To amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas.

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

Legislative proposals affecting Medicare and Medicaid funding Proposed changes to Medicare hospital reimbursement policies Health Care Reform Implementation Graduate Medical Education - H.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013 S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, Medicare Hospital Wage Index Equity Act" S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013 H.R. 3698, Two Midnight Rule Delay Act S. 2082, Two-Midnight Rule Coordination and Improvement Act of 2014 S. 2353 and H.R. 1821, Registered Nurses Safe Staffing Act S. 2501, Hospital Readmission Accountability and Improvement Act Hospitals Improvements for Payment (HIP) Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013 S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, "Medicare Hospital Wage Index Equity Act" S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013 H.R. 3698, Two Midnight Rule Delay Act S. 2082, Two-Midnight Rule Coordination and Improvement Act of 2014 S. 2353 and H.R. 1821, Registered Nurses Safe Staffing Act S. 2501, Hospital Readmission Accountability and Improvement Act Hospitals Improvements for Payment (HIP) Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policies Medicare hospital prospective payment system S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, Medicare Hospital Wage Index Equity Act" S. 2353 and H.R. 1821, Registered Nurses Safe Staffing Act - Provisions setting nurse staff ratios "Hospitals Improvements for Payment (HIP) Act of 2014" S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013

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

Government targets: HOUSE OF REPRESENTATIVES, 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

Promoted Missouri congressional delegation discussion of a backlog in processing of Administrative Law Judge review of appeals of Medicare payment and benefit decision, as well as Recovery Audit Contractor reform legislation (H.R. 1250 and S. 1012) with Secretary of Health and Human Services nominee Sylvia BurwellPromoted enactment of H.R. 1250 and S. 1012 Responded to a congressional office request for information about Missouri hospitals which may be applying for a grant under CMS Medicare Care Choices Model project Responded to a congressional office request for information about litigation challenging the backlog in Administrative Law Judge review of Medicaid payment and benefit decision Provided information to selected members of the Missouri congressional delegation regarding another states actions regarding the decision of CMS to extend the imputed wage index floor for that state Distributed information to the Missouri congressional delegation regarding Missouri hospitals participation in the federal Partnership for Patients/Hospital Engagement Network initiative. Promoted enactment of S. 183 and H.R. 2053 Provided advocacy information to the Missouri congressional delegation regarding: - a profile of the characteristics of Missouri hospitals - changes in the schedule of implementation of federal statutory reductions in Medicaid disproportionate share hospital payments - federal payment reductions for Missouri hospitals by Medicare, including Medicare sequestration and Medicaid disproportionate share hospital payments - Missouri state and district-specific analyses of the characteristics and health care utilization of the uninsured - the role and benefits of the 340B prescription drug purchasing discount program for participating Missouri hospitals - expected debate of legislation regarding Medicare payment and standards for post-acute health care providers, reflected in a bicameral draft of the Improving Medicare Post-Acute Care Transformation Act of 2014. Promoted enactment of H.R. 4188 or expected companion Senate legislation Provided to the Missouri congressional delegation the Missouri Hospital Associations comments regarding CMS proposed regulation governing the payment of premiums on behalf of health insurance exchange enrollees Discussed potential topics for future health policy briefings with the Missouri congressional delegation

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid funding Proposed changes to Medicare hospital reimbursement policies Health Care Reform Implementation Graduate Medical Education - H.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013 S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, Medicare Hospital Wage Index Equity Act" S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013 H.R. 3698, Two Midnight Rule Delay Act S. 2082, Two-Midnight Rule Coordination and Improvement Act of 2014 S. 2353 and H.R. 1821, Registered Nurses Safe Staffing Act S. 2501, Hospital Readmission Accountability and Improvement Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education Payments H.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013 S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, "Medicare Hospital Wage Index Equity Act" S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013 H.R. 3698, Two Midnight Rule Delay Act S. 2082, Two-Midnight Rule Coordination and Improvement Act of 2014 S. 2353 and H.R. 1821, Registered Nurses Safe Staffing Act S. 2501, Hospital Readmission Accountability and Improvement Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policies Medicare hospital prospective payment system S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, Medicare Hospital Wage Index Equity Act" S. 2353 and H.R. 1821, Registered Nurses Safe Staffing Act - Provisions setting nurse staff ratios

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed legislation concerning the impact of cuts in Medicare and Medicaid rates on healthcare providers. HR 2053, the Medicare Hospital Wage Index Equity Act, bill would repeal a provision in the Affordable Care Act requiring the state's urban hospitals be reimbursed under Medicare under the same rate as its rural hospitals.S. 183, the Hospital Payment Fairness Act requiring that the state's urban hospitals be reimbursed under Medicare at the same rate as its rural hospitals.

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

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

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

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

Promoted H.R. 5227 Provided information on rural health care issues in Missouri in response to a congressional staff query Participated in a briefing for congressional staff regarding the Medicare wage index formulas used in computing Medicare payments to prospective payment system hospitals and discussed the potential for future legislation Queried Missouri congressional staff for topics of interest in upcoming visits to congressional offices Invited a CMS staffer to speak to hospital officials in advance of congressional advocacy visits Promoted enactment of H.R. 1250 and S. 1012 Promoted enactment of S. 183 and H.R. 2053 Provided advocacy information to the Missouri congressional delegation regarding: - a profile of the characteristics of Missouri hospitals - federal payment reductions for Missouri hospitals by Medicare, including Medicare sequestration and Medicaid disproportionate share hospital payments - a pending settlement offer by CMS to address a backlog in appeals of Medicare payment denials - concerns raised by the current Medicare wage index formulas used to calculate Medicare payments to hospitals under the prospective payment system - the role and benefits of the 340B prescription drug purchasing discount program for participating Missouri hospitals - the expected effect of recently-enacted legislation regarding the Veterans Affairs health care system in providing access to private-sector providers - legislation regarding Medicare payment and standards for post-acute health care providers, pursuant to Improving Medicare Post-Acute Care Transformation Act of 2014.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, 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 dealing with 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.Res.59; 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 of 2014;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1012 / H.R. 1250: Medicare Audit Improvement Act S. 183 / H.R. 2053: Hospital Payment Fairness Act H.R. 2329: Administrative Relief and Accurate Medicare Payments Act H.R. 3698: Two Midnight Rule Delay Act S. 2082: Two-Midnight Rule Coordination and Improvement Act S. 1143 / H.R. 2801: Protecting Access to Rural Therapy Services Act H.R. 3769: Delays enforcement of physician supervision requirements for CAHs S. 2037 / H.R. 3991: Critical Access Hospital Relief Act S. 2187: Rural Community Hospital Demonstration Extension Act S. 2359: Craig Thomas Rural Hospital and Provider Equity Act H.R. 5227: Making the Education of Nurses Dependable for Schools Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed legislation concerning the impact of cuts in Medicare and Medicaid rates on healthcare providers. HR 2053, the Medicare Hospital Wage Index Equity Act, bill would repeal a provision in the Affordable Care Act requiring the state's urban hospitals be reimbursed under Medicare under the same rate as its rural hospitals.S. 183, the Hospital Payment Fairness Act requiring that the state's urban hospitals be reimbursed under Medicare at the same rate as its rural hospitals.

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

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

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

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

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

S.183, Hospital Payment Fairness Act of 2013, Issues pertaining to sunsetting national budget neutrality for the hospital wage index. H.R. 2053, 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 201, 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. 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.

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

Government targets: Energy, Dept of, HOUSE OF REPRESENTATIVES, Natl Science Foundation (NSF), 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 dealing with 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.Res. 59; S.1143 and H.R. 2801 Protecting Access to Rural Therapy Services Act; Protecting Access to Medicare Act of 2014 - H.R.4302;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1012 / H.R. 1250: Medicare Audit Improvement Act of 2013 S. 183 / H.R. 2053: Hospital Payment Fairness Act of 2013 H.R. 2329: Administrative Relief and Accurate Medicare Payments Act of 2013 H.R. 3698: Two Midnight Rule Delay ActS. 2082: Two-Midnight Rule Coordination and Improvement Act of 2014 S. 1143 / H.R. 2801: Protecting Access to Rural Therapy Services Act H.R. 3769: Delays enforcement of physician supervision requirements for CAHs S. 2037 / H.R. 3991: Critical Access Hospital Relief Act of 2014 S. 2187: Rural Community Hospital Demonstration Extension Act of 2014 S. 2359: Craig Thomas Rural Hospital and Provider Equity Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Promoted Missouri congressional delegation discussion of a backlog in processing of Administrative Law Judge review of appeals of Medicare payment and benefit decision, as well as Recovery Audit Contractor reform legislation (H.R. 1250 and S. 1012) with Secretary of Health and Human Services nominee Sylvia BurwellPromoted enactment of H.R. 1250 and S. 1012 Responded to a congressional office request for information about Missouri hospitals which may be applying for a grant under CMS Medicare Care Choices Model project Responded to a congressional office request for information about litigation challenging the backlog in Administrative Law Judge review of Medicaid payment and benefit decision Provided information to selected members of the Missouri congressional delegation regarding another states actions regarding the decision of CMS to extend the imputed wage index floor for that state Distributed information to the Missouri congressional delegation regarding Missouri hospitals participation in the federal Partnership for Patients/Hospital Engagement Network initiative. Promoted enactment of S. 183 and H.R. 2053 Provided advocacy information to the Missouri congressional delegation regarding: - a profile of the characteristics of Missouri hospitals - changes in the schedule of implementation of federal statutory reductions in Medicaid disproportionate share hospital payments - federal payment reductions for Missouri hospitals by Medicare, including Medicare sequestration and Medicaid disproportionate share hospital payments - Missouri state and district-specific analyses of the characteristics and health care utilization of the uninsured - the role and benefits of the 340B prescription drug purchasing discount program for participating Missouri hospitals - expected debate of legislation regarding Medicare payment and standards for post-acute health care providers, reflected in a bicameral draft of the Improving Medicare Post-Acute Care Transformation Act of 2014. Promoted enactment of H.R. 4188 or expected companion Senate legislation Provided to the Missouri congressional delegation the Missouri Hospital Associations comments regarding CMS proposed regulation governing the payment of premiums on behalf of health insurance exchange enrollees Discussed potential topics for future health policy briefings with the Missouri congressional delegation

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid funding Proposed changes to Medicare hospital reimbursement policies Health Care Reform Implementation Graduate Medical Education - H.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, Medicare Hospital Wage Index Equity Act" S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013 H.R. 3698, Two Midnight Rule Delay Act S. 2082, Two-Midnight Rule Coordination and Improvement Act of 2014 S. 2353 and H.R. 1821, Registered Nurses Safe Staffing Act S. 2501, Hospital Readmission Accountability and Improvement Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education PaymentsH.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013 S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, "Medicare Hospital Wage Index Equity Act" S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013 H.R. 3698, Two Midnight Rule Delay Act S. 2082, Two-Midnight Rule Coordination and Improvement Act of 2014 S. 2353 and H.R. 1821, Registered Nurses Safe Staffing Act S. 2501, Hospital Readmission Accountability and Improvement Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policies Medicare hospital prospective payment system S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, Medicare Hospital Wage Index Equity Act"S. 2353 and H.R. 1821, Registered Nurses Safe Staffing Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.382; Medicaid and Medicare Payment Reform - discussions, hearings, etc.; H.R.574; S1012 and H.R.1250 - Medicare Audit Improvement Act; H.R.2053 and S.183 dealing with 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.Res.59; S.1143 and H.R.2801 Protecting Access to Rural Therapy Services Act; Protecting Access to Medicare Act of 2014 - H.R.4302

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

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 2013S. 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

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 2013S. 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

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 2013S. 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

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

S.183, Hospital Payment Fairness Act of 2013, Issues pertaining to sunsetting national budget neutrality for the hospital wage index. H.R. 2053, 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. Issues pertaining to the 340 B Drug pricing program. 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. Issues pertaining to protecting funding for direct graduate medical education and indirect medical education and the President's FY 2015 request to cut IME.

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

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid funding Proposed changes to Medicare hospital reimbursement policies Health Care Reform Implementation Graduate Medical Education - H.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, Medicare Hospital Wage Index Equity Act" S. 1557, Children's Hospital GME Support Reauthorization Act S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013 H.R. 3698, Two Midnight Rule Delay Act S. 2082, Two-Midnight Rule Coordination and Improvement Act of 2014 H.R. 4015 and S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act H.R. 4302, Protecting Access to Medicare Act, provisions related to ICD-10 delay and two-midnight rule

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education PaymentsH.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013 S. 1557, Childrens Hospital GME Support Reauthorization Act S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, "Medicare Hospital Wage Index Equity Act" S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013 H.R. 3698, Two Midnight Rule Delay Act S. 2082, Two-Midnight Rule Coordination and Improvement Act of 2014 H.R. 4015 and S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act H.R. 4302, Protecting Access to Medicare Act, provisions related to the ICD-10 delay and two-midnight rule

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policies Medicare hospital prospective payment systemS. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, Medicare Hospital Wage Index Equity Act" H.R. 4015 and S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act H.R. 4302, "Protecting Access to Medicare Act," provisions related to ICD-10 delay and the two-midnight rule

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed legislation concerning the impact of cuts in Medicare and Medicaid rates on healthcare providers. HR 2053, the Medicare Hospital Wage Index Equity Act, bill would repeal a provision in the Affordable Care Act requiring the state's urban hospitals be reimbursed under Medicare under the same rate as its rural hospitals.S. 183, the Hospital Payment Fairness Act requiring that the state's urban hospitals be reimbursed under Medicare at the same rate as its rural hospitals. Advocated in support of HR 3698, the Two-Midnight Rule Delay Act and S. 2082, the Two-Midnight Rule Coordination and Improvement Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1250/S. 1012 Medicare Audit Improvement Act of 2013, entire bill. H.R. 2578, the Rural Hospital Fairness Act of 2013, entire bill. S. 1143, Protecting Access to Rural Therapy Services Act, entire bill. H.R. 1787/S. 842, the Rural Hospital Access Act of 2013, entire bills.S. 183, Hospital Payment Fairness Act of 2013. S. 1053/H.R. 2302, the HELP Hospice Act, entire bill. H.R. 2053/ S. 183, to amend title XVIII of the Social Security Act to apply budget neutrality on a state-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas, entire bill. H.R. 1920, DSH Reduction Relief Act of 2013, entire bill. H.R. 2801/S. 1143, Protecting Access to Rural Therapy Services (PARTS) Act, entire bill. H.R. 2810, Medicare Patient Access and Quality Improvement Act of 2013. Proposals surrounding the Sustainable Growth Rate (SGR) and deficit/debt reduction as related to hospitals and physicians, including H.R.2810, the Medicare Patient Access and Quality Improvement Act of 2013, entire bill. Bi-partisan, bi-cameral proposal in Senate Finance Committee to permanently repeal SGR and amendments. H. Resolution 356/ S Resolution 26, The Importance of Rural Health Access for American Communities. President Obama's budget for FY 2014, budget proposal with a focus on Medicare and Medicaid policies. H.R. 3698, Two Midnight Rule Delay Act of 2013; S 2082: Two Midnight Rule Coordination and Improvement Act of 2014 H.R. 3991/ S. 2037 Critical Access Hospital Relief Act of 2014 (96 Hour Rule) HR 4067/S 1954: Extension of Moratorium on Direct Supervision; HR 3769: Extension of Moratorium on Direct Supervision HR 4015/ S 2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014; HR 4302: Protecting Access to Medicare Act 2014 S. 25: Repealing the Reduction in the Cost of Living Adjustment (COLA) for Retired Members of the Armed Services Bureau By Extending the Medicare Sequester. S.540 - Temporary Debt Limit Extension Act and preceeding potential proposals for raising the debt limit and funding.H.R. 3590, Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3401: Independent Payment Advisory Board; Section 3015: hospital readmissions program; Section 3124: Extension of Medicare Dependent Hospital program; Section 3137: Section 508 Reclassification; Section 9007: non-profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: Primary Care Provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: Expansion of Medicaid, CHIP; Sections 1311-1343: CO-OPs and Exchanges; Section 3022: Accountable Care Organizations; Section 3023: Hospital Bundling Provision; Section 6401-6402: Program Integrity Provisions; Section 6501-6503, 6505, 6508: Medicaid Program Integrity Provisions; Section 3141: Changes to the Rural Floor of the Hospital Wage Index. H.R. 4872, Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States. H.R. 3630 (introduced by 112th Congress), Middle Class Tax Relief and Job Creation Act of 2011, Title II, Subtitle C--Medicare Extensions; Other Health Provisions, Part 1--Medicare extensions, Section 2201, Physician payment update. Section 2202: Ambulance Add-ons; Section 2203: Medicare payment for outpatient therapy services; Section 2204: Work geographic Adjustment; Part 3--Offsets, Section 2223: Parity in Medicare payments for hospital outpatient department evaluation and management office visit services; Section 2224, Reduction of bad debt treated as an allowable cost; Section 2225, Rebasing of State DSH allotments for FY 2021. Part 2 of Subtitle C--Other Health Provisions, Section 2213: Modification to requirements for qualifying for exception to Medicare prohibition on certain physician referrals for hospitals. Other issues: 2014 Inpatient/Long term care hospital Prospective Payment System rule, entire rule. 2014 Outpatient Prospective Payment System rule, entire rule. Medicaid DSH Reduction rule, entire rule. Medicare and Medicaid Recovery Audit Contractor programs, including CMS' proposed changes to the rebilling policy for hospitals, CMS1455P. Medicare and Medicaid Electronic Health Record Payment Incentive Programs. Simpson/Bowles Budget proposal released in April 2013, entire proposal. Implementation of the state health insurance exchanges. 340B Drug Discount Program. Critical Access Hospitals/OIG report and potential changes to CAH designation. Proposals involving site-neutral payment policies impacting payments to hospitals.

Client expense: $63,803 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- Communicated with the Missouri congressional delegation regarding the Department of Health and Human Services decision to suspend most new requests for Administrative Law Judge hearings of appeals of Medicare payment denials because of a backlog of cases. The issue was linked to H.R. 1250 and S. 1012.- Met with Missouri congressional offices to discuss trends in Medicare and Medicaid hospital finance, H.R. 1250 and S. 1012, and the need for equity and predictability in applying therapy caps and an associated exception process to different care settings. - Provided requested information to a congressional office regarding Medicare and Medicaid payment reductions. - Provided requested information regarding the amount of federal revenue foregone in 2014 by virtue of the Missouri General Assemblys failure to enact in 2013 the expansion of Medicaid eligibility standards authorized by the Patient Protection and Affordable Care Act of 2010. - Discussed the potential involvement of a Missouri federal legislator in news conferences to promote H.R. 1250 and S. 1012. - Encouraged members of the Missouri congressional delegation in the House of Representatives to endorse a joint letter to Secretary of Health and Human Services regarding the Medicare Recovery Audit Contractor program and H.R. 1250 and S. 1012. - Contacted the Missouri congressional delegation in support of S. 183 and H. R. 2053. - Contacted offices of Missouri Senators asking them to consider discussing endorsement of a joint letter to CMS Director Marilyn Tavenner regarding reimbursement of inpatient rehabilitation hospitals and hospital units. - Voiced support for the Establishing Beneficiary Equity in the Hospital Readmission Program Act of Rep. Renacci. - Responded to a legislators request for MHAs stance regarding emerging legislation to postpone payment reductions to Medicare physicians as required by the Sustainable Growth Rate Formula. - Urged the Missouri congressional delegation to oppose legislative efforts to reduce hospital Medicare or Medicaid payments as an offset to the cost of a temporary delay of payment cuts for physician services under the Medicare program.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1012 / H.R. 1250: Medicare Audit Improvement Act of 2013 S. 183 / H.R. 2053: Hospital Payment Fairness Act of 2013 H.R. 2329: Administrative Relief and Accurate Medicare Payments Act of 2013 H.R. 3698: Two Midnight Rule Delay ActS. 2082: Two-Midnight Rule Coordination and Improvement Act of 2014 S. 1143 / H.R. 2801: Protecting Access to Rural Therapy Services Act S. 842 / H.R. 1787: Rural Hospital Access Act of 2013 H.R. 2578: Rural Hospital Fairness Act of 2013 H.R. 3769: Delays enforcement of physician supervision requirements for CAHs H.R. 4302: Protecting Access to Medicare Act of 2014 S. 2037 / H.R. 3991: Critical Access Hospital Relief Act of 2014 S. 2187: Rural Community Hospital Demonstration Extension Act of 2014

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare hospital reimbursement policies H.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013 S. 183, "Hospital Payment Fairness Act of 2013" H.R. 2053, "Medicare Hospital Wage Index Equity Act"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policies Medicare hospital prospective payment system H.R. 2869, "The Medicare Patient Access to Cancer Treatment Act"S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, Medicare Hospital Wage Index Equity Act"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid funding Proposed changes to Medicare hospital reimbursement policies Health Care Reform Implementation Graduate Medical Education - H.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, Medicare Hospital Wage Index Equity Act" H.R. 297, Childrens Hospital GME Support Reauthorization Act of 2013 S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013 H.R. 2869, "The Medicare Patient Access to Cancer Treatment Act"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare hospital reimbursement policies H.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013 S. 183, "Hospital Payment Fairness Act of 2013" H.R. 2053, "Medicare Hospital Wage Index Equity Act"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Health Care Reform Implementation Medicare Graduate Medical Education PaymentsH.R. 1180 and S. 577, Resident Physician Shortage Reduction Act of 2013 H.R. 1201, Training Tomorrows Doctors Today Act H.R. 297, Childrens Hospital GME Support Reauthorization Act of 2013 S. 183, Hospital Payment Fairness Act of 2013 H.R. 2053, "Medicare Hospital Wage Index Equity Act" S. 1012 and H.R. 1250, Medicare Audit Improvement Act of 2013 H.R. 2869, "The Medicare Patient Access to Cancer Treatment Act" H.R. 3698, Two Midnight Rule Delay Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE