Medicare DMEPOS Market Pricing Program Act of 2013

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 942/S. 948- Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013, all provisions; H.R. 1250/S. 1012- Medicare Audit Improvement Act of 2013, all provisions; H.R. 27- Small Supplier Fairness in Bidding Competition Act of 2013, all provisions; H.R. 1717- Medicare DMEPOS Market Pricing Program Act of 2013, all provisions; H.R. 2375- Transparency and Accountability in Medicare Bidding Act of 2013, all provisions; H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; H.R. 4302 - Protecting Access to Medicare Act of 2014, all provisions; H.R. 4920 Medicare DMEPOS Competitive Bidding Improvement Act of 2014.

Client expense: $80,000 · Firm income: Not reported

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

Affordable Care Act of 2010 H.R. 1041: Fairness in Medicare Bidding Act Medicare Claim Audit Volume and Contractor Procedures H.R. 6490: The Medicare DMEPOS Market Pricing Program Act H.R. 1717 Medicare DMEPOS Market Pricing Program Act of 2013

Client expense: $10,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), 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.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013, Competitive bidding program and makret pricing issues for Durable Medical Equipment (DME) H.R.2375, Transparency and Accountability in Medicare Bidding Act of 2013, Issues related to Medical Device issues

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013, Competitive bidding program and makret pricing issues for Durable Medical Equipment (DME) H.R.2375, Transparency and Accountability in Medicare Bidding Act of 2013, Issues related to Medical Device issues HR.1250/S.1012, Medicare Audit Improvement Act, Medical Device issues H.R.2329, Administrative Relief and Accurate Medicare Payments Act of 2013, Medical device issues H.R.5083, Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014, Medical device issues Monitor the following: Public Law 113-93, Protecting Access to Medicare Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 942 and S. 948, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013; H.R. 2375, Transparency and Accountability in Medicare Bidding Act of 2013; H.R. 4920 and S. 2975 Medicare DMEPOS Competitive Bidding Improvement Act

Client expense: $109,572 · Firm income: Not reported

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

HR 3509: Patient Protection and Affordable Care Act of 2010 - various provisions including: Medical Device Excise Tax, various reimbursement cuts and policy proposals for medical imaging; remote monitoring technology in the context of accountable care organizations, medical homes and post acute bundling; transparency HR 3692: The Affordable Health Care for America Act: Imaging cuts, device tax transparency and remote monitoringHR 4695 Medicare OSA Sleep Testing Bill HR 1932 Better Care, Lower Cost Act PL 110-275: "Medicare Improvements for Patient and Providers Act" (sec. 135) - Medical imaging accreditations program; medical imaging clinical appropriateness demonstration program Decline in growth rate of Medicare non-hospital imaging services S 596 - The FITT Act of 2013 (Fostering Independence Through Technology Act) - specifically the telehealth provisions HR 2914 - Imaging self-referral HR 1717 - The Medicare DMEPOS - Marketing Pricing Program Act of 2013 HR 8 - "American Tax Payer Relief Act of 2012" - Medicare Imaging Cuts & Sustainable Growth Rate Extension Site-neutrality in payments (no bill number yet) HR 2375 - The Transparency and Accountability in Medicare Bidding Act of 2013 HR 4015 - Long-term Sustainable Growth Rate (SGR) replacement legislation Appropriate Use Criteria CT Dose Optimization HR 6179 - "The Telehealth Promotion Act of 2012" HR 6626 - "The Health Care Innovation and Marketplace Technologies Act of 2012" - Telemedicine provisions. Drafts in the House and Senate addressing the SGR formula - potential telehealth provisions. HR 4920 - The Medicare DMEPOS Competitive Bidding Improvement Act of 2014 HR 5083 The Medicare DMEPOS Audit Improvement and Reform Act

Client expense: $370,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 942/S. 948- Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013, all provisions; H.R. 1250/S. 1012- Medicare Audit Improvement Act of 2013, all provisions; H.R. 27- Small Supplier Fairness in Bidding Competition Act of 2013, all provisions; H.R. 1717- Medicare DMEPOS Market Pricing Program Act of 2013, all provisions; H.R. 2375- Transparency and Accountability in Medicare Bidding Act of 2013, all provisions; H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; H.R. 4302 - Protecting Access to Medicare Act of 2014, all provisions; H.R. 4920/ H.R. 5809/S.2975 Medicare DMEPOS Competitive Bidding Improvement Act of 2014.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), Government Accountability Office (GAO), 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 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

HR 3509: Patient Protection and Affordable Care Act of 2010 - various provisions including: Medical Device Excise Tax, various reimbursement cuts and policy proposals for medical imaging; remote monitoring technology in the context of accountable care organizations, medical homes and post acute bundling; transparency HR 3692: The Affordable Health Care for America Act: Imaging cuts, device tax transparency and remote monitoringHR 4695 Medicare OSA Sleep Testing Bill HR 1932 Better Care, Lower Cost Act PL 110-275: "Medicare Improvements for Patient and Providers Act" (sec. 135) - Medical imaging accreditations program; medical imaging clinical appropriateness demonstration program Decline in growth rate of Medicare non-hospital imaging services S 596 - The FITT Act of 2013 (Fostering Independence Through Technology Act) - specifically the telehealth provisions HR 2914 - Imaging self-referral HR 1717 - The Medicare DMEPOS - Marketing Pricing Program Act of 2013 HR 8 - "American Tax Payer Relief Act of 2012" - Medicare Imaging Cuts & Sustainable Growth Rate Extension Site-neutrality in payments (no bill number yet) HR 2375 - The Transparency and Accountability in Medicare Bidding Act of 2013 HR 4015 - Long-term Sustainable Growth Rate (SGR) replacement legislation Appropriate Use Criteria CT Dose Optimization HR 6179 - "The Telehealth Promotion Act of 2012" HR 6626 - "The Health Care Innovation and Marketplace Technologies Act of 2012" - Telemedicine provisions. Drafts in the House and Senate addressing the SGR formula - potential telehealth provisions. HR 4920 - The Medicare DMEPOS Competitive Bidding Improvement Act of 2014 HR 5083 The Medicare DMEPOS Audit Improvement and Reform Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE

H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013, Competitive bidding program and makret pricing issues for Durable Medical Equipment (DME) H.R.2375, Transparency and Accountability in Medicare Bidding Act of 2013, Issues related to Medical Device issues HR.1250/S.1012, Medicare Audit Improvement Act, Medical Device issues H.R.2329, Administrative Relief and Accurate Medicare Payments Act of 2013, Medical device issues H.R.5083, Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014, Medical device issues Monitor the following: Public Law 113-93, Protecting Access to Medicare Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013, Competitive bidding program and makret pricing issues for Durable Medical Equipment (DME) H.R.2375, Transparency and Accountability in Medicare Bidding Act of 2013, Issues related to Medical Device issues

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues concerning competitive bidding, including H.R. 1717, The Medicare DMEPOS Markets Pricing Program Act of 2013.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 942 and S. 948, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013; H.R. 2375, Transparency and Accountability in Medicare Bidding Act of 2013; H.R. 4920 Medicare DMEPOS Competitive Bidding Improvement Act

Client expense: $115,439 · Firm income: Not reported

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 942/S. 948- Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013, all provisions; H.R. 1250/S. 1012- Medicare Audit Improvement Act of 2013, all provisions; H.R. 27- Small Supplier Fairness in Bidding Competition Act of 2013, all provisions; H.R. 1717- Medicare DMEPOS Market Pricing Program Act of 2013, all provisions; H.R. 2375- Transparency and Accountability in Medicare Bidding Act of 2013, all provisions; H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; H.R. 4302 - Protecting Access to Medicare Act of 2014, all provisions; H.R. 4920 Medicare DMEPOS Competitive Bidding Improvement Act of 2014.

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

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 942/S. 948- Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013, all provisions; H.R. 1250/S. 1012- Medicare Audit Improvement Act of 2013, all provisions; H.R. 27- Small Supplier Fairness in Bidding Competition Act of 2013, all provisions;H.R. 1717- Medicare DMEPOS Market Pricing Program Act of 2013, all provisions; H.R. 2375- Transparency and Accountability in Medicare Bidding Act of 2013, all provisions; H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; H.R. 4302 - Protecting Access to Medicare Act of 2014, all provisions; H.R. 4920 Medicare DMEPOS Competitive Bidding Improvement Act of 2014.

Client expense: $80,000 · Firm income: Not reported

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

Affordable Care Act of 2010 H.R. 1041: Fairness in Medicare Bidding Act S.1203/H.R. 2195: Medicare Home Infusion Therapy Coverage Act of 2011 Medicare Claim Audit Volume and Contractor ProceduresH.R. 6490: The Medicare DMEPOS Market Pricing Program Act H.R. 1717 Medicare DMEPOS Market Pricing Program Act of 2013

Client expense: $110,000 · Firm income: Not reported

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

HR 3509: Patient Protection and Affordable Care Act of 2010 - various provisions including: Medical Device Excise Tax, various reimbursement cuts and policy proposals for medical imaging; remote monitoring technology in the context of accountable care organizations, medical homes and post acute bundling; transparency HR 3692: The Affordable Health Care for America Act: Imaging cuts, device tax transparency and remote monitoringHR 4695 Medicare OSA Sleep Testing Bill HR 1932 Better Care, Lower Cost Act PL 110-275: "Medicare Improvements for Patient and Providers Act" (sec. 135) - Medical imaging accreditations program; medical imaging clinical appropriateness demonstration program Decline in growth rate of Medicare non-hospital imaging services S 596 - The FITT Act of 2013 (Fostering Independence Through Technology Act) - specifically the telehealth provisions HR 2914 - Imaging self-referral HR 1717 - The Medicare DMEPOS - Marketing Pricing Program Act of 2013 HR 8 - "American Tax Payer Relief Act of 2012" - Medicare Imaging Cuts & Sustainable Growth Rate Extension Site-neutrality in payments (no bill number yet) HR 2375 - The Transparency and Accountability in Medicare Bidding Act of 2013 HR 4015 - Long-term Sustainable Growth Rate (SGR) replacement legislation Appropriate Use Criteria CT Dose Optimization HR 6179 - "The Telehealth Promotion Act of 2012" HR 6626 - "The Health Care Innovation and Marketplace Technologies Act of 2012" - Telemedicine provisions. Drafts in the House and Senate addressing the SGR formula - potential telehealth provisions.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE

H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013, Competitive bidding program and makret pricing issues for Durable Medical Equipment (DME) H.R.2375, Transparency and Accountability in Medicare Bidding Act of 2013, Issues related to Medical Device issues

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013, Competitive bidding program and makret pricing issues for Durable Medical Equipment (DME) H.R.2375, Transparency and Accountability in Medicare Bidding Act of 2013, Issues related to Medical Device issues HR.1250/S.1012, Medicare Audit Improvement Act, Medical Device issues H.R.2329, Administrative Relief and Accurate Medicare Payments Act of 2013, Medical device issues Monitor the following: Public Law 113-93, Protecting Access to Medicare Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 942/S. 948- Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013, all provisions; H.R. 1250/S. 1012- Medicare Audit Improvement Act of 2013, all provisions; H.R. 27- Small Supplier Fairness in Bidding Competition Act of 2013, all provisions;H.R. 1717- Medicare DMEPOS Market Pricing Program Act of 2013, all provisions; H.R. 2375- Transparency and Accountability in Medicare Bidding Act of 2013, all provisions; H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; H.R. 4302 - Protecting Access to Medicare Act of 2014, all provisions; H.R. 4920 Medicare DMEPOS Competitive Bidding Improvement Act of 2014.

Client expense: $80,000 · Firm income: Not reported

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

H.R. 942 and S. 948, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013; H.R. 2375, Transparency and Accountability in Medicare Bidding Act of 2013; H.R. 4920 Medicare DMEPOS Competitive Bidding Improvement Act

Client expense: $151,710 · Firm income: Not reported

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

H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013, Competitive bidding program and makret pricing issues for Durable Medical Equipment (DME) H.R.2375, Transparency and Accountability in Medicare Bidding Act of 2013, Issues related to Medical Device issues HR.1250/S.1012, Medicare Audit Improvement Act, Medical Device issues H.R.2329, Administrative Relief and Accurate Medicare Payments Act of 2013, Medical device issues Monitor the following: S.1871, SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R.4302, Protecting Access to Medicare Act of 2014 H.R.2810, Medicare Patient Access and Quality Improvement Act of 2013

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013, Competitive bidding program and makret pricing issues for Durable Medical Equipment (DME) H.R.2375, Transparency and Accountability in Medicare Bidding Act of 2013, Issues related to Medical Device issues

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities. Discussed passage of House and Senate legislation, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013 -HR 942/S 948. Discussed raising the capped rental rule on some complex rehab technology products and accessories. Discussed possible solutions around improved access to wheelchair repair. Discussed next steps regarding FDA action around biosimilar regulation and the implementation of biosimilar clinical trials. Discussed opposition to restricting Medicare coverage of protected classes of prescription drugs under Medicare Part D. Discussed solutions regarding Medicare physician payment updates known as the 'doc fix' including the repeal of the therapy cap. Discussed solutions regarding Medicare and Medicaid secondary payer regulations. Discussed solutions with state governments and Federal agencies regarding the administration of Medicaid Managed Care programs to ensure protections are in place for people with disabilities. Discussed solutions around CMS guidance on home and commuity based settings. Promote adequate fudning for all Medicaid services that allow people with disabilities to remina in their homes and contribute to the community. Discussed solutions to Medicare's current competitive acquisition program and support - Medicare DMEPOS Market Pricing Program Act of 2013 - HR 1717 Discussed solutions around improved quality measures for home and community based services for the aging and disability communities with HHS. Support advocacy efforts to expand Medicaid.

Client expense: $75,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), Education, Dept of, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Transportation, Dept of (DOT), White House Office

Affordable Care Act of 2010 H.R. 1041: Fairness in Medicare Bidding Act S.1203/H.R. 2195: Medicare Home Infusion Therapy Coverage Act of 2011 Medicare Claim Audit Volume and Contractor ProceduresH.R. 6490: The Medicare DMEPOS Market Pricing Program Act H.R. 1717 Medicare DMEPOS Market Pricing Program Act of 2013

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

Government targets: Centers For Medicare and Medicaid Services (CMS), 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 Medicaid long-term services and supports. (no bill) 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) Discussed measures for re-balancing in medicaid managed LTSS waivers and dual demonstration programs in sign on letter to CMS. (no bill) H.R. 1717 - Discussed Medicare DMEPOS Market Pricing Program Act. H.R. 3531 - Discussed Creating Access to Rehabilitation for Every Senior (CARES) Act. Discussed implementation of regulations regarding minimum wage and overtime for home care workers and consumer-directed care.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 Medicaid managed care and long-term services and supports broadly. 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) Discussed the AARP Initiative called "You've Earned a Say". (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 observation issues. (no bill) Discussed rebalancing measures in Medicaid managed LTSS in 1115 waivers and duals demonstration programs. (no bill) Discussed proposed regulation relating to Medicaid expansion coverage and minimum essential coverage. (no bill) Discussed Medicaid expansion and estate recovery. (no bill) Discussed Medicaid and asset transfers. (no bill) Discussed draft legislation regarding Dual Eligible Special Need Plans (D-SNP) - Strengthing Healthcare Options for Vulnerable Populations Act. (no bill) Discussed post-acute care reform. (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. Participated on press call on the bill. Discussed comments regarding Medicare and You handbook. (no bill) Discussed CMS information regarding healthcare marketplaces. H. R. 933, Consolidated and Further Continuing Appropriations Act, 2013 - 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. S. Con. Res. 8, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. H.Con. Res. 25, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation.Lobbied on expected "QM" safe harbor amendment. (The amendment was not offered) 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) H.R. 3547/H.J.R. 59/H.R. 2775/H.J.R. 106, Consolidated Appropriations Act, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. S. 1284, 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. 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) H.R. 2810/S. 1871 - Discussed SGR repeal and health care extender provisions, including the Qualified Individual low-income Medicare beneficiary assistance program. 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, prescriotion drugs, waste, fraud and abuse). Discussed implementation of provision to require reporting of nursing home staffing data based on payroll data. (no bill) S. 1932/H.R. 3890 - Discussed logistics and attended event to introduce the Better Care, Lower Cost Act. Discussed non-residential settings and Medicaid home and community-based setting final regulation. (no bill) Discussed person-centered planning and family caregiver assessment in Medicaid HCBS state plan option final rule. Submitted comment letter on distaster preparedness requirements for Medicare and Medicaid providers. (no bill) Discussed Money Follows the Person Rebalancing Demonstration and Balancing Incentive Payments Program. (no bill)Discussed Medicare Advantage. H.R. 3616, Protecting Seniors from Medicare Act- Sent letters endorsing bill. H.R. 2810, The SGR Repeal and Medicare Beneficiary Improvement Act - Sent letters endorsing bill. Discussed observation care and "two-midnight rule". 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.

Client expense: $1,990,000 · 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), 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

Policy issues relating to competitive bidding for durable medical equipment, including H.R. 1717, the "Medicare DMEPOS Market Pricing Program Act" and H.R.2375, the "Transparency and Accountability in Medicare Bidding Act."

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013, Competitive bidding program and makret pricing issues for Durable Medical Equipment (DME) H.R.2375, Transparency and Accountability in Medicare Bidding Act of 2013, Issues related to Medical Device issues HR.1250/S.1012, Medicare Audit Improvement Act, Medical Device issues H.R.2329, Administrative Relief and Accurate Medicare Payments Act of 2013, Medical device issues Monitor the following: S.1871, SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R.4302, Protecting Access to Medicare Act of 2014 H.R.2810, Medicare Patient Access and Quality Improvement Act of 2013

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013, Competitive bidding program and makret pricing issues for Durable Medical Equipment (DME) H.R.2375, Transparency and Accountability in Medicare Bidding Act of 2013, Issues related to Medical Device issues

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3509: Patient Protection and Affordable Care Act of 2010 - various provisions including: Medical Device Excise Tax, various reimbursement cuts and policy proposals for medical imaging; remote monitoring technology in the context of accountable care organizations, medical homes and post acute bundling; transparency HR 3692: The Affordable Health Care for America Act: Imaging cuts, device tax transparency and remote monitoringPL 110-275: "Medicare Improvements for Patient and Providers Act" (sec. 135) - Medical imaging accreditations program; medical imaging clinical appropriateness demonstration program Decline in growth rate of Medicare non-hospital imaging services S. 596 - The FITT Act of 2013 (Fostering Independence Through Technology Act) - specifically the telehealth provisions HR 2914 - Imaging self-referral HR 1717 - The Medicare DMEPOS - Marketing Pricing Program Act of 2013 HR 8 - "American Tax Payer Relief Act of 2012" - Medicare Imaging Cuts & Sustainable Growth Rate Extension Site-neutrality in payments (no bill number yet) HR 2375 - The Transparency and Accountability in Medicare Bidding Act of 2013 HR 4015 - Long-term Sustainable Growth Rate (SGR) replacement legislation Appropriate Use Criteria CT Dose Optimization HR 6179 - "The Telehealth Promotion Act of 2012" HR 6626 - "The Health Care Innovation and Marketplace Technologies Act of 2012" - Telemedicine provisions. Drafts in the House and Senate addressing the SGR formula - potential telehealth provisions.

Client expense: $640,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE

H.R. 942 and S. 948, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; H.R.1717, Medicare DMEPOS Market Pricing Program Act of 2013; H.R. 2375, Transparency and Accountability in Medicare Bidding Act of 2013

Client expense: $197,069 · Firm income: Not reported

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 942/S. 948- Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013, all provisions; H.R. 1250/ S. 1012- Medicare Audit Improvement Act of 2013, all provisions; H.R. 27- Small Supplier Fairness in Bidding Competition Act of 2013, all provisions;H.R. 1717- Medicare DMEPOS Market Pricing Program Act of 2013, all provisions; H.R. 2375- Transparency and Accountability in Medicare Bidding Act of 2013, all provisions; H.R. 2810 - Medicare Patient Access and Quality Act of 2013, all provisions; S. 1871 - The SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013, all provisions; H.R. 4302- Protecting Access to Medicare Act of 2014, all provisions.

Client expense: $120,000 · Firm income: Not reported

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, competitive rates for Medicaid bidding and fraud abuse; H.R. 942/S. 948, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013, all provisions; H.R. 1250/S. 1012, Medicare Audit Improvement Act of 2013, all provisions; (see contination page)H.R 27, Small Supplier Fairness in Building Competition Act of 2013, all provisions. H.R. 1717, Medicare DEMPOS Market Pricing Program Act of 2013, all provisions. H.R. 2375, Transparency and Accountability in Medicare Bidding, Act of 2013, all provisions. H.R. 2810, Medicare Patient Access and Quality Act of 2013, all provisions. S. 1871, The SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013, all provisions. H.R. 4302, Protecting Access to Medicare Act of 2014, all provisions.

Client expense: Not reported · Firm income: $40,000

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Affordable Care Act of 2010 H.R. 1041: Fairness in Medicare Bidding Act Medicare Claim Audit Volume and Contractor Procedures H.R. 6490: The Medicare DMEPOS Market Pricing Program Act H.R. 1717 Medicare DMEPOS Market Pricing Program Act of 2013 DOT and FDA policies related to home healthcare services and products Medicare Part B and Part D drug policies Medicaid policies related to home healthcare services and products Medicare reimbursement policies and administrative procedures related to home healthcare services and products

Client expense: Not reported · Firm income: Not reported

Affordable Care Act of 2010 H.R. 1041: Fairness in Medicare Bidding Act Medicare Claim Audit Volume and Contractor Procedures H.R. 6490: The Medicare DMEPOS Market Pricing Program Act H.R. 1717 Medicare DMEPOS Market Pricing Program Act of 2013 DOT and FDA policies related to home healthcare services and products Medicare Part B and Part D drug policies Medicaid policies related to home healthcare services and products Medicare reimbursement policies and administrative procedures related to home healthcare services and products

Client expense: Not reported · Firm income: Not reported

Affordable Care Act of 2010 H.R. 1041: Fairness in Medicare Bidding Act Medicare Claim Audit Volume and Contractor Procedures H.R. 6490: The Medicare DMEPOS Market Pricing Program Act H.R. 1717 Medicare DMEPOS Market Pricing Program Act of 2013 DOT and FDA policies related to home healthcare services and products Medicare Part B and Part D drug policies Medicaid policies related to home healthcare services and products Medicare reimbursement policies and administrative procedures related to home healthcare services and products

Client expense: Not reported · Firm income: Not reported

Affordable Care Act of 2010 H.R. 1041: Fairness in Medicare Bidding Act Medicare Claim Audit Volume and Contractor Procedures H.R. 6490: The Medicare DMEPOS Market Pricing Program Act H.R. 1717 Medicare DMEPOS Market Pricing Program Act of 2013 DOT and FDA policies related to home healthcare services and products Medicare Part B and Part D drug policies Medicaid policies related to home healthcare services and products Medicare reimbursement policies and administrative procedures related to home healthcare services and products

Client expense: Not reported · Firm income: Not reported

Affordable Care Act of 2010 H.R. 1041: Fairness in Medicare Bidding Act Medicare Claim Audit Volume and Contractor Procedures H.R. 6490: The Medicare DMEPOS Market Pricing Program Act H.R. 1717 Medicare DMEPOS Market Pricing Program Act of 2013 DOT and FDA policies related to home healthcare services and products Medicare Part B and Part D drug policies Medicaid policies related to home healthcare services and products Medicare reimbursement policies and administrative procedures related to home healthcare services and products

Client expense: Not reported · Firm income: Not reported

Affordable Care Act of 2010 H.R. 1041: Fairness in Medicare Bidding Act Medicare Claim Audit Volume and Contractor Procedures H.R. 6490: The Medicare DMEPOS Market Pricing Program Act H.R. 1717 Medicare DMEPOS Market Pricing Program Act of 2013 DOT and FDA policies related to home healthcare services and products Medicare Part B and Part D drug policies Medicaid policies related to home healthcare services and products Medicare reimbursement policies and administrative procedures related to home healthcare services and products

Client expense: Not reported · Firm income: Not reported

Discussed possible solutions for improving access to Medicaid for military families who have children with disabilities.HR 942/S. 948 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013 Creates a separate benefit category under Medicare for CRT, protecting access to these customized products so that people living with significant disabilities, including MS, can remain independent and address their medical needs. Advocate for improved benefits and services under Medicare and Medicaid for people with disabilities. Supports HR 1717 - The Medicare DMEPOS Market Pricing Program Act of 2013/HR 1717 will replace the poorly designed bidding program at the Centers for Medicare and Medicaid Services (CMS) with a market pricing program to ensure that access to quality equipment and services is protected.

Client expense: $75,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, White House Office

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 family caregiving, long-term care, Older Americans Act, private LTC insurance. (no bill) Discussed Medicaid long-term services and supports. (no bill) 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) S. 1439 - Discussed and endorsed the Care Planning Act of 2013. Discussed status of regulations regarding disclosure of nursing home ownership. (no bill) Discussed regulations defining whether a home and community-based setting in medicaid and state data on ome and community-based services spending. (no bill) Discussed family caregiver assessment in proposed regulations and shared a report on the topics. (no bill) Discussed measures for re-balancing in medicaid managed LTSS waivers and dual demonstration programs in sign on letter to CMS. (no bill) H.R. 1717 - Discussed Medicare DMEPOS Market Pricing Program Act. H.R. 3531 - Discussed Creating Access to Rehabilitation for Every Senior (CARES) Act.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 Medicaid managed care and long-term services and supports broadly. 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) Discussed the AARP Initiative called "You've Earned a Say". (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 and Florida 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. 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. 933, Consolidated and Further Continuing Appropriations Act, 2013 - 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. S. Con. Res. 8, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. H.Con. Res. 25, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation.Lobbied on expected "QM" safe harbor amendment. (The amendment was not offered) 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) Discussed the Medicare Adult Day Services Act. (no bill) Discussed the Commission on Long-Term Care and Senate Aging Committee hearing and long-term care generally. H.J.R. 59/H.R. 2775, Continuing Appropriations Resolution, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. S. 1284, 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. 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) H.R. 2810/S. 1871 - Discussed SGR repeal and health care extender provisions, including the Qualified Individual low-income Medicare beneficiary assistance program. Discussed fraud, Medicare home healthcare, ways to find savings in Medicare without harming Medicare beneficiaries (care coordination, prescription drugs, waste, fraud and abuse). Discussed new report on observation services that included policy recommendations. Discussed you've earned a say, ways to find savings in medicare without harming medicare beneficiaries (care coordination, prescriotion drugs, waste, fraud and abuse).Discussed and shared invitation for a Hill briefing on innovation and progress in long-term services and supports. (no bill) Submitted and shared written testimony for the record for the Senate Aging Committee hearing on the future of Long-Term Care Policy and Continuing the Conversation. (no bill) Discussed Medicare Advantage. H.R. 3616, Protecting Seniors from Medicare Act- Sent letters endorsing bill. H.R. 2810, The SGR Repeal and Medicare Beneficiary Improvement Act - Sent letters endorsing bill. Discussed observation care and "two-midnight rule".

Client expense: $2,500,000 · 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), 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 Council on Disability, 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

Affordable Care Act of 2010 H.R. 1041: Fairness in Medicare Bidding Act S.1203/H.R. 2195: Medicare Home Infusion Therapy Coverage Act of 2011 Medicare Claim Audit Volume and Contractor ProceduresH.R. 6490: The Medicare DMEPOS Market Pricing Program Act H.R. 1717 Medicare DMEPOS Market Pricing Program Act of 2013

Client expense: $100,000 · Firm income: Not reported

HR 3509: Patient Protection and Affordable Care Act of 2010 - various provisions including: Medical Device Excise Tax, various reimbursement cuts and policy proposals for medical imaging; remote monitoring technology in the context of accountable care organizations, medical homes and post acute bundling; transparency HR 3692: The Affordable Health Care for America Act: Imaging cuts, device tax transparency and remote monitoringPL 110-275: "Medicare Improvements for Patient and Providers Act" (sec. 135) - Medical imaging accreditations program; medical imaging clinical appropriateness demonstration program Decline in growth rate of Medicare non-hospital imaging services S. 596 - The FITT Act of 2013 (Fostering Independence Through Technology Act) - specifically the telehealth provisions HR 2914 - Imaging self-referral HR 1717 - The Medicare DMEPOS - Marketing Pricing Program Act of 2013 HR 8 - "American Tax Payer Relief Act of 2012" - Medicare Imaging Cuts & Sustainable Growth Rate Extension Site-neutrality in payments (no bill number yet) MR / CT cost center change (no bill number yet) HR 2375 - The Transparency and Accountability in Medicare Bidding Act of 2013 Long-term Sustainable Growth Rate (SGR) replacement legislation Appropriate Use Criteria CT Dose Optimization CMS Maintenance Directive revision HR 6179 - "The Telehealth Promotion Act of 2012" HR 6626 - "The Health Care Innovation and Marketplace Technologies Act of 2012" - Telemedicine provisions. Drafts in the House and Senate addressing the SGR formula - potential telehealth provisions.

Client expense: $320,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE