DSH Reduction Relief Act of 2013

HR 1250 Medicare Audit Improvement Act of 2013, HR 803 SKILLS Act Sustainable Growth Rate Repeal & Reform Proposal, Medicaid Disproportionate Share Hospital Reductions per the Affordable Care Act, HR 1920, DSH Reductions Relief Act, IPPS FY 2014 Rule, Graduate Medical Education, 340B Discount Drug Program, Meaningful Use of Electronic Health Records Regulations

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1201, Training Tomorrows Doctors Today Act H.R. 1250, the Medicare Audit Improvement Act H.R. 1180/S. 577, The Resident Physician Shortage Reduction Act of 2013 H.R. 1920, the DSH Reduction Relief Act S. 2728, Community-Based Medical Education Act of 2014 S. 2658, The Accelerating Biomedical Research Act S. 2501, the Hospital Readmissions Program Accuracy and Accountability Act of 2014 H.R. 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act H.R. 4994, Improving Medicare Post-Acute Care Transformation Act of 2014 H.R. 5339, The Expanding Opportunities for Recovery Act H.R. 5110, SAVE Medicare Home Health Act of 2014 H.R. 5458, Building a Healthcare Workforce of the Future Act H.R. 5481, The Flexibility in Health IT Reporting (Flex-IT) Act OMHA-1401-NC, Medicare Program; Administrative Law Judge Hearing Program for Medicare Claim Appeals, Request for Information CMS-3819-P, Medicare and Medicaid Program: Conditions of Participation for Home Health Agencies; Proposed Rule

Client expense: $312,120 · Firm income: Not reported

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

HR 1201 "Training Tomorrow's Doctors Today Act" All Provisions S 577 "Resident Physician Shortage Act of 2013" All Provisions HR 574 "Medicare Physician Payment Innovation Act" All Provisions H.R. 4302 Protecting Access to Medicare Act of 2014 All Provisions P.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. H.R. 1180 The Resident Physician Shortage Reduction Act of 2013. All Provisions. H.R. 1920 DSH Reduction Relief Act of 2013. All Provisions. S. 1012 The Medicare Audit Improvement Act of 2013. All Provisions. H.R. 1250 The Medicare Audit Improvement Act of 2013. All Provisions. H. R. 2810 Medicare Patient Access and Quality Improvement Act of 2013. All Provisions. Senate Finance Committee: The SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013. All Provisions. The SGR Repeal and Medicare Beneficiary Accesst Improvement Act of 2013, offered as a substitute amendment to H.R.2810 Medicare Patient Access and Quality Improvement Act of 2013. All Provisions. H.J. Res.59 Continuing Appropriations Resolution, 2014 Short Title: Bipartisan Budget Act of 2013 and Pathway for SGR Reform Act of 2013. All Provisions related to the Medicare Physican Payment H.R. 3698 Two-Midnight Rule Relay Act, All provision Medicare Advantage 2015 Advance Notice of Methodological Changes for Calendar Year 2015 for Medicare Advantage Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter. All Provisions S.1932 Medicare Better Care Program. All provisions. H.R. 3890 Medicare Better Care Program. All provisions. H.R. 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act. All provisions. H.R. 1920 DSH Reduction Relief Act of 2013. All provisions. S. 2082 Two-Midnight Rule Coordination and Improvement Act of 2014. All provisions. H.R. 4673 Bundling and Coordinating Post-Acute Care Act of 2014. All provisions. H.R. 4994 Impact Act of 2014 - Improving Medicare Post-Acute Care Transformation Act of 2014. All provisions. H.R. 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act. All provisions. Medicare Shared Savings Program/Accountable Care Organizations: Potential Regulatory Reforms H.R. 5481 To continue the use of a 3-month quarter EHR reporting period for health care providers to demonstrate meaningful use for 2015 under the Medicare and Medicaid EHR incentive payment programs, and for other purposes. Hospital Improvements for Payment Act of 2014 Discussion Draft - All Provisions H.R. 5771 Tax Increase Prevention Act of 2014. All Provisions CMMI Demonstration Project

Client expense: $160,000 · Firm income: Not reported

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

Submitted comments on the Hatch Entitlement Reform in support of the several key reforms proposed for the Medicare program as alternative reductions to provider payments; Support S 351 Protecting Seniors Access to Medicare Act, a bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; Support HR 297 and S1557, Children's Hospital GME Support Reauthorization Act of 2013, the bill would reauthorize the CHGME program for an additional five years through fiscal year (FY) 2017; Support HR 1250 and S 1012 Medicare Audit Improvement Act of 2013, a bill to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Support S. 596 Fostering Independence Through Technology Act of 2014, a bill to establish pilot projects under the Medicare program to provide incentives for home health agencies to furnish remote patient monitoring services that reduce expenditures under such program; Support HR 1787 and S 842 Rural Hospital Access Act of 2013, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support HR 1920 and S 1555 DSH Reduction Relief Act of 2013, a bill to amend titles XVIII and XIX of the Social Security Act to provide for a delay in the implementation schedule of the reductions in disproportionate share hospital payments;AHA submitted a statement to the Presidents and Other Bipartisan Proposals to Reform Medicare Post-Acute Care Payments hearing to provide input on proposals to reform Medicares post-acute care payment systems; AHA submitted a statement to the Program Integrity: Oversight of Recovery Audit Contractors hearing supporting increased oversight of Recovery Audit Contractors (RACs); Support HR 2578 Rural Hospital Fairness Act of 2013, a bill to amend title XVIII of the Social Security Act to extend for one year the hold harmless provision for small rural hospitals and sole community hospitals under the Medicare prospective payment system for hospital outpatient department services related to enhanced physician supervision requirements; AHA submitted a statement to the Health Care Quality: The Path Forward hearing in support of improving transparency for the public, continuing and enhancing support of efforts to improve the safety and quality of the care delivered,and reduce unnecessary hospital expenditures; Support HR 2931 Fairness in Health Care Claims, Guidance and Investigations Act, a bill to amend the false claims provisions of title 31, United States Code, with respect to health care programs; Request additional guidance on and delay of two-midnight rule from CMS; Request issue corrected data on OPPS proposed rule and delay comment period from CMS; Discussion of ACAs patient safety evaluation system with CMS; Discussed the improvements to the National Practitioner Data Bank and new compliance efforts at HRSA; Discussions of Medicaid presumptive eligibility; Medicaid DSH; and request release of DSH audit rule with CMS; Follow up on GPO exclusion related to 340(b) entities; discussions to help shape upcoming proposed rule on 340B with HRSA; Discussed the Qualified Health Plans (QHP) 90day grace period with HHS and its implications for hospitals; Support HJ Res 59, a continuing Appropriations Resolution for 2014, which includes a provision that averts Medicare physician payment cuts as Congress continues to work on a replacement of the flawed SGR formula; Support HR 3444 Critical Access Hospital Flexibility Act of 2013, to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program; Support H.R.3698 and S. 2037 Two-Midnight Rule Delay Act of 2013, to delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays; Requested CMS and ONC to extend the EHR Incentive program regulatory timelines for 2014 and allow all providers greater flexibility in Stage 2 by giving all hospitals the option to make the transition to the 2014 Edition Certified EHR and the Stage 2 requirements (or the revised Stage 1 requirements, as applicable) over the course of 2014 or 2015; Support HR 3991 and S 2037 Critical Access Hospital Relief Act of 2014, amends title XVIII (Medicare) of the Social Security Act to repeal the 96-hour physician certification requirement for inpatient critical access hospital services under which a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital; Support HR 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act, to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support H.R. 2801 and S1143 Protecting Access to Rural Therapy Services (PARTS) Act of 2013, a bill to adopt a default standard of general supervision for outpatient therapeutic services, develop a reasonable exceptions process with provider input to identify specific procedures that require direct supervision, ensure that, for CAHs, the definition of direct supervision is consistent with the CAH conditions of participation that allow a physician or NPP to present within 30 minutes of being called and prohibit enforcement of CMSs retroactive reinterpretation that the direct supervision requirements applied to services furnished since January 1, 2001; S.1932/H.R. 3890 Better Care, Lower Cost Act , AHA has not taken position on the bill, but did establish an AHA working group to analyze the legislation to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program to provide integrated care for Medicare beneficiaries with chronic conditions; requested that the increasing number of hospital compliance reviews performed by the Office of Inspector General (OIG) Office of Audit Services in which the OIG has extrapolated audit findings to estimate Medicare overpayments to the hospitals and the hospitals Medicare Administrative Contractors (MACs)have sought to recover the extrapolated overpayment amounts be halted without delay; Support HR 5481, The Flexibility in Health IT Reporting (Flex-It) Act, a bill to continue the use of a 3-month quarter EHR reporting period for health care providers to demonstrate meaningful use for 2015 under the Medicare and Medicaid EHR incentive payment programs. Senate briefing on legal barriers to providers' ability to manage risk, particularly with respect to Medicare ACO programs. Support HR 4656 and S2276, Caring for America's Heroes Act, a bill to improve access to mental health services under the TRICARE program; Funding for Ebola treatment and preparedness as part of the FY15 Omnibus Appropriations Act. Met to discuss the HHS calculator issue to ensure employers cannot offer health plans that exclude inpatient hospital care.

