SGR Repeal and Medicare Beneficiary Access Act of 2013

Issues relating to Medicare Advantage, Medicare reform, Medicaid issues, CHIP reauthorization. Issues related to health reform legislation and regulation, including treatment of Medicare Advantage Five Star Plans and the implementation of the Patient Protection and Affordable Care Act (P.L. 111-148); issues related to the Medicare Sustainable Growth Rate (SGR); the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810); the Protecting Access to Medicare Act of 2014 (H.R. 4302).

Client expense: $150,708 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Office of Personnel Management (OPM), SENATE

Issues relating to Medicare Advantage, Medicare reform, Medicaid issues, CHIP reauthorization. Issues related to health reform legislation and regulation, including treatment of Medicare Advantage Five Star Plans and the implementation of the Patient Protection and Affordable Care Act (P.L. 111-148); issues related to the Medicare Sustainable Growth Rate (SGR); the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810); the Protecting Access to Medicare Act of 2014 (H.R. 4302).

Client expense: $126,195 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Office of Personnel Management (OPM), SENATE

Issues relating to Medicare Advantage, Medicare reform, Medicaid issues, CHIP reauthorization. Issues related to health reform legislation and regulation, including treatment of Medicare Advantage Five Star Plans and the implementation of the Patient Protection and Affordable Care Act (P.L. 111-148); issues related to the Medicare Sustainable Growth Rate (SGR); the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810); the Protecting Access to Medicare Act of 2014 (H.R. 4302).

Client expense: $194,178 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Office of Personnel Management (OPM), SENATE

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 942/S. 948- Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013, all provisions; H.R. 1250/S. 1012- Medicare Audit Improvement Act of 2013, all provisions; H.R. 27- Small Supplier Fairness in Bidding Competition Act of 2013, all provisions; H.R. 1717- Medicare DMEPOS Market Pricing Program Act of 2013, all provisions; H.R. 2375 - Transparency and Accountability in Medicare Bidding Act of 2013, all provisions; H.R. 2810 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013, all provisions; H.R. 4302 - Protecting Access to Medicare Act of 2014, all provisions; H.R. 4920/ H.R. 5809/S. 2975 Medicare DMEPOS Competitive Bidding Improvement Act of 2014; H.R. 1516 Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015, all provisions; Complex rehab technology relating to competitive bidding; H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015, competitive bidding provisions.

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

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

HR 3590 & HR 4872 - Patient Protection & Affordable Care Act & Reconciliation Act of 2010 - effect on home office procedures, self-insured plan, executive compensation limitation. Implications to dental product. HR 185 - Regulatory Accountability Act - Provisions amending burdensome regulations. HR 1478/S 798 - Policyholder Protection Act - Source of strength requirements. Sen. Hatch Report on Taxes - provisions impacting insurance and banking industries. Camp Comprehensive Discussion Draft on Tax Reform - Provisions impacting insurance and banking industries. HR 4302 - Protecting Access to Medicare Act of 2014 - SGR Patch S 2157 - Commonsense Medicare SGR Repeal & Beneficiary Access Improvement Act of 2014 - SGR Repeal S 2122 - Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 - SGR Repeal HR 4015 - AGR Repeal and Medicare Provider Payment Modernization Act of 2014 - Potential Medigap impact. S 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 - SGR Repeal HR 2810 - Medicare Patient Access & Quality Improvement Act of 2013 - SGR Repeal S.CON.RES.8 - Senate Budget FY 2014 - Potential Medigap impact H.CON.RES.25 - House Budget FY 2014 - Potential Medigap impact HR 4510/S 2270 - Insurance Clarification Capital Standards Act - Provisions exempting insurers from Dodd-Frank Act capital requirements. HR 1090 - Retail Investor Protection Act - Provisions requiring SEC & DOL to work together before releasing rules relating to a fiduciary duty standard.

Client expense: $297,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR formula and move to a new value-based payment and delivery system under Medicare. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 574 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. Advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentives-both non-financial and financial-for engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Advocated for halting the nearly 25 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2014; Advocated for H.R. 2810, the SGR Repeal and Medicare Beneficiary Access Act of 2013, which would repeal the SGR and transition to a new value-based payment and delivery system; Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). FY2016 Appropriations: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Advocated to federal health agencies that wellness programs must not be used as a means to discriminate against the sick and vulnerable. Wellness programs must be developed to encourage prevention and improve health rather than penalize those who are medically unable to meet wellness program goals; Advocated that employers and health plans should fund programs proven to be effective in reducing obesity, stopping smoking, deterring alcohol abuse, and promoting wellness and providing coverage or subsidies for individuals to participate in such programs. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Essential Health Benefits: Commented on the proposed rule regarding essential benefits, actuarial value, and accreditation as issued by the U.S. Department of Health & Human Services on November 20, 2012; Advocated that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress) Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Tobacco Regulation: Expressed strong opposition to House appropriators to any amendment that would exempt any type of cigar from regulation under the Family Smoking Prevention and Tobacco Control Act, P.L. 111-31, or would impede the rulemaking process the Food and Drug Administration (FDA) has initiated to determine the appropriate level of oversight for tobacco products not currently regulated by the agency; the FDA should retain the authority to regulate all tobacco products, including cigars, and should be permitted to use a science-based process for determining those regulations; Advocated in Aug. 2014 for the Child Nicotine Poisoning Prevention Act of 2014, which gives the U.S. Consumer Product Safety Commission the authority to require the use of child-proof packaging on liquid nicotine containers sold to consumers.

Client expense: $98,691 · Firm income: Not reported

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

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Increase Medicare Fee Schedule payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR formula and move to a new value-based payment and delivery system under Medicare. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 574 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. Advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentives-both non-financial and financial-for engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Advocated for halting the nearly 25 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2014; Advocated for H.R. 2810, the SGR Repeal and Medicare Beneficiary Access Act of 2013, which would repeal the SGR and transition to a new value-based payment and delivery system; Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). FY2016 Appropriations: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Advocated to federal health agencies that wellness programs must not be used as a means to discriminate against the sick and vulnerable. Wellness programs must be developed to encourage prevention and improve health rather than penalize those who are medically unable to meet wellness program goals; Advocated that employers and health plans should fund programs proven to be effective in reducing obesity, stopping smoking, deterring alcohol abuse, and promoting wellness and providing coverage or subsidies for individuals to participate in such programs. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Essential Health Benefits: Commented on the proposed rule regarding essential benefits, actuarial value, and accreditation as issued by the U.S. Department of Health & Human Services on November 20, 2012; Advocated that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress) Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Tobacco Regulation: Expressed strong opposition to House appropriators to any amendment that would exempt any type of cigar from regulation under the Family Smoking Prevention and Tobacco Control Act, P.L. 111-31, or would impede the rulemaking process the Food and Drug Administration (FDA) has initiated to determine the appropriate level of oversight for tobacco products not currently regulated by the agency; the FDA should retain the authority to regulate all tobacco products, including cigars, and should be permitted to use a science-based process for determining those regulations; Advocated in Aug. 2014 for the Child Nicotine Poisoning Prevention Act of 2014, which gives the U.S. Consumer Product Safety Commission the authority to require the use of child-proof packaging on liquid nicotine containers sold to consumers.

Client expense: $205,772 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), President of the U.S., 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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter

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

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

no specific bill - medicare coverage and reimbursement PL 111-148 - The Patient Protection and Affordable Care Act, implementation issues related to diabetes care H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013, SDP renewal H.R. 4302 - Protecting Access to Medicare Act of 2014, SDP renewal

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

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

Average Sales Price (H.R. 800, H.R. 1416, S. 806) PPACA Implementation (PL 111-148) CMS - (Sunshine, AMP and NADAC) SGR (H.R. 2810, S. 1871) Medicare Extenders (H.R. 3402) Centers For Medicare and Medicaid Services (Sunshine, AMP and NADAC)

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, ICD-10

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, White House Office

PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation, Medicare and Medicaid Drug Reimbursement, 340b, Innovation Center H.R. 351/S. 351 - Protecting Seniors' Access to Medicare Act of 2013, IPAB repeal H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), Medicare and Medicaid Drug Reimbursement, Medicaid Rebate, Medicare Part D, Non-Interference, health care reform implementation, AMP, Sunshine, conditions of participation

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation H.R. 351/S. 351 - Protecting Seniors' Access to Medicare Act of 2013 H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), diagnostics, Medicare Physician Reimbursement; reimbursement for imaging and technology; value based purchasing, Accountable Care Organizations, Sunshine Act, bundling, PODs, Cost centers, ICD-10

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

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

Medicare and Medicaid Drug Reimbursement, Medicaid Rebate, Medicare Part D Non-Interference, health care reform, drug implementation, biosimilars, 340B, Sunshine, discount cards PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation H.R. 351/S. 351 - Protecting Seniors' Access to Medicare Act of 2013 H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014

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

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

Implementation of the Patient Protection and Affordable Care Act (PL111-148) H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill, Medicaid data, Medicare and Medicaid reimbursement policies related to health care associated conditions, health care associated infections, readmissions, payment bundling, ACOs, Sunshine, ICD-10, potentially preventable events

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

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

- Medicare coverage and reimbursement, sunshine, diagnostics H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation, care coordination, long-term care HOPE for Alzheimer's Act H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013, SGR H.R. 3547 - the Consolidated Appropriations Act, 2014 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill, Medicare coverage and reimbursement, Medicaid home and community based care, anti-psychotics, risk adjustment, Medicare Special Needs Plans

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation, ESRD, clinical laboratory payment H.R. 351/S. 351 - Protecting Seniors' Access to Medicare Act of 2013, IPAB H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), implementation of QIP and MIPPA ESRD bundling provisions, Medicare Reimbursement, Medicaid Rebate, Medicaid reimbursement, quality indicators, deficit reduction

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation, Medicare and Medicaid Reimbursement, Medicaid Rebate H.R. 351/S. 351 - Protecting Seniors' Access to Medicare Act of 2013, IPAB H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), Medicare and Medicaid Drug Reimbursement, Medicaid Rebate, dual eligibles, Sunshine, discount cards, MedPAC

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation H.R. 351/S. 351 - Protecting Seniors' Access to Medicare Act of 2013, IPAB H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), Medicare Coverage, Regulation and Reimbursement of Imaging Services, Medicare Physician Payment, Sunshine Act, equipment maintenance, dose optimization

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation H.R. 351/S. 351 - Protecting Seniors' Access to Medicare Act of 2013 H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), diagnostics, Medicare Physician Reimbursement; reimbursement for imaging and technology; value based purchasing, Accountable Care Organizations, Sunshine Act, bundling, PODs, Cost centers, ICD-10

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation, Medicare and Medicaid Drug Reimbursement, 340b, Innovation Center H.R. 351/S. 351 - Protecting Seniors' Access to Medicare Act of 2013, IPAB repeal H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), Medicare and Medicaid Drug Reimbursement, Medicaid Rebate, Medicare Part D, Non-Interference, health care reform implementation, AMP, Sunshine, conditions of participation

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

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

Medicare and Medicaid Drug Reimbursement, Medicaid Rebate, Medicare Part D Non-Interference, health care reform, drug implementation, biosimilars, 340B, Sunshine, discount cards PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation H.R. 351/S. 351 - Protecting Seniors' Access to Medicare Act of 2013 H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter

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

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

Average Sales Price (H.R. 800, H.R. 1416, S. 806) PPACA Implementation (PL 111-148) CMS - (Sunshine, AMP and NADAC) SGR (H.R. 2810, S. 1871) Medicare Extenders (H.R. 3402) Centers For Medicare and Medicaid Services (Sunshine, AMP and NADAC)

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

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

no specific bill - medicare coverage and reimbursement PL 111-148 - The Patient Protection and Affordable Care Act, implementation issues related to diabetes care H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013, SDP renewal H.R. 4302 - Protecting Access to Medicare Act of 2014, SDP renewal

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, SGR S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R. 4302 - Protecting Access to Medicare Act of 2014 ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, ICD-10

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, White House Office

H.R. 713/S. 367-Medicare Access to Rehabilitation Services Act (Repeal of Therapy Caps) Payments to Physical Therapists under the Medicare Physician Fee Schedule Permanent Repeal of/alternatives to the Sustainable Growth Rate (SGR) Formula H.R. 574 Medicare Physician Payment Innovation Act Opposition of Multiple Procedure Payment Reduction for PT Services Physician Quality Reporting System H.R. 2914 Promoting Integrity in Medicare Act H.R. 1310 and S. 236 Medicare Patient Empowerment Act Prevention Initiatives for Fraud and Abuse in the Medicare program Accountable Care Organizations/Patient Centered Medical Homes Electronic Health Records/ Health Information Technology incentives for Physical Therapists Development of Alternatives to Medicare Therapy Cap Medicare Payment Reform Local Coverage Determinations NCCI Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage PCORI National Priority for Research and Research Agenda Health Information Technology Medicare Physician Payment Innovation Act Functional Limitation Reporting Therapy Cap: Manual Medical Review Essential Health Benefits Sustainable Growth Rate Reform H.R. 1179/S. 569 Improving Access to Medicare Coverage Act Medicaid Essential Health Benefits EHR/LTPAC Settings: Transitions of Care Medicare Improvement Standards Bundled Payment Models Common assessment tool for Medicare post-acute care Medicare appeals process H.R. 3426 Prevent Interruptions in Physical Therapy Act/S.2818 H.R. 942 and S. 948 Ensuring Access to Quality Complex Rehabilitation Technology H.R. 2810 Medicare Patient Access and Quality Improvement Act Inclusion of physical therapists in quality programs in SGR Reform H.R. 4015 and S.2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014 FTC Anti-competition Self-referral S.1871 SGR Repeal and Medicare Beneficiary Access Act S.2110 Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2157 Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act H.R.4302 Protecting Access to Medicare Act Statement for the record on Ways and Means Health Subcommittee Current Hospital Issues in Medicare H.R. 4755 Access to In-patient Rehabilitation Therapy Act H.R. 4994/S.2553 IMPACT Act Able Act Comments on CY2015 OPPS rule H.R. 5380 Medicare Telehealth Parity Act Comments on draft Fraud & Abuse Legislation Hospital Improvements for Payment Act H.R. 5380 Medicare Telehealth Parity Act

