-eligibles. The Commission on Long-Term Care. (No bill). Proposals and recommendations made to Congress by the Long-Term Care Commission, established under Section 643 of the American Taxpayer Relief Act of 2012 (P.L. 112-240).

Client expense: $240,000 · Firm income: Not reported

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