Client expense: $5,590,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), SENATE, Veterans Affairs, Dept of (VA)

S.183, Hospital Payment Fairness Act of 2013, Issues pertaining to sunsetting national budget neutrality for the hospital wage index. H.R. 2053, S. 1012, Medicare Hospital Wage Index Equity Act, Issues pertaining to changing the national budget neutrality for the hospital wage index to a state neutrality. H.R. 1180, S.577, Resident Physician Shortage Reduction Act of 2013, Issues pertaining to increasing the cap on the number of resident physicians. H.R. 1201, Training Tomorrow's Doctors Today Act, Issues pertaining to increasing the cap on the number of resident physicians. H.R. 1250, S. 1012, Medicare Audit Improvement Act of 2013, Issues pertaining to RAC audits for hospitals. H.R. 1920, S. 1555, DSH Reduction Relief Act of 2013, Issues regarding delaying implementation of DSH cuts. Issues pertaining to protecting funding for direct graduate medical education and indirect medical education. S.1871, SGR Repeal and Medicare Beneficiary Access Act of 2013, Issues pertaining to the Sustainable Growth Rate and its offsets. H.R.2810, Medicare Patient Access and Quality Improvement Act of 2013, Issues pertaining to the Sustainable Growth Rate and its offsets. H.R. 3698, S. 2082, Two-Midnight Rule Delay Act of 2013, Support for delaying the two-midnight rule from CMS and issuing a clear policy on stays for less than two midnights. HR 4188, Establishing Beneficiary Equity in the Hospital Readmission Program Act, Issues relating to adjusting for patient disparities. S 2728, Community-Based Medical Education Act of 2014, Issues relating to concerns about reductions to IME and other items. S 2501, Hospital Readmissions Program Accuracy and Accountability Act of 2014, Issues relating to adjusting for patient socioeconomic disparities.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 297 - Children's Hospital GME Support Reauthorization Act of 2013 S. 1557 - Children's Hospital GME Support Reauthorization Act of 2013 H.R. 1920 - DSH Reduction Relief Act of 2013 H.R. 2053 - Medicare Hospital Wage Index Equity Act of 2013 S. 183 - The Hospital Payment Fairness Act of 2013 S. 744 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 1555 - DSH Reduction Relief Act of 2013 H.R. 3547 - Consolidated Appropriations Act, 2014 H.Con.Res.96 - Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024. H.R.3698 - Two-Midnight Rule Delay Act of 2013 S. 2082 - Two-Midnight Rule Coordination and Improvement Act of 2014 S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4015 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R. 4209 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2122 - Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2157 - Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 H.R. 4302 - Protecting Access to Medicare Act of 2014 S. 2450 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 H.R. 3230 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 S. 2501 - Hospital Readmissions Program Accuracy and Accountability Act of 2014 H.R. 4994 - IMPACT Act of 2014 H.J. Res. 124 - Continuing Appropriations Resolution, 2015 H.R. 4930 - ACE Kids Act of 2014 H.R. 83 - Consolidated and Further Continuing Appropriations Act, 2015 H.J. Res. 130 - Making further continuing appropriations for fiscal year 2015, and for other purposes.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

H.R. 297 - Children's Hospital GME Support Reauthorization Act of 2013 S. 1557 - Children's Hospital GME Support Reauthorization Act of 2013 H.R. 1920 - DSH Reduction Relief Act of 2013 H.R. 2053 - Medicare Hospital Wage Index Equity Act of 2013 S. 183 - The Hospital Payment Fairness Act of 2013 S. 744 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 1555 - DSH Reduction Relief Act of 2013 H.R. 3547 - Consolidated Appropriations Act, 2014 H.Con.Res.96 - Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024. H.R.3698 - Two-Midnight Rule Delay Act of 2013 S. 2082 - Two-Midnight Rule Coordination and Improvement Act of 2014 S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4015 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R. 4209 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2122 - Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2157 - Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 H.R. 4302 - Protecting Access to Medicare Act of 2014 S. 2450 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 H.R. 3230 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 S. 2501 - Hospital Readmissions Program Accuracy and Accountability Act of 2014 H.R. 4994 - IMPACT Act of 2014 H.J. Res. 124 - Continuing Appropriations Resolution, 2015 H.R. 4930 - ACE Kids Act of 2014 H.R. 83 - Consolidated and Further Continuing Appropriations Act, 2015 H.J. Res. 130 - Making further continuing appropriations for fiscal year 2015, and for other purposes.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