Client expense: $308,338 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

S. 264, H.R. 1263, the Excellence in Mental Health Act H.R. 794, To amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. H.R. 574, the Medicare Physician Payment Innovation Act of 2013 S. 577, H.R. 1201, Training Tomorrows Doctors Today Act S. 236, H.R. 1310, the Medicare Patient Empowerment Act of 2013 H.R. 1331, the Electronic Health Records Improvement Act S. 351, H.R. 351, the Protecting Seniors Access to Medicare Act of 2013 H.R. 297, the Childrens Hospital GME Support Reauthorization Act of 2013 H.R. 2545, the Accuracy in Medicare Physician Payment Act of 2013 S. 1064, Medicare Mental Health Access Act H.R. 2810, the Medicare Patient Access and Quality Improvement Act of 2013 H.R. 3128, the Protect Patients Act of 2013 H.R. 3717, the Helping Families in Mental Health Crisis Act of 2013 H.R. 3662, the Mental Health Access Improvement Act of 2013 H.R. 4302, the Protecting Access to Medicare Act of 2014 H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2110, the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2122, the Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 H.R. 4762, the Medicare Transitional Care Act of 2014 H.R. 5353, the Medicaid Parity Act of 2014 H.R. 5136, the Breaking Addiction Act of 2014 H.R. 5339, the Expanding Opportunities for Recovery Act of 2014 H.R. 5587, the Opioid Abuse Prevention and Treatment Act of 2014 Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models & Other Revisions to Part B for CY 2015 (CMS-2014-0094-2364)

Client expense: $72,153 · Firm income: Not reported

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

S. 153, H.R. 274, the Mental Health First Aid Act of 2013 S. 195, H.R. 628, the Mental Health in Schools Act of 2013 H.R. 1100, the Mental Health on Campus Improvement Act S. 264, H.R. 1263, the Excellence in Mental Health Act H.R. 794, To amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. H.R. 574, the Medicare Physician Payment Innovation Act of 2013 S. 577, H.R. 1201, Training Tomorrows Doctors Today Act S. 236, H.R. 1310, the Medicare Patient Empowerment Act of 2013 H.R. 1331, the Electronic Health Records Improvement Act H.R. 1427, the Truth in Healthcare Marketing Act of 2013 S. 351, H.R. 351, the Protecting Seniors Access to Medicare Act of 2013 S. 265, Community-Based Mental Health Improvements Act S. 648, Helping Educators Support All Students Act S.162, Justice and Mental Health Collaboration Act of 2013; S. 649, Safe Communities, Safe Schools Act of 2013 S. 2461: The CHIP Extension Act of 2014 S. 2728: The Community Based Medical Education Act H.R. 1615, A bill to provide for a study by the Institute of Medicine on gaps in mental health services and how these gaps can increase the risk of violent acts. H.R. 2037, the Native American Psychiatric and Mental Health Care Improvement Act H.R. 2545, the Accuracy in Medicare Physician Payment Act of 2013 S. 1064, Medicare Mental Health Access Act H.R. 2775, No Subsidies Without Verification Act H.R. 2810, the Medicare Patient Access and Quality Improvement Act of 2013 H.R. 3128, the Protect Patients Act of 2013 H.R. 2817, the Protect Patient Access to Quality Health Professionals Act of 2013 H.R. 2734, the Garrett Lee Smith Memorial Act Reauthorization of 2013 H.R. 2910, the Gun Violence Prevention and Reduction Act H.R. 3717, the Helping Families in Mental Health Crisis Act of 2013 H Con Res 69, the Stop Harming Our Kids Resolution of 2013 H.R. 4302, the Protecting Access to Medicare Act of 2014 H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2110, the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 S. 2122, the Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 H.R. 4762, the Medicare Transitional Care Act of 2014 H.R. 4574, the Strengthening Mental Health in Our Communities Act H.R. 4783, the Promoting Healthy Minds for Safer Communities Act H.R. 4581, the Parental Control Act of 2014 H.R. 5353, the Medicaid Parity Act of 2014 H.R. 5136, the Breaking Addiction Act of 2014 H.R. 5587, the Opioid Abuse Prevention and Treatment Act of 2014 H.R. 5339, the Expanding Opportunities for Recovery Act of 2014 H.R. 5364: The CHIP Extension and Improvement Act of 2014

Client expense: $72,153 · Firm income: Not reported

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

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

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

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

Issues related to long-term care providers including S. 501, Fostering Independence through Technology Act H.R.2810, Medicare Patient Access and Quality Improvement Act of 2013 SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013 H.R. 4302, Protecting Access to Medicare Act of 2014 H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R. 1179, Improving Access to Medicare Coverage Act of 2013 S. 569, Improving Access to Medicare Coverage Act of 2013

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

Government targets: Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), 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 2013 H.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: $5,850

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

Medical privacy; general issues. Standards for health care technology and medical devices; general issues. Interoperability of health information and health IT management; general issues. S. 1871 SGR Repeal and Medicare Beneficiary Access Act of 2013; issues related to interoperability of health records, access to CMS data and telemedicine. H.R. 2810 Medicare Patient Access and Quality Improvement Act of 2013; issues related to interoperability of health records, access to CMS data and telemedicine. H.R. 4209 SGR Repeal and Medicare Provider Payment Modernization Act of 2014; issues related to telemedicine, data transparency, and interoperability. H.R. 4870 Defense Appropriation Bill; issues pertaining to electronic health records. H.R. 4486 Military Construction/Veterans Appropriations; issues pertaining to electronic health records.

Client expense: $1,520,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Security Agency (NSA), Office of Science & Technology Policy (OSTP), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA)

General issues regarding government procurement policy. General issues related to IT procurement. Matters surrounding cybersecurity and procurement. General issues regarding information technology procurement, DOD and VA Health Records. Executive Order 13636 Improving Critical Infrastructure Cybersecurity; implementation of entire order. H.R. 2810 Medicare Patient Access and Quality Improvement Act of 2013; issues related to interoperability of health records, CMS data and telemedicine. Cybersecurity Information Sharing Act of 2014 draft bill; entire bill. H.R. 624 Cyber Intelligence Sharing and Protection Act; entire bill. H.R. 4660 and S. 2437 Commerce, Justice, Science and Related Agencies Appropriations Act, 2015; section 515. H.R. 4870 Defense Appropriation Bill; issues pertaining to electronic health records. H.R. 4486 Military Construction/Veterans Appropriations; issues pertaining to electronic health records.

Client expense: $1,520,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Security Agency (NSA), Office of Science & Technology Policy (OSTP), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA)

Implementation of the Patient Protection and Affordable Care Act (PL 111-148) and the Health Care and Education Reconciliation Act (PL 111-152) Medicare and Medicaid reimbursement policies related to healthcare associated conditions, healthcare associated infections, readmission, payment bundling, and potentially preventable events. Comparative effectiveness research and policies Accountable Care Organizations (ACO) Policy Competitive Bidding Policy Regulations and legislation related to the Adoption of International Classification of Diseases, version 10 (ICD-10) Implementation of the Physician Payments Sunshine Act (PL 111-152, Section 6002) Implementation of the Food and Drug Administration Safety and Innovation Act (FDASIA) User Fee Program H.R.523-Protect Medical Innovation Act of 2013 S.232 - Medical Device Access and Innovation Protection Act Klobuchar / Hatch amendment #297 to S. Con. Res 8, the Senate FY 2014 Budget Resolution to support repeal of the medical device tax H.R.1701 / S.972 - Cutting Costly Codes Act H.R.2810 - Medicare Patient Access and Quality Improvement Act S.1871 - SGR Repeal and Medicare Beneficiary Access Act H.R.4302 - Protecting Access to Medicare Act H.R.5823 - Incentivizing Healthcare Quality Outcomes Act of 2014

Client expense: $1,500,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Federal Highway Administration (FHA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), SENATE, Securities & Exchange Commission (SEC), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. International Trade Commission (ITC), U.S. Trade Representative (USTR)

Implementation of the Patient Protection and Affordable Care Act (PL 111-148) and the Health Care and Education Reconcilation Act (PL 111-152) Medicare and Medicaid reimbursement policies related to healthcare associated conditions, healthcare associated infections, readmissions, payment bundling, and potentially preventable events. Comparative effectiveness research and policies Accountable Care Organizations (ACO) Policy Competitive Bidding Policy Regulations and legislation related to the Adoption of International Classification of Diseases, version 10 (ICD-10) Implementation of the Physician Payments Sunshine Act (PL 111-152, Section 6002) H.R.1701 / S.972 - Cutting Costly Codes Act H.R.2810 - Medicare Patient Access and Quality Improvement Act S.1871 - SGR Repeal and Medicare Beneficiary Access Act H.R.4302 - Protecting Access to Medicare Act H.R.5823 - Incentivizing Healthcare Quality Outcomes Act of 2014

Client expense: $1,500,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Federal Highway Administration (FHA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), SENATE, Securities & Exchange Commission (SEC), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. International Trade Commission (ITC), U.S. Trade Representative (USTR)

Issues related to hospitals, healthcare systems and Medicare/Medicaid payments ACA Implementation Issues H.R. 297, Children's Hospital GME Support Reauthorization Act of 2013/S. 1557 H.R. 2810 Medicare Patient Access and Quality Improvement Act of 2013 SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013 Proposals related to the Sustainable Growth Rate Issues related to teh 340B Program Telehealth Issues UNOS Liver Transplant Process Reform Implementation of healthcare reform generally pertaining to pediatric healthcare and autism services Medicaid program reforms S. 1557 (Children's Hospital GME Support Reauthorization Act of 2013), all provisions H.R. 4631 and S. 2449 (Autism CARES Act of 2014), all provisions H.R. 4930 (ACE Kids Act of 2014), all provisions

Client expense: $103,387 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), 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 2013 H.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: $120,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

H.R. 2810, SGR Repeal and Medicare Beneficiary Improvement Act of 2013 S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013 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 SOR Repeal and Beneficiary Access Improvement Act of 2014 H.R. 763, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act S. 603, Jobs and Premium Protection Act H.R. 1960, National Defense Authorization Act for Fiscal Year 2014 S. 1034, National Defense Authorization Act for Fiscal Year 2014 H.J.RES.5, Proposing an amendment to the Constitution of the United States relative to balancing the budget S. 2173, CHOICE Act, to amend the Patient Protection and Affordable Care Act to provide a permanent path for the direct enrollment of individuals in qualified health plans S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R. 3367, To amend section 9010 of the Patient Protection and Affordable Care Act to delay the application of the health insurance provider annual fee until 2016 and to provide a process to return to consumers any amounts attributable to the expected application of the annual fee to 2014 or 2015 H.R. 430, The Protecting Access to Medicare Act

Client expense: $128,894 · Firm income: Not reported

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

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill. HR 1281, Newborn Screening Saves lives Reauthorization Act, Supporting parent and provider newborn screening education programs and research at NIH. HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill. HR 1281, Newborn Screening Saves lives Reauthorization Act, Supporting parent and provider newborn screening education programs and research at NIH. HR 2642, 5-year Farm Bill, FDA, tobacco regulation and nutrition programs. HR 2810, Repeal of Medicare SGR formula, Repeal of SGR to be replaced by a positive payment update and higher rate for primary care, Medicare Physician Payment rate and implementation of alternative payment models. HR 3547, Promoting Teaching Health Centers, AHRQ, Title VII primary care grants and NHSC appropriations, AAFP budget priorities, Title VII Sec 747, Teaching Health Center grants, NHSC, AHRQ. HR 4302 (SGR patch legislation), Advocate for inclusion of policies that benefit primary care, e.g. 9-month length. HR 4302, Protecting Access to Medicare Act, Medicare physician payment rate extended for one year. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1871, SGR Repeal and Medicare Beneficiary Access, Medicare Physician Payment rate and implementation of alternative payment models. S. 1978, Increasing Primary Care Access Act, Family physician workforce. S. 2000, SGR repeal and Medicare provider Payment Modernization, Medicare Physician Payment rate and implementation of alternative payment models. S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. S. 2157, the commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014; advocate for members to mention at E&C hearing. No Bill Number, Telemedicine, educate staff on AAFP's view of telemedicine policies. No Bill Number, Rural physician workforce, Access to care in rural areas; Increased family physician workforce. No Bill Number, Call for an end to sequestration, End accross-the-board cuts to Medicare, NHSC, CHC, primary care research and training. No Bill Number, AHRQ 15th anniversary, Promoting primary care research. No Bill Number, President's FY 2015 budget, Federal spending prioritiesto support workforce, research. No Bill Number, AHEC Title VII section 751 program, Family physician workforce. No Bill Number, Coalition meetings to promote Medicaid parity payment, extend Medicaid parity for primary care. No Bill Number, HRSA budget, promoting health care access and increase physician workforce. No Bill Number, Medicare physician payment reform of the SGR, 2014 conversion factor. No Bill Number, E-Cigarettes, Urge FDA to regulate all tobacco products. No Bill Number, Graduate Medical Education, Nominate FP's to Council on GME. No Bill Number, Health insurance marketplaces, concerns with 90-day grace period. No Bill Number, Anti-competitive aspects of healthcare, FTC hearing and request for comments on professional regulations role. No Bill Number, Part D formularies, Opposed CMS changes to Part D formularies. No Bill Number, Nomination of Dr. Vivek Murthy for Surgeon General. No Bill Number, Tobacco Cessation Programs, Asking HHS to clearly define a comprehensive tobacco cessation benefit in health insurance coverage. No Bill Number, FY 2015 Federal Budget Proposal, Supporting budget proposals for primary care research, education and training programs. No Bill Number, Competition in Health Care Industries, Recommending state oversight in health care scope of practice and FTC oversight of hospital and insurance consolidations. No Bill Number, Notification of Lapsed Payment of Health Care Insurance Premiums, Revising policy to have insurance plans notify physicians that a patient has not paid on-month's premium. No Bill Number, Primary Care Incentive Payment Revision, Monitoring MedPac recommendation to make PCIP a capitated payment. No Bill Number, First Fridays Meetings, Provider outreach group for Affordable Care Act issues. No Bill Number, FTC Healthcare Competition Workshop, Scope of Practice issues. No Bill Number, Hearing of Energy and Commerce Subcommittee on Oversight and Investigations, Implementation of the Affordable Care Act's Health Insurance Marketplaces. No Bill Number, Energy and Commerce Health Subcommittee Hearing on drug shortages, reducing the incidence of local and regional shortage of drugs. No Bill Number, Energy and Commerce Subcommittee on Oversight and Investigations - Hearing on Counterfeit drugs. No Bill Number, Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade - hearing on Sports safety.

Client expense: $629,961 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, Small Business Administration (SBA), White House Office

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill; urge W&M offices to discuss during March 2014 budget hearing. HR 2810, Repeal of Medicare SGR formula, Repeal of SGR to be replaced by a positive payment update and higher rate for primary care. Medicare Patient Access and Quality Improvement Act, Medicare Physician paymnent rate and implementation of alternative payment models. HR 4302 (SGR patch legislation), Advocate for inclusion of policies that benefit primary care, e.g. 9-month length, Protecting Access to Medicare Act, prevent 24 percent cut medicare physician payment. HR 4302 (PL-113-93), Protecting Access to Medicare Act, Medicare physician payment rate extended for one year. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1871, SGR Repeal and Medicare Beneficiary Access, Medicare Physician Payment rate and implementation of alternative payment models. S. 2000, Repeal Medicare Sustainable Growth Rate, Repeal SGR. Positive update and higher rate for primary care, Medicare Physician Payment rate and implementation of alternative payment models. S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. S. 2157, the commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014. No Bill Number, Call for an end to sequestration, End accross-the-board cuts to Medicare, NHSC, CHC, primary care research and training. No Bill Number, AHRQ 15th anniversary, Promoting primary care research. No Bill Number, President's FY 2015 budget, Federal spending priorities to support workforce, research; Supporting budget proposals for primary care research, education and training programs. No Bill Number, Coalition meetings to promote Medicaid parity payment, extend Medicaid parity for primary care. No Bill Number, AHEC Title VII section 751 program, Family physician workforce. No Bill Number, Medicare physician payment reform of the SGR, 2014 Proposed Medicare physician fee schedule. No Bill Number, Conversion to ICD-10, Urged HHS to delay and test ICD-10 before requiring it. No Bill Number, Medicare Part-D Formulary, Opposing regulation that would eliminate protected statuys of antidepressants and antipsychotics in the Part D formulary. No Bill Number, Notification of Lapsed Payment of Health Insurance Premiums, Revising policy to have insurance plans notify physicians that a patient has not paid one month's permium. No Bill Number, Primary Care Incentive Payment Revision, Monitoring MedPAC recommendation to make PCIP a capitated payment. No Bill Number, Extend Medicare/medicare parity for primary care services, Extend increase in Medicaid payments for primary care services to Medicare levels beyond 2015. No Bill Number, Coalition meetings to promote Medicaid parity payment, Extend Medicaid parity for primary care. No Bill Number, Hearing of Energy and Commerce Subcommittee on Oversight and Investigations, Implementation of the Affordable Care Act's health Insurance Marketplaces. No Bill Number, Rural Physician Workforce, Access to care in rural areas; increased family physician workforce.

Client expense: $629,961 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, Small Business Administration (SBA), White House Office

Medicare Reforms: Medicare A & B; Delivery System Reforms, Benefit Restructuring ; Medigap first-dollar coverage; Quality Initiatives/SGR Reform, HIPAA Code Adoption Process, Medicare Advantage Risk Delay Part D Cuts, HR 2810 Introduced by Burgess (R-TX) on July 31, 2013 HR 3392 Introduced October 13, 2013 by Gus Bilirakis (R-FL) To amend title XVIII of the Social Security Act to provide for a PDP safety program to prevent fraud and abuse in the dispensing of controlled substances under part D of the Medicare program, and for other purposes. Multi-State Plan Programs, Medicare Patient Access and Quality Improvement Act of 2013, Medicare Prescription Drug Integrity. Medicare fraud; Provider terminations in Medicare Advantage; CHIP (Children's Health Insurance Program) reauthorization HR 4160 Introduced March 6, 2014 by Renee Ellmers (R-NC) Keep the Promise to Seniors Act of 2014 - Prohibits the Secretary of Health and Human Services (HHS) from taking any action (through promulgation of a final or interim final regulation, issuance of regulatory or program guidance, use of federal payment audit procedures, or other enforcement or administrative action, policy, or practice) to implement any provision of the proposed regulation (relating to policy and technical changes to the MedicareAdvantage and part D programs under Medicare) published in the Federal Register on January 10, 2014, insofar as that regulation relates to part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act (SSA), including its application to MedicareAdvantage- Prescription Drug (MA-PD) plans under part C (Medicare+Choice Program). HR 4930 Introduced June 20, 2014 by Joe Barton (R-TX) Advancing Care for Exceptional Kids Act of 2014 or the ACE Kids Act of 2014 - Amends titles XIX (Medicaid) and XXI (Children's Health Insurance) (CHIP) of the Social Security Act to extend medical assistance to payment for items and services furnished under a Medicaid Children's Care Coordination (MCCC) Program which the state may elect to provide to eligible children with complex medical conditions HR 4577 Introduced May 6, 2014 by H. Griffith (R-VA) Ensuring Seniors Access to Local Pharmacies Act of 2014 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act with respect to a prescription drug plan that has, in its network of pharmacies, one or more pharmacies located in a health professional shortage area, in a medically underserved area, or among a medically underserved population, and that provides a reduction in coinsurance or copayments for covered part D drugs dispensed through them. Declares that such a plan shall extend to any pharmacy located in that area or among that population the option to be an in-network pharmacy with respect to such plan under terms and conditions comparable to those the plan has agreed upon with other in-network pharmacies located in the area or among that population. HR 2960 Introduced August 1, 2013 by Frank Pallone (D-NJ) Medicare Prescription Drug Integrity Act of 2013 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act (SSA) to require a prescription drug plan (PDP) sponsor to have in place procedures designed to prevent fraud and abuse in PDPs. HR 5083 Introduced July 11, 2014 by Renee Ellmers (R-NC) Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a Medicare Administrative Contractor Payment Outreach and Education Program for DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies) suppliers HR 5010 Introduced June 26, 2014 by Jackie Speier (D-CA) To provide greater clarity in the regulation of electronic nicotine delivery systems, including electronic cigarettes, cigars, cigarillos, pipes, and hookahs, and for other purposes. as introduced. HR 5460 Introduced September 11, 2014 by Greg Walden (R-OR) To amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program. as introduced. HR 5547 Introduced September 18, 2014 by Matthew Cartwright (D-PA) To ensure that Medicaid beneficiaries have the opportunity to receive care in a home and community-based setting HR 5558 Introduced September 18, 2014 by Diane Black (R-TN) To amend title XVIII of the Social Security Act to improve the Medicare accountable care organization (ACO) program, and for other purposes HR 4494 Introduced June 26, 2014 by Dave Camp (R-MI) Improving Medicare Post-Acute Care Transformation Act of 2014 or the IMPACT Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to provide for standardized post-acute care assessment data for quality, payment, and discharge planning, and for other purposes. HR 2925 Introduced August 1, 2013 by Kevin Brady (R-TX) Strengthening Medicare Anti-Fraud Measures Act of 2013 - Amends title XI of the Social Security Act to authorize the Secretary of Health and Human Services (HHS) to exclude from participation in any federal health care program entities affiliated with a sanctioned entity, as well as any officer or managing employee of an affiliated entity (currently, only individuals with an ownership or control interest in a sanctioned entity), if the affiliated entity was so affiliated at the time of any of the conduct forming the basis for the conviction or exclusion of the sanctioned entity.

Client expense: $1,870,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office