H.R. 297 - Children's Hospital GME Support Reauthorization Act of 2013 S. 1557 - Children's Hospital GME Support Reauthorization Act of 2013 H.R. 1920 - DSH Reduction Relief Act of 2013 H.R. 2053 - Medicare Hospital Wage Index Equity Act of 2013 S. 183 - The Hospital Payment Fairness Act of 2013 S. 744 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 1555 - DSH Reduction Relief Act of 2013 H.R. 3547 - Consolidated Appropriations Act, 2014 H.Con.Res.96 - Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024. H.R.3698 - Two-Midnight Rule Delay Act of 2013 S. 2082 - Two-Midnight Rule Coordination and Improvement Act of 2014 S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4015 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R. 4209 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2122 - Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2157 - Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 H.R. 4302 - Protecting Access to Medicare Act of 2014 S. 2450 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 H.R. 3230 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 S. 2501 - Hospital Readmissions Program Accuracy and Accountability Act of 2014 H.R. 4994 - IMPACT Act of 2014 H.J. Res. 124 - Continuing Appropriations Resolution, 2015 H.R. 4930 - ACE Kids Act of 2014 H.R. 83 - Consolidated and Further Continuing Appropriations Act, 2015 H.J. Res. 130 - Making further continuing appropriations for fiscal year 2015, and for other purposes.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

H.R. 83: Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83) Funding for Ebola preparedness and treatment Medicare Audit Improvement Act of 2013 (H.R. 1250) Resident Physician Shortage Reduction Act (S. 577/H.R. 1180) Protecting Seniors Access to Medicare Act of 2013 (H.R. 351 and S. 351) The DSH Reduction Relief Act of 2013 (H.R. 1920) Rural Hospital Access Act (H.R. 1787) Rural Hospital Fairness Act (H.R. 2578) Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 4188)/ Hospital Readmissions Program Accuracy and Accountability Act of 2014 (S. 2501) Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Flexibility in Health IT Reporting Act (HR 5481) Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Medicare physician fee schedule fix Severe sepsis protocols Medicare and Medicaid Recovery Audit Contractor (RAC) Programs Funding for National Institutes of Health Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) Payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, inpatient coding offset, hospital outpatient department (HOPD) evaluation and management (E/M) services, and sequestration. Medicare and Medicaid Electronic Health Record Incentive Payment Programs Medicaid, New York State Medicaid Vital Access Provider Program Hospital and health system pricing transparency Clinical quality measures and electronic clinical quality measures FY 2014 Inpatient Prospective Payment System Final Rule (CMS-1599-F) - Two-Midnight Policy FFY 2015 Inpatient Prospective Payment System Proposed Rule (CMS-1607-P) - Two-Midnight Policy

Client expense: $250,000 · Firm income: Not reported

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

Monitor Medicare Disproportionate Share Payments regulations, H.R. 1920 & S. 1555, DSH Reduction Relief Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Record (EHR) Incentive Program in 2015 - Request HHS provide for a shortened, 90-day EHR reporting period in 2015, which would give time for providers to continue their transition without having to drop out of the program. Children's Health Insurance Program (CHIP) - Urged Congress to take action and continue funding the programs. DSH Reduction relief Act of 2013 (S.1555 and H.R. 1920) Urged Congress to support legislation which would delay scheduled reductions to the Medicare and Medicaid Disproportionate Share Hospital (DSH) programs to allow states additional time to determine the level of health care coverage expansions. S. 2110 - the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 - Urged Senators to enact legislation to repeal and replace the Medicare physician payment formula, specifically the sustainable growth rate (SGR) to ensure adequate Medicare reimbursement for physicians who treat seniors. Urged the Department of Health and Human Services to continue to promote the Medicaid final rule which would ensure that individual's rights and protections under Medicaid are upheld when considering state Medicaid 1115 waivers. Urged Congress to extend the HEN program for at least an additional year. S. 569 and H.R. 1179 Improving Access to Medicare Coverage Act of 2013 - The bill amends the Medicare statute's definition of "post hospital extended care services" to clarify that Medicare beneficiaries in observation are deemed inpatients in the hospital.

Client expense: $152,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE, White House Office

Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical education, Medicaid provider taxes, Medicare bad debt payments Medicare and Medicaid paymentMedicaid Waivers Extension of Medicare Sustainable Growth Rate Medicare Evaluation and Management Reimbursement Reduction Proposal Issues related to waste, fraud, and abuse in Medicaid Medicare Disproportionate Share Hospital Payments H.R. 574 Medicare Physician Payment Innovation Act of 2013, all provisions H.R. 1853 Medicaid Accountability and Care Act, all provisions H.R. 574 Medicare Physician Payment Act, all provisions 5.577/HR 1180 Resident Physician Shortage Reduction Act , all provisions H.R. 1201 Training Tomorrow's Doctors Act, all provisions H.R. 1250/5.1012 Medicare Audit Improvement Act, all provisions H.R. 1487 Improved Healthcare at a Lower Cost Act, all provisions H.R. 1698 Stabilize Medicaid and CHIP Coverage, all provisions H.R. 1326 Health Care Price Transparency Promotion Act, all provisions H.R. 1920 DSH Reduction Relief Act, all provisions Issues related to Medicaid enrollment of newborns CMS FY2014 Hospital Inpatient Prospective Payment System Rule Issues related to admission and medical review criteria for inpatient services ("two midnights rule") S.1555 DSH Reduction Relief Act of 2013, all provisions S.1871 SGR Repeal and Medicare Beneficiary Access Act - all sections H.R. 2810 Medicare Patient Access and Quality Improvement Act - all sections H.R. 4302 Protecting Access to Medicare Act - all sections H.R. 4015 SGR Repeal and Medicare Provider Payment Modernization Act S. 1980 Medicaid and CHIP Continuous Quality Act H.R. 3678 Two-Midnight Rule Delay Act - all sections H.R. 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 2082 Two-Midnight Rule Coordination and Improvement Act S. 2501 Hospitals Readmissions Program Accuracy and Accountability Act, all sections Issues related to quality measures reporting in Medicaid S. 2461 CHIP Extension act of 2014, all provisions Issues related to Medicare payment for patients in "observation status" in hospitals CMS FY 2014 Outpatient Prospective Payment System Rule Issues related to Medicare Recovery Audit Contractors S. 2941 Medicare Protection Act, all Provisions Extension of SSA 1902 (a) (b) (c) - Medicaid Primary Care payment parity Childrens Health Insurance Program Medicare Hospital Re-admissions Program Meaningful Use Stage 2 H.R. 5481 The Flexibility in Health IT Reporting Act H.R. 5364 CHIP Extension and Improvement Act, All provisions Hospital Improvements for Payment Act of 2014 (generally and specific sections) Section 101: Hospital Prospective Payment System 102: Per Diem payment rate for short lengths of stay 103: Repeal of the Two- Midnights payment reduction 104 and 105: Monitoring performance of and improvements to the RAC program 109: Hospital assessment data 110: Cost information on hospital payments 201: Repeal of the moratorium on physician owned hospitals 214: Tennessee DSH allotment for FY2015 and succeeding fiscal years 216: NOTICE Act 217: Establishing equity in the Hospital Readmissions Program Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

President's Budget, FY2015, Medicare and Medicaid hospital reimbursement issues. Health care reform, Hospital related issues and initiatives. Public Law 111-148, The Patient Protection and Affordable Care Act, Hospital related issues and initiatives. H.R.4872, Health Care and Education Reconciliation Act of 2010, Hospital related issues and initiatives. Sequestration and fiscal cliff issues generally. S.Con.Res.8, Concurrent Resolution on the Budget Fiscal Year 2014, Hospital related issues and initiatives. H.R.1250, Medicare Audit Improvement Act of 2013, Recovery Audit Contractors H.R.1326, Health Care Price Transparency Promotion Act of 2013, Pricing Transparency issues. H.R.1920, DSH Reduction Relief Act of 2013, Disproportionate Share Hospital payment H.R.1180, Resident Physician Shortage Reduction Act of 2013, Graduate Medical Expense (GME) Public Law 113-93, Protecting Access to Medicare Act of 2014, SGR related issues. S.2110, Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014, SGR related issues. H.R.4188, Establishing Beneficiary Equity in the Hospital Readmission Program Act, Hospital related issues. H.R.3776, Stark Administrative Simplification Act, Hospital related issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Draft Hospital Improvements for Payment Act of 2014; Improving Medicare Post-Acute Care Transformation Act of 2014 (P.L. 113-185); H.R. 1250/S. 1012, Medicare Audit Improvement Act of 2013; H.R. 1787/S. 842, Rural Hospital Access Act of 2013; S. 1555/H.R. 1920, DSH Reduction Relief Act of 2013; CMS/HHS on Medicare and Medicaid reimbursement

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

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

S.382 Medicaid and Medicare Payment Reform Discussions, hearings, etc.; H.R.574; S.1012 and H.R.1250 Medicare Audit Improvement Act; H.R.2053 and S.183 Medicare Hospital Wage Index Floor for non-rural areas; H.R.1920 the DSH Reduction Relief Act of 2013; S.351 and H.R.351 Repeal of IPAB; H.J.Res59; S.1143 and H.R.2801 Protecting Access to Rural Therapy Services Act; H.R.4302 Protecting Access to Medicare Act of 2014; H.R.4930 Ace Kids Act;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3698/S2082: The Two Midnight Rule Coordination & Improvement Act HR 3993/S2037: Critical Access Hospital Relief Act HR 1250/S1012: Medicare Audit Improvement Act - Legislation to improve the system of hospital payment audits conducted by Medicare Recovery Audit Contractors. HR 1920/S1555: DSH Reduction Relief Act - Legislation to delay the Medicare & Medicaid disproportionate share hospital (DSH) cuts contained in the ACA until Fiscal Year 2016. HR 2801/S842: Protecting Access to Rural Therapy Services Act - Legislation to protect access to outpatient therapeutic services in small & rural and critical access hospitals. HR 4302: Protecting Access to Medicare Act of 2014 - Sustainable growth rate - doc. fix. HR 1201: Training Tomorrow's Doctors Act - Legislation to revise the distribution of resident positions and calculation of payment for direct medical education costs. HR 2810/S2000: Permanent Sustainable Growth Rate for Medicare Physicians HR 1787/S842: Rural Hospital Access Act HR 5481: Continue 3 month quarter reporting in 2015 under Medicare & Medicaid EHR Site Neutral Payments. Medicaid & Medicare Funding in the Federal Budget Medicare Payment Advisory Commission

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

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

S.1555, DSH Reduction Relief Act of 2013; H.R.1920, DSH Reduction Relief Act of 2013; H.R.1698, Stabilize Medicaid and CHIP Coverage Act of 2013; S.1980, Medicaid and CHIP Continuous Quality Act of 2014. Issues related to hospital, physician and other provider reimbursements. Issues related to Medicaid enrollment practices. Issues related to managed care. Issues relating to Medicare Advantage quality and special needs plans.

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

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

Two Midnight Rule (HR 3698 / S. 2082) Socioeconomic adjustment of the hospital readmission reduction program (H.R. 4188 / S. 2501) Medicare Audit Improvement Ace (H.R. 1250 / S. 1012) DSH Reduction Relief Act (H.R. 1920 / S. 1555)Sustainable Growth Rate Medical Liability Reform (S. 1769 / H.R. 1473, H.R. 36 / S. 961) Mental Health Policy (H.R. 3717) Rural Hospital Policies (H.R. 1787 /S. 842, H.R. 3991 / S. 2037, H.R. 3444, S. 2359, H.R. 2801 / S. 1143) Post Acute Care Policies (H.R. 4994) Graduate Medical Education (H.R. 1201 / S. 577 / H.R. 1180) Meaningful Use of Electronic Health Records (H.R. 5481) Children's Health Insurance Program Veterans Access to Care Nurse Education Policies 340B Drug Discount Program Home Health Face-To-Face Requirement FY 2015 IPPS

Client expense: $46,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocated to support rural hospitals in CMS rulemaking Advocated for support of Medicaid Provider Assessment Advocated for modifying hospital readmissions policies - HR 4188 / S 2501 Advocated to delay 2 midnights rule - HR 3698 / S 2082 Advocated to support DSH hospitals - HR 1920 / S 1555 Advocated to modify Medicare audits - HR 1250 / S. 1012 Advocated for delay of implementation of DEA controlled substances final rule Advocated in support for ebola emergency funding

Client expense: Not reported · Firm income: $15,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

CHIP Extension and Improvement Act (H.R. 5364/S. 2461) DSH Reduction Relief Act (H.R. 1920/S. 1555) Medicare Audit Improvement Act (H.R. 1250/S. 1012) SGR Repeal and Medicare Provider Payment Modernization Act (H.R. 4015/S. 2000)

Client expense: $12,500 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- Medicare Audit Improvement Act of 2013 (H.R. 1250) - Resident Physician Shortage Reduction Act (S. 577/H.R. 1180) - The DSH Reduction Relief Act of 2013 (H.R. 1920) - Critical Access Hospital and Rural Hospital funding

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES

-Advocated in support of the Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R.4188) and its Senate companion legislation - the Hospital Readmissions Program Accuracy and Accountability Act of 2014 (S.2501) -Advocated for the delay of the Two-midnights rule through support of the Two-Midnight Rule Delay Act (H.R.3698) and its Senate companion legislation (S.2082) -Advocated in support of the Disproportional Share Hospital (DSH) Reduction Relief Act (H.R.1920) and its Senate companion legislation (S.1555) -Advocated in support of the Medicare Audit Improvement Act (H.R.1250) and its Senate companion legislation (S.1012) -Engaged in discussions regarding 21st Century Cures Initiative, which is designed to accelerate processes at the National Institutes of Health and Food and Drug Administration n order to improve drug and device processes, increase discovery, and improve delivery -Discussed Alzheimers Disease research efforts on campus -Discussed support for efforts at HRSA regarding cord blood banking

Client expense: $88,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Submitted comments on the Hatch Entitlement Reform in support of the several key reforms proposed for the Medicare program as alternative reductions to provider payments; Support S 351 Protecting Seniors Access to Medicare Act, a bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; Support HR 297 and S1557, Children's Hospital GME Support Reauthorization Act of 2013, the bill would reauthorize the CHGME program for an additional five years through fiscal year (FY) 2017; Support HR 1250 and S 1012 Medicare Audit Improvement Act of 2013, a bill to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Support S. 596 Fostering Independence Through Technology Act of 2014, a bill to establish pilot projects under the Medicare program to provide incentives for home health agencies to furnish remote patient monitoring services that reduce expenditures under such program; Support HR 1787 and S 842 Rural Hospital Access Act of 2013, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support HR 1920 and S 1555 DSH Reduction Relief Act of 2013, a bill to amend titles XVIII and XIX of the Social Security Act to provide for a delay in the implementation schedule of the reductions in disproportionate share hospital payments;AHA submitted a statement to the Presidents and Other Bipartisan Proposals to Reform Medicare Post-Acute Care Payments hearing to provide input on proposals to reform Medicares post-acute care payment systems; AHA submitted a statement to the Program Integrity: Oversight of Recovery Audit Contractors hearing supporting increased oversight of Recovery Audit Contractors (RACs); Support HR 2578 Rural Hospital Fairness Act of 2013, a bill to amend title XVIII of the Social Security Act to extend for one year the hold harmless provision for small rural hospitals and sole community hospitals under the Medicare prospective payment system for hospital outpatient department services related to enhanced physician supervision requirements; AHA submitted a statement to the Health Care Quality: The Path Forward hearing in support of improving transparency for the public, continuing and enhancing support of efforts to improve the safety and quality of the care delivered,and reduce unnecessary hospital expenditures; Support HR 2931 Fairness in Health Care Claims, Guidance and Investigations Act, a bill to amend the false claims provisions of title 31, United States Code, with respect to health care programs; Request additional guidance on and delay of two-midnight rule from CMS; Request issue corrected data on OPPS proposed rule and delay comment period from CMS; Discussion of ACAs patient safety evaluation system with CMS; Discussed the improvements to the National Practitioner Data Bank and new compliance efforts at HRSA; Discussions of Medicaid presumptive eligibility; Medicaid DSH; and request release of DSH audit rule with CMS; Follow up on GPO exclusion related to 340(b) entities; discussions to help shape upcoming proposed rule on 340B with HRSA; Discussed the Qualified Health Plans (QHP) 90day grace period with HHS and its implications for hospitals; Support HJ Res 59, a continuing Appropriations Resolution for 2014, which includes a provision that averts Medicare physician payment cuts as Congress continues to work on a replacement of the flawed SGR formula; Support HR 3444 Critical Access Hospital Flexibility Act of 2013, to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program; Support H.R.3698 and S. 2037 Two-Midnight Rule Delay Act of 2013, to delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays; Requested CMS and ONC to extend the EHR Incentive program regulatory timelines for 2014 and allow all providers greater flexibility in Stage 2 by giving all hospitals the option to make the transition to the 2014 Edition Certified EHR and the Stage 2 requirements (or the revised Stage 1 requirements, as applicable) over the course of 2014 or 2015; Support HR 3991 and S 2037 Critical Access Hospital Relief Act of 2014, amends title XVIII (Medicare) of the Social Security Act to repeal the 96-hour physician certification requirement for inpatient critical access hospital services under which a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital; Support HR 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act, to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support H.R. 2801 and S 1143 Protecting Access to Rural Therapy Services (PARTS) Act of 2013, a bill to adopt a default standard of general supervision for outpatient therapeutic services, develop a reasonable exceptions process with provider input to identify specific procedures that require direct supervision, ensure that, for CAHs, the definition of direct supervision is consistent with the CAH conditions of participation that allow a physician or NPP to present within 30 minutes of being called and prohibit enforcement of CMSs retroactive reinterpretation that the direct supervision requirements applied to services furnished since January 1, 2001; S.1932/H.R. 3890 Better Care, Lower Cost Act , AHA has not taken position on the bill, but did establish an AHA working group to analyze the legislation to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program to provide integrated care for Medicare beneficiaries with chronic conditions; requested that the increasing number of hospital compliance reviews performed by the Office of Inspector General (OIG) Office of Audit Services in which the OIG has extrapolated audit findings to estimate Medicare overpayments to the hospitals and the hospitals Medicare Administrative Contractors (MACs)have sought to recover the extrapolated overpayment amounts be halted without delay; Support HR 5481, The Flexibility in Health IT Reporting (Flex-It) Act, a bill to continue the use of a 3-month quarter EHR reporting period for health care providers to demonstrate meaningful use for 2015 under the Medicare and Medicaid EHR incentive payment programs.

Client expense: $4,270,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), SENATE

- Medicare Audit Improvement Act of 2013 (H.R. 1250) - Resident Physician Shortage Reduction Act (S. 577/H.R. 1180) - The DSH Reduction Relief Act of 2013 (H.R. 1920)Rural Hospital Access Act (H.R. 1787) Rural Hospital Fairness Act (H.R. 2578) Medicare physician fee schedule fix Structural changes to Medicare combining Parts A and B Severe sepsis protocols Medicare and Medicaid Recovery Audit Contractor (RAC) Programs Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, inpatient coding offset, outpatient department hold harmless for certain rural and Sole Community Hospitals, hospital outpatient department (HOPD) evaluation and management (E/M) services, and Medicaid provider taxes. Medicare and Medicaid Programs; Electronic Health Record Incentive Payment Programs certification requirements. Hospital and health system pricing transparency Clinical quality measures and electronic clinical quality measures Medicare and Medicaid Disproportionate Share Hospital (DSH) Payments FY 2014 Inpatient Prospective Payment System Final Rule (CMS-1599-F) Two-Midnight Policy Vital Access Provider (VAP) program

Client expense: Not reported · Firm income: Not reported

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

H.R. 1180, S.577, Resident Physician Shortage Reduction Act of 2013, Issues pertaining to increasing the cap on the number of resident physicians. H.R. 1201, Training Tomorrow's Doctors Today Act, Issues pertaining to increasing the cap on the number of resident physicians. H.R. 1920, S. 1555, DSH Reduction Relief Act of 2013, Issues regarding delaying implementation of DSH cuts. S.1871, SGR Repeal and Medicare Beneficiary Access Act of 2013, Issues pertaining to the Sustainable Growth Rate and its offsets. H.R.2810, Medicare Patient Access and Quality Improvement Act of 2013, Issues pertaining to the Sustainable Growth Rate and its offsets. Issues pertaining to offsets for SGR patch. H.R. 3698, S. 2082, Two-Midnight Rule Delay Act of 2013, Support for delaying the two-midnight rule from CMS and issuing a clear policy on stays for less than two midnights. H.R. 4188, Establishing Beneficiary Equity in the Hospital Readmission Program Act, Issues relating to adjusting for patient disparities. S. 2501, Hospital Readmissions Program Accuracy and Accountability Act of 2014, Issues relating to adjusting for patient disparities/socioeconomic status.

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

Government targets: Economic Development Administration, HOUSE OF REPRESENTATIVES, SENATE

Record (EHR) Incentive Program in 2015 - Request HHS provide for a shortened, 90-day EHR reporting period in 2015, which would give time for providers to continue their transition without having to drop out of the program. Children's Health Insurance Program (CHIP) - Urged Congress to take action and continue funding the programs. DSH Reduction relief Act of 2013 (S.1555 and H.R. 1920) Urged Congress to support legislation which would delay scheduled reductions to the Medicare and Medicaid Disproportionate Share Hospital (DSH) programs to allow states additional time to determine the level of health care coverage expansions. S. 2110 - the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 - Urged Senators to enact legislation to repeal and replace the Medicare physician payment formula, specifically the sustainable growth rate (SGR) to ensure adequate Medicare reimbursement for physicians who treat seniors. Urged the Department of Health and Human Services to continue to promote the Medicaid final rule which would ensure that individual's rights and protections under Medicaid are upheld when considering state Medicaid 1115 waivers. Urged Congress to extend the HEN program for at least an additional year. S. 569 and H.R. 1179 Improving Access to Medicare Coverage Act of 2013 - The bill amends the Medicare statute's definition of "post hospital extended care services" to clarify that Medicare beneficiaries in observation are deemed inpatients in the hospital.

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

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

Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical education, Medicaid provider taxes, Medicare bad debt payments Medicare and Medicaid paymentMedicaid Waivers Extension of Medicare Sustainable Growth Rate Medicare Evaluation and Management Reimbursement Reduction Proposal Issues related to waste, fraud, and abuse in Medicaid Medicare Disproportionate Share Hospital Payments H.R. 574 Medicare Physician Payment Innovation Act of 2013, all provisions H.R. 1853 Medicaid Accountability and Care Act, all provisions H.R. 574 Medicare Physician Payment Act, all provisions 5.577/HR 1180 Resident Physician Shortage Reduction Act , all provisions H.R. 1201 Training Tomorrow's Doctors Act, all provisions H.R. 1250/5.1012 Medicare Audit Improvement Act, all provisions H.R. 1487 Improved Healthcare at a Lower Cost Act, all provisions H.R. 1698 Stabilize Medicaid and CHIP Coverage, all provisions H.R. 1326 Health Care Price Transparency Promotion Act, all provisions H.R. 1920 DSH Reduction Relief Act, all provisions Issues related to Medicaid enrollment of newborns CMS FY2014 Hospital Inpatient Prospective Payment System Rule Issues related to admission and medical review criteria for inpatient services ("two midnights rule") S.1555 DSH Reduction Relief Act of 2013, all provisions S.1871 SGR Repeal and Medicare Beneficiary Access Act - all sections H.R. 2810 Medicare Patient Access and Quality Improvement Act - all sections H.R. 4302 Protecting Access to Medicare Act - all sections H.R. 4015 SGR Repeal and Medicare Provider Payment Modernization Act S. 1980 Medicaid and CHIP Continuous Quality Act H.R. 3678 Two-Midnight Rule Delay Act - all sections H.R. 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 2082 Two-Midnight Rule Coordination and Improvement Act S. 2501 Hospitals Readmissions Program Accuracy and Accountability Act, all sections Issues related to quality measures reporting in Medicaid S. 2461 CHIP Extension act of 2014, all provisions Issues related to Medicare payment for patients in "observation status" in hospitals CMS FY 2014 Outpatient Prospective Payment System Rule Issues related to Medicare Recovery Audit Contractors S. 2941 Medicare Protection Act, all Provisions Extension of SSA 1902 (a) (b) (c) - Medicaid Primary Care payment parity Childrens Health Insurance Program Medicare Hospital Re-admissions Program Meaningful Use Stage 2 H.R. 5481 The Flexibility in Health IT Reporting Act H.R. 5364 CHIP Extension and Improvement Act, All provisions

Client expense: $160,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

H.R. 1201- Training Tomorrow's Doctors Today; Graduate Medical Education provisions S. 577, H.R. 1180- Resident Physician Shortage Reducation Act Hospital Evaluation and Management site-neutrality payment proposal H.R. 1920- DSH Reducation Relief Act of 2013H.R. 1787, S. 842- Rural Hospital Access Act of 2013; Critical Access Hospitals S. 1143, H.R. 2801- Protecting Access to Rural Therapy Services Act- provisions re "direct supervision" at Critical Access Hospitals S. 1871- SGR Repeal and Medicare Beneficiary Access Improvement Act; Medicare Sustainable Growth Rate provisions and "general supervision" provisions for rural and Critical Access Hospitals H.R. 2810- Medicare Patient Access and Quality Improvement Act; Sustainable Growth Rate Provisions H.R. 3077-Telehealth Enhancement Act of 2013 H.R. 3991- Critical Access Hospital Relief Act of 2014; provisions on 96-hour physician certification requirement H.R. 4302- Protecting Access to Medicare Act of 2014 CMS-1606-P Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal Year Beginning October 1, 2014 H.R. 5558- ACO Improvement Act H.R. 4851- FLEX-IT Act; provsions related to "Meaningful Use"

Client expense: Not reported · Firm income: $34,400

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), SENATE

H.R. 1201- Training Tomorrow's Doctors Today; Graduate Medical Education provisions S. 577, H.R. 1180- Resident Physician Shortage Reducation Act Hospital Evaluation and Management site-neutrality payment proposal H.R. 1920- DSH Reducation Relief Act of 2013H.R. 1787, S. 842- Rural Hospital Access Act of 2013; Critical Access Hospitals S. 1143, H.R. 2801- Protecting Access to Rural Therapy Services Act- provisions re "direct supervision" at Critical Access Hospitals S. 1871- SGR Repeal and Medicare Beneficiary Access Improvement Act; Medicare Sustainable Growth Rate provisions and "general supervision" provisions for rural and Critical Access Hospitals H.R. 2810- Medicare Patient Access and Quality Improvement Act; Sustainable Growth Rate Provisions H.R. 3077-Telehealth Enhancement Act of 2013 H.R. 3991- Critical Access Hospital Relief Act of 2014; provisions on 96-hour physician certification requirement H.R. 4302- Protecting Access to Medicare Act of 2014 CMS-1606-P Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal Year Beginning October 1, 2014 H.R. 5558- ACO Improvement Act H.R. 4851- FLEX-IT Act; provsions related to "Meaningful Use"

Client expense: $100,018 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), SENATE

Medicare Audit Improvement Act of 2013 (H.R. 1250) Resident Physician Shortage Reduction Act (S. 577/H.R. 1180) Protecting Seniors Access to Medicare Act of 2013 (H.R. 351 and S. 351) The DSH Reduction Relief Act of 2013 (H.R. 1920) Rural Hospital Access Act (H.R. 1787) Rural Hospital Fairness Act (H.R. 2578) Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 4188)/ Hospital Readmissions Program Accuracy and Accountability Act of 2014 (S. 2501) Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Flexibility in Health IT Reporting Act (HR 5481) Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227)? Medicare physician fee schedule fix Structural changes to Medicare - combining Parts A and B Severe sepsis protocols Medicare and Medicaid Recovery Audit Contractor (RAC) Programs Funding for National Institutes of Health Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) Payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, inpatient coding offset, outpatient department hold harmless for certain rural and Sole Community Hospitals, hospital outpatient department (HOPD) evaluation and management (E/M) services, Medicaid provider taxes, and sequestration. Medicare and Medicaid Electronic Health Record Incentive Payment Programs Medicaid, New York State Medicaid Redesign Team, 1115 Waiver Medicare Advantage Plan implementation of sequestration reductions Hospital and health system pricing transparency Clinical quality measures and electronic clinical quality measures FY 2014 Inpatient Prospective Payment System Final Rule (CMS-1599-F) - Two-Midnight Policy FFY 2015 Inpatient Prospective Payment System Proposed Rule (CMS-1607-P) - Two-Midnight Policy Meaningful Use Proposed Rule (CMS-0052-P) Vital Access Provider (VAP) program

Client expense: $210,000 · 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. 297 - Children's Hospital GME Support Reauthorization Act of 2013 S. 1557 - Children's Hospital GME Support Reauthorization Act of 2013 H.R. 1920 - DSH Reduction Relief Act of 2013 H.R. 2053 - Medicare Hospital Wage Index Equity Act of 2013 S. 183 - The Hospital Payment Fairness Act of 2013 S. 744 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 1555 - DSH Reduction Relief Act of 2013 H.R. 3547 - Consolidated Appropriations Act, 2014 H.Con.Res.96 - Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024. H.R.3698 - Two-Midnight Rule Delay Act of 2013 S. 2082 - Two-Midnight Rule Coordination and Improvement Act of 2014 S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4015 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R. 4209 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2122 - Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2157 - Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 H.R. 4302 - Protecting Access to Medicare Act of 2014 S. 2450 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 H.R. 3230 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 S. 2501 - Hospital Readmissions Program Accuracy and Accountability Act of 2014 H.R. 4994 - IMPACT Act of 2014 H.J. Res. 124 - Continuing Appropriations Resolution, 2015 H.R. 4930 - ACE Kids Act of 2014

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

H.R. 297 - Children's Hospital GME Support Reauthorization Act of 2013 S. 1557 - Children's Hospital GME Support Reauthorization Act of 2013 H.R. 1920 - DSH Reduction Relief Act of 2013 H.R. 2053 - Medicare Hospital Wage Index Equity Act of 2013 S. 183 - The Hospital Payment Fairness Act of 2013 S. 744 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 1555 - DSH Reduction Relief Act of 2013 H.R. 3547 - Consolidated Appropriations Act, 2014 H.Con.Res.96 - Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024. H.R.3698 - Two-Midnight Rule Delay Act of 2013 S. 2082 - Two-Midnight Rule Coordination and Improvement Act of 2014 S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4015 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R. 4209 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2122 - Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2157 - Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 H.R. 4302 - Protecting Access to Medicare Act of 2014 S. 2450 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 H.R. 3230 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 S. 2501 - Hospital Readmissions Program Accuracy and Accountability Act of 2014 H.R. 4994 - IMPACT Act of 2014 H.J. Res. 124 - Continuing Appropriations Resolution, 2015 H.R. 4930 - ACE Kids Act of 2014

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

H.R. 297 - Children's Hospital GME Support Reauthorization Act of 2013 S. 1557 - Children's Hospital GME Support Reauthorization Act of 2013 H.R. 1920 - DSH Reduction Relief Act of 2013 H.R. 2053 - Medicare Hospital Wage Index Equity Act of 2013 S. 183 - The Hospital Payment Fairness Act of 2013 S. 744 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 1555 - DSH Reduction Relief Act of 2013 H.R. 3547 - Consolidated Appropriations Act, 2014 H.Con.Res.96 - Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024. H.R.3698 - Two-Midnight Rule Delay Act of 2013 S. 2082 - Two-Midnight Rule Coordination and Improvement Act of 2014 S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4015 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R. 4209 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2122 - Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2157 - Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 H.R. 4302 - Protecting Access to Medicare Act of 2014 S. 2450 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 H.R. 3230 - Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 S. 2501 - Hospital Readmissions Program Accuracy and Accountability Act of 2014 H.R. 4994 - IMPACT Act of 2014 H.J. Res. 124 - Continuing Appropriations Resolution, 2015 H.R. 4930 - ACE Kids Act of 2014

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

H.R. 1250/S. 1012, Medicare Audit Improvement Act of 2013; H.R. 1787/S. 842, Rural Hospital Access Act of 2013; S. 1555/H.R. 1920, DSH Reduction Relief Act of 2013; CMS/HHS on Medicare and Medicaid reimbursement

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

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

HR 1250 Medicare Audit Improvement Act of 2013, HR 803 SKILLS Act Sustainable Growth Rate Repeal & Reform Proposal, Medicaid Disproportionate Share Hospital Reductions per the Affordable Care Act, HR 1920, DSH Reductions Relief Act, IPPS FY 2014 Rule, Graduate Medical Education, 340B Discount Drug Program, Meaningful Use of Electronic Health Records Regulations

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.183, Hospital Payment Fairness Act of 2013, Issues pertaining to sunsetting national budget neutrality for the hospital wage index. H.R. 2053, S. 1012, Medicare Hospital Wage Index Equity Act, Issues pertaining to changing the national budget neutrality for the hospital wage index to a state neutrality.H.R. 1180, S.577, Resident Physician Shortage Reduction Act of 2013, Issues pertaining to increasing the cap on the number of resident physicians. H.R. 1201, Training Tomorrow's Doctors Today Act, Issues pertaining to increasing the cap on the number of resident physicians. H.R. 1250, S. 1012Medicare Audit Improvement Act of 2013, Issues pertaining to RAC audits for hospitals. H.R. 1920, S. 1555, DSH Reduction Relief Act of 2013, Issues regarding delaying implementation of DSH cuts. Issues pertaining to protecting funding for direct graduate medical education and indirect medical education and not supporting the President's FY 2015 request to cut IME. S.1871, SGR Repeal and Medicare Beneficiary Access Act of 2013, Issues pertaining to the Sustainable Growth Rate and its offsets. H.R.2810, Medicare Patient Access and Quality Improvement Act of 2013, Issues pertaining to the Sustainable Growth Rate and its offsets. H.R. 3698, S. 2082, Two-Midnight Rule Delay Act of 2013, Support for delaying the two-midnight rule from CMS and issuing a clear policy on stays for less than two midnights. HR 4188, Establishing Beneficiary Equity in the Hospital Readmission Program Act, Issues relating to adjusting for patient disparities. S. 2728, Community-Based Medical Education Act of 2014, Issues relating to concerns about reductions to IME and other items. S. 2501, Hospital Readmissions Program Accuracy and Accountability Act of 2014, Issues relating to adjusting for patient disparities/ socioeconomic status.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1180, S.577, Resident Physician Shortage Reduction Act of 2013, Issues pertaining to increasing the cap on the number of resident physicians. H.R. 1201, Training Tomorrow's Doctors Today Act, Issues pertaining to increasing the cap on the number of resident physicians. H.R. 1920, S. 1555, DSH Reduction Relief Act of 2013, Issues regarding delaying implementation of DSH cuts.S.1871, SGR Repeal and Medicare Beneficiary Access Act of 2013, Issues pertaining to the Sustainable Growth Rate and its offsets. H.R.2810, Medicare Patient Access and Quality Improvement Act of 2013, Issues pertaining to the Sustainable Growth Rate and its offsets. Issues pertaining to offsets for SGR patch H.R. 3698, S. 2082, Two-Midnight Rule Delay Act of 2013, Support for delaying the two-midnight rule from CMS and issuing a clear policy on stays for less than two midnights. H.R. 4188, Establishing Beneficiary Equity in the Hospital Readmission Program Act, Issues relating to adjusting for patient disparities. S. 2501, Hospital Readmissions Program Accuracy and Accountability Act of 2014, Issues relating to adjusting for patient disparities/socioeconomic status.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3698/ S. 2082: The Two Midnight Rule Coordination & Improvement Act HR 3993/ S. 2037: Critical Access Hospital Relief Act HR 1250/ S. 1012: Medicare Audit Improvement Act - Legislation to improve the system of hospital payment audits conducted by Medicare Recovery Audit contractors. HR 1920/ S. 1555: DSH Reduction Relief Act - Legislation to delay the Medicare & Medicaid disproportionate share hospital (DSH) cuts contained in the Affordable Care Act for two years until fiscal year 2016. HR 2801/S. 842: Protecting Access to Rural Therapy Services Act - Legislation to protect access to outpatient therapeutic services in small & rural and critical access hospitals. HR 4302: Protecting Access to Medicare Act of 2014 - Sustainable growth rate - doc. fix. HR 1201: Training Tomorrow's Doctors Act - Legislation to revise the distribution of resident positions and the calculation of payments for direct medical education costs. HR 2810/ S. 2000: Permant Sustainable Growth Rate for Medicare Physicians HR 1787/ S. 842: Rural Hospital Access Act HR 5481: Continue 3 - month quarter reporting in 2015 under Medicare & Medicaid EHR Site Neutral Payments Medicaid & Medicare Funding in the Federal Budget Medicare Payment Penalties for Hospital Aquired Conditions (HACs)

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

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

HR 1201 "Training Tomorrow's Doctors Today Act" All Provisions S 577 "Resident Physician Shortage Act of 2013" All Provisions HR 574 "Medicare Physician Payment Innovation Act" All Provisions H.R. 4302 Protecting Access to Medicare Act of 2014 All ProvisionsP.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. H.R. 1180 The Resident Physician Shortage Reduction Act of 2013. All Provisions. H.R. 1920 DSH Reduction Relief Act of 2013. All Provisions. S. 1012 The Medicare Audit Improvement Act of 2013. All Provisions. H.R. 1250 The Medicare Audit Improvement Act of 2013. All Provisions. H. R. 2810 Medicare Patient Access and Quality Improvement Act of 2013. All Provisions. Senate Finance Committee: The SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013. All Provisions. The SGR Repeal and Medicare Beneficiary Accesst Improvement Act of 2013, offered as a substitute amendment to H.R.2810 Medicare Patient Access and Quality Improvement Act of 2013. All Provisions. H.J. Res.59 Continuing Appropriations Resolution, 2014 Short Title: Bipartisan Budget Act of 2013 and Pathway for SGR Reform Act of 2013. All Provisions related to the Medicare Physican Payment H.R. 3698 Two-Midnight Rule Relay Act, All provision Medicare Advantage 2015 Advance Notice of Methodological Changes for Calendar Year 2015 for Medicare Advantage Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter. All Provisions S.1932 Medicare Better Care Program. All provisions. H.R. 3890 Medicare Better Care Program. All provisions. H.R. 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act. All provisions. H.R. 1920 DSH Reduction Relief Act of 2013. All provisions. S. 2082 Two-Midnight Rule Coordination and Improvement Act of 2014. All provisions. H.R. 4673 Bundling and Coordinating Post-Acute Care Act of 2014. All provisions. H.R. 4994 Impact Act of 2014 - Improving Medicare Post-Acute Care Transformation Act of 2014. All provisions. H.R. 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act. All provisions. Medicare Shared Savings Program/Accountable Care Organizations: Potential Regulatory Reforms H.R. 5481 To continue the use of a 3-month quarter EHR reporting period for health care providers to demonstrate meaningful use for 2015 under the Medicare and Medicaid EHR incentive payment programs, and for other purposes.

Client expense: $160,000 · Firm income: Not reported

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

President's Budget, FY2015, Medicare and Medicaid hospital reimbursement issues. Health care reform, Hospital related issues and initiatives. Public Law 111-148, The Patient Protection and Affordable Care Act, Hospital related issues and initiatives. H.R.4872, Health Care and Education Reconciliation Act of 2010, Hospital related issues and initiatives. Sequestration and fiscal cliff issues generally. S.Con.Res.8, Concurrent Resolution on the Budget Fiscal Year 2014, Hospital related issues and initiatives. H.R.1250, Medicare Audit Improvement Act of 2013, Recovery Audit Contractors H.R.1326, Health Care Price Transparency Promotion Act of 2013, Pricing Transparency issues. H.R.1920, DSH Reduction Relief Act of 2013, Disproportionate Share Hospital payment H.R.1180, Resident Physician Shortage Reduction Act of 2013, Graduate Medical Expense (GME) Public Law 113-93, Protecting Access to Medicare Act of 2014, SGR related issues. S.2110, Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014, SGR related issues. H.R.4188, Establishing Beneficiary Equity in the Hospital Readmission Program Act, Hospital related issues. H.R.3776, Stark Administrative Simplification Act, Hospital related issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocated to support DHS hospitals - HR 1920/ S 1555 Advocated for delay "two midnights" CMS ruling in budget negotiations - HR 3698/S2082 Advocated to ensure CO Telehealth Network receives funding via USACAdvocated for support of Medicaid Provider Assessment Advocated for modifying hospital readmissions policies - HR 4188 / S 2501 Advocated to modify Medicare audits HR 1250 / S. 1012

Client expense: Not reported · Firm income: $15,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.1555, DSH Reduction Relief Act of 2013; H.R.1920, DSH Reduction Relief Act of 2013; H.R.1698, Stabilize Medicaid and CHIP Coverage Act of 2013; S.1980, Medicaid and CHIP Continuous Quality Act of 2014. Issues related to hospital, physician and other provider reimbursements. Issues related to Medicaid enrollment practices. Issues related to managed care. Issues relating to Medicare Advantage quality and special needs plans.

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

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

Monitor Medicare Disproportionate Share Payments regulations, H.R. 1920 & S. 1555, DSH Reduction Relief Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Two Midnight Rule (HR 3698 / S. 2082) Socioeconomic adjustment of the hospital readmission reduction program (H.R. 4188 / S. 2501) Medicare Audit Improvement Ace (H.R. 1250 / S. 1012) DSH Reduction Relief Act (H.R. 1920 / S. 1555)Sustainable Growth Rate (H.R. 4302) Medical Liability Reform (S. 1769 / H.R. 1473, H.R. 36 / S. 961) Mental Health Policy (H.R. 3717) Rural Hospital Policies (H.R. 1787 /S. 842, H.R. 3991 / S. 2037, H.R. 3444, S. 2359, H.R. 2801 / S. 1143) Post Acute Care Policies (H.R. 4994) Graduate Medical Education (H.R. 1201 / S. 577 / H.R. 1180) Meaningful Use of Electronic Health Records (H.R. 5481) Nurse Education Policies 340B Discount Drug Program Home Health Face-to-Face Requirement FY 2015 IPPS

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

CHIP Extension and Improvement Act (H.R. 5364/S. 2461) DSH Reduction Relief Act (H.R. 1920/S. 1555) Medicare Audit Improvement Act (H.R. 1250/S. 1012)

Client expense: $12,500 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE