Fairness in Health Care Claims, Guidance, and Investigations Act

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

Client expense: $4,370,000 · Firm income: Not reported

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

340B Program - hearings, reports, proposed rules, regulations; H.R.2931 the Fairness in Health Care Claims, Guidance and Investigation Act;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Fairness in Health Care Claims, Guidance, and Investigations Act (H.R. 2931) Hospital Readmission Accuracy and Accountability Act (S. 2501) Protecting access to care in sustainable growth rate (SGR) bill Trauma Relief Access for Universal Medical Assistance Act (H.R. 2660)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B Program - hearings, reports, proposed rules, regulations; H.R.2931 the Fairness in Health Care Claims, Guidance and Investigations Act;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Submitted comments on the Hatch Entitlement Reform in support of the several key reforms proposed for the Medicare program as alternative reductions to provider payments; Support S 351 Protecting Seniors Access to Medicare Act, a bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; Support HR 297 and S1557, Children's Hospital GME Support Reauthorization Act of 2013, the bill would reauthorize the CHGME program foran additional five years through fiscal year (FY) 2017; Support HR 1250 and S 1012 Medicare Audit Improvement Act of 2013, a bill to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Support S. 596 Fostering Independence Through Technology Act of 2014, a bill to establish pilot projects under the Medicare program to provide incentives for home health agencies to furnish remote patient monitoring services that reduce expenditures under such program; Requested the Health Resource and Service Admin (HRSA) to delay the compliance date by at least six months to allow sufficient time for affected hospitals to make the necessary modifications to their existing inventory management practices as required by the new GPO guidance and recommend that HRSA continue to work with affected 340B hospitals to provide guidance and education on the GPO compliance issues.; Discussion of the Medicaid ACA implementation --DSH, expansion, eligibility at CMS; Discussion of the implementation of the American Taxpayer Relief Act (ATRA) specifically, the outpatient therapy provision and extension of the MDH program and enhanced low-volume adjustment at CMS; Urged CMS to to extend the timeline for meaningful use in 2014 and provide greater flexibility in Stage 2; Support HR 1787 and S 842 Rural Hospital Access Act of 2013, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support HR 1920 and S 1555 DSH Reduction Relief Act of 2013, a bill to amend titles XVIII and XIX of the Social Security Act to provide for a delay in the implementation schedule of the reductions in disproportionate share hospital payments; AHA submitted a statement to the Presidents and Other Bipartisan Proposals to Reform Medicare Post-Acute Care Payments hearing to provide input on proposals to reform Medicares post-acute care payment systems; AHA submitted a statement to the Program Integrity: Oversight of Recovery Audit Contractors hearing supporting increased oversight of Recovery Audit Contractors (RACs); Support HR 2578 Rural Hospital Fairness Act of 2013, a bill to amend title XVIII of the Social Security Act to extend for one year the hold harmless provision for small rural hospitals and sole community hospitals under the Medicare prospective payment system for hospital outpatient department services related to enhanced physician supervision requirements; AHA submitted a statement to the Health Care Quality: The Path Forward hearing in support of improving transparency for the public, continuing and enhancing support of efforts to improve the safety and quality of the care delivered, and reduce unnecessary hospital expenditures; Support HR 2931 Fairness in Health Care Claims, Guidance and Investigations Act, a bill to amend the false claims provisions of title 31, United States Code, with respect to health care programs; Request additional guidance on and delay of two-midnight rule from CMS; Request issue corrected data on OPPS proposed rule and delay comment period from CMS; Discussion of ACAs patient safety evaluation system with CMS; Discussed the improvements to the National Practitioner Data Bank and new compliance efforts at HRSA; Discussions of Medicaid presumptive eligibility; Medicaid DSH; and request release of DSH audit rule with CMS; Follow up on GPO exclusion related to 340(b) entities; discussions to help shape upcoming proposed rule on 340B with HRSA; Discussed the Qualified Health Plans (QHP) 90day grace period with HHS and its implications for hospitals; Support HJ Res 59, a continuing Appropriations Resolution for 2014, which includes a provision that averts Medicare physician payment cuts as Congress continues to work on a replacement of the flawed SGR formula; Support HR 3444 Critical Access Hospital Flexibility Act of 2013, to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program; Support H.R.3698 and S. 2037 Two-Midnight Rule Delay Act of 2013, to delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays; Requested CMS and ONC to extend the EHR Incentive program regulatory timelines for 2014 and allow all providers greater flexibility in Stage 2 by giving all hospitals the option to make the transition to the 2014 Edition Certified EHR and the Stage 2 requirements (or the revised Stage 1 requirements, as applicable) over the course of 2014 or 2015; Requested CMS to expedite its ICD-10 testing plans to ensure that testing begins no later than January 2014, be made available to all hospitals and include extensive end-to-end testing by Medicare contractors and state Medicaid agencies of both the electronic transaction and the adjudication of the claim; Support HR 3991 and S 2037 Critical Access Hospital Relief Act of 2014, amends title XVIII (Medicare) of the Social Security Act to repeal the 96-hour physician certification requirement for inpatient critical access hospital services under which a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital; Support HR 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act, to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support H.R. 2801 and S 1143 Protecting Access to Rural Therapy Services (PARTS) Act of 2013, a bill to adopt a default standard of general supervision for outpatient therapeutic services, develop a reasonable exceptions process with provider input to identify specific procedures that require direct supervision, ensure that, for CAHs, the definition of direct supervision is consistent with the CAH conditions of participation that allow a physician or NPP to present within 30 minutes of being called and prohibit enforcement of CMSs retroactive reinterpretation that the direct supervision requirements applied to servicesfurnished since January 1, 2001; S. 1932/H.R. 3890 Better Care, Lower Cost Act , AHA has not taken position on the bill, but did establish an AHA working group to analyze the legislation to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program to provide integrated care for Medicare beneficiaries with chronic conditions.

Building a Health Care Workforce for the Future Act (S. 1152) Fairness in Health Care Claims, Guidance, and Investigations Act (H.R. 2931) Poison Center Network Act (H.R. 3527/S. 1719) Protecting access to care in sustainable growth rate (SGR) bill.Training Tomorrow's Doctors Today Act (H.R. 1201/S. 577) Trauma Relief Access for Universal Medical Assistance Act (H.R. 2660)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Budget Negotiations FY2015 Graduate Medical Education Medicaid Provider Tax: Bad Debt Medicare reform proposalsMedicaid 340(b) Drug Discount Program Medicaid Graduate Medical Education (GME) funding reductions IPAB Repeal SGR-Outpatient HOPD spending cuts/repeal Medicaid Reform Proposals Residency Slot Increases Medicare Audit Improvement Act (H.R.1250; S1012) DSH Reductions Relief Act (H.R.1920) Fairness in Health Care Claims, Guidance and Investigations Act (H.R.2931) CMS implementation of "two midnight" policy regarding patient status Meaningful Use Stage 2 modifications CMS policy on rebilling Medicare Part A claims CR-Debt Ceiling Negotiations (pay-fors related to health care) ICD 10 implementation delay Disaster Preparedness Funding

Client expense: $25,000 · Firm income: Not reported

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

Budget Negotiations FY2015 GME and Medicaid provider tax program GME:Payment Reductions SGR-Outpatient HOPD spending cuts/Repeal Medicare reform proposalsMedicare Physician Payments Patient Protection and Affordability Care Act IPAB Repeal Medicaid Reform Proposals Residency Slot Increases Changes to Medicaid 340 (b) Drug Discount Program Medicare Audit Improvement Act (H.R.1250; S1012) DSH Reductions Relief Act (H.R.1920) Fairness in Health Care Claims, Guidance and Investigations Act (H.R.2931) CMS implementation of "two midnight" policy regarding patient status Meaningful Use Stage 2 modifications CMS policy on rebilling Medicare Part A claims Disaster Preparedness Funding ICD 10 Implementation delay

Client expense: $130,000 · Firm income: Not reported

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

Submitted comments on the Hatch Entitlement Reform in support of the several key reforms proposed for the Medicare program as alternative reductions to provider payments; Support S 351 Protecting Seniors Access to Medicare Act, a bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; Support HR 297 and S1557, Children's Hospital GME Support Reauthorization Act of 2013, the bill would reauthorize the CHGME program foran additional five years through fiscal year (FY) 2017; Support HR 1250 and S 1012 Medicare Audit Improvement Act of 2013, a bill to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Support S. 596 Fostering Independence Through Technology Act of 2014, a bill to establish pilot projects under the Medicare program to provide incentives for home health agencies to furnish remote patient monitoring services that reduce expenditures under such program; Requested the Health Resource and Service Admin (HRSA) to delay the compliance date by at least six months to allow sufficient time for affected hospitals to make the necessary modifications to their existing inventory management practices as required by the new GPO guidance and recommend that HRSA continue to work with affected 340B hospitals to provide guidance and education on the GPO compliance issues.; Discussion of the Medicaid ACA implementation --DSH, expansion, eligibility at CMS; Discussion of the implementation of the American Taxpayer Relief Act (ATRA) specifically, the outpatient therapy provision and extension of the MDH program and enhanced low-volume adjustment at CMS; Urged CMS to allow the second option of reporting given that individual electronic health records (EHRs) or hospitals may not be ready to report inpatient quality reporting (IQR) measures electronically by a date certain of the implementation of the Medicare and Medicaid EHR Incentive Programs with CMS and the Office of the National Coordinator for Health Information Technology (ONC); Support HR 1787 and S 842 Rural Hospital Access Act of 2013, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support HR 1920 and S 1555 DSH Reduction Relief Act of 2013, a bill to amend titles XVIII and XIX of the Social Security Act to provide for a delay in the implementation schedule of the reductions in disproportionate share hospital payments; AHA submitted a statement to the Presidents and Other Bipartisan Proposals to Reform Medicare Post-Acute Care Payments hearing to provide input on proposals to reform Medicares post-acute care payment systems; AHA submitted a statement to the Program Integrity: Oversight of Recovery Audit Contractors hearing supporting increased oversight of Recovery Audit Contractors (RACs); Support HR 2578 Rural Hospital Fairness Act of 2013, a bill to amend title XVIII of the Social Security Act to extend for one year the hold harmless provision for small rural hospitals and sole community hospitals under the Medicare prospective payment system for hospital outpatient department services related to enhanced physician supervision requirements; AHA submitted a statement to the Health Care Quality: The Path Forward hearing in support of improving transparency for the public, continuing and enhancing support of efforts to improve the safety and quality of the care delivered, and reduce unnecessary hospital expenditures; Support HR 2931 Fairness in Health Care Claims, Guidance and Investigations Act, a bill to amend the false claims provisions of title 31, United States Code, with respect to health care programs; Request additional guidance on and delay of two-midnight rule from CMS; Request issue corrected data on OPPS proposed rule and delay comment period from CMS; Discussion of ACAs patient safety evaluation system with CMS; Discussed the improvements to the National Practitioner Data Bank and new compliance efforts at HRSA; Discussions of Medicaid presumptive eligibility; Medicaid DSH; and request release of DSH audit rule with CMS; Follow up on GPO exclusion related to 340(b) entities; discussions to help shape upcoming proposed rule on 340B with HRSA; Discussed the Qualified Health Plans (QHP) 90day grace period with HHS and its implications for hospitals; Support HJ Res 59, a continuing Appropriations Resolution for 2014, which includes a provision that averts Medicare physician payment cuts as Congress continues to work on a replacement of the flawed SGR formula; Support HR 3444 Critical Access Hospital Flexibility Act of 2013, to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program; Support H.R.3698 Two-Midnight Rule Delay Act of 2013, to delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays; Support HR 3717 Helping Families in Mental Health Crisis Act of 2013, the bill focuses programs and resources on psychiatric care for patients and families most in need of services; Support critical access hospital (CAH) 96 hours rule, physicians at (CAHs) must certify a condition of payment, at a hospital within 96 hours after admission to the CAH. Requested CMS and ONC to extend the EHR Incentive program regulatory timelines for 2014 and allow all providers greater flexibility in Stage 2 by giving all hospitals the option to make the transition to the 2014 Edition Certified EHR and the Stage 2 requirements (or the revised Stage 1 requirements, as applicable) over the course of 2014 or 2015; Requested CMS to expedite its ICD-10 testing plans to ensure that testing begins no later than January 2014, be made available to all hospitals and include extensive end-to-end testing by Medicare contractors and state Medicaid agencies of both the electronic transaction and the adjudication of the claim.

Building a Health Care Workforce for the Future Act (S. 1152) Fairness in Health Care Claims, Guidance and Investigations Act (H.R. 2931) Poison Center Network Act (H.R. 3527/S.1719) Training Tomorrows Doctors Today Act (H.R. 1201)Trauma Relief Access for Universal Medical Assistance Act (H.R. 2660)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Budget Negotiations FY2014: Sequestration-GME and Medicaid provider tax program GME:Payment Reductions SGR-Outpatient HOPD spending cuts/Repeal Medicare reform proposalsMedicare Physician Payments Patient Protection and Affordability Care Act IPAB Repeal Medicaid Reform Proposals Residency Slot Increases Changes to Medicaid 340 (b) Drug Discount Program Medicare Audit Improvement Act (H.R.1250; S1012) DSH Reductions Relief Act (H.R.1920) Fairness in Health Care Claims, Guidance and Investigations Act (H.R.2931) CMS implementation of "two midnight" policy regarding patient status Meaningful Use Stage 2 modifications CMS policy on rebilling Medicare Part A claims CR-Debt Ceiling Negotiations (pay-fors related to health care)

Client expense: $130,000 · Firm income: Not reported

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

Budget Negotiations FY2014 Graduate Medical Education Medicaid Provider Tax: Bad Debt Medicare reform proposalsMedicaid 340(b) Drug Discount Program Medicaid Graduate Medical Education (GME) funding reductions IPAB Repeal SGR-Outpatient HOPD spending cuts/repeal Medicaid Reform Proposals Residency Slot Increases Medicare Audit Improvement Act (H.R.1250; S1012) DSH Reductions Relief Act (H.R.1920) Fairness in Health Care Claims, Guidance and Investigations Act (H.R.2931) CMS implementation of "two midnight" policy regarding patient status Meaningful Use Stage 2 modifications CMS policy on rebilling Medicare Part A claims CR-Debt Ceiling Negotiations (pay-fors related to health care)

Client expense: $25,000 · Firm income: Not reported

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

Submitted comments on the Hatch Entitlement Reform in support of the several key reforms proposed for the Medicare program as alternative reductions to provider payments; Support S 351 Protecting Seniors Access to Medicare Act, a bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; Support HR 297, Children's Hospital GME Support Reauthorization Act of 2013, the bill would reauthorize the CHGME program for anadditional five years through fiscal year (FY) 2017; Support HR 1250 and S 1012 Medicare Audit Improvement Act of 2013, a bill to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Support S. 596 Fostering Independence Through Technology Act of 2014, a bill to establish pilot projects under the Medicare program to provide incentives for home health agencies to furnish remote patient monitoring services that reduce expenditures under such program; Requested the Health Resource and Service Admin (HRSA) to delay the compliance date by at least six months to allow sufficient time for affected hospitals to make the necessary modifications to their existing inventory management practices as required by the new GPO guidance and recommend that HRSA continue to work with affected 340B hospitals to provide guidance and education on the GPO compliance issues.; Discussion of the Medicaid ACA implementation --DSH, expansion, eligibility at CMS; Discussion of the implementation of the American Taxpayer Relief Act (ATRA) specifically, the outpatient therapy provision and extension of the MDH program and enhanced low-volume adjustment at CMS; Urged CMS to allow the second option of reporting given that individual electronic health records (EHRs) or hospitals may not be ready to report inpatient quality reporting (IQR) measures electronically by a date certain of the implementation of the Medicare and Medicaid EHR Incentive Programs with CMS and the Office of the National Coordinator for Health Information Technology (ONC); Opposing CMSs proposed rule on Part A to Part B rebilling as too limiting regarding what claims would qualify for rebilling; Support HR 1787 and S 842 Rural Hospital Access Act of 2013, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support HR 1920 and S 1555 DSH Reduction Relief Act of 2013, a bill to amend titles XVIII and XIX of the Social Security Act to provide for a delay in the implementation schedule of the reductions in disproportionate share hospital payments; AHA submitted a statement to the Presidents and Other Bipartisan Proposals to Reform Medicare Post-Acute Care Payments hearing to provide input on proposals to reform Medicares post-acute care payment systems; AHA submitted a statement to the Program Integrity: Oversight of Recovery Audit Contractors hearing supporting increased oversight of Recovery Audit Contractors (RACs); Support HR 2578 Rural Hospital Fairness Act of 2013, a bill to amend title XVIII of the Social Security Act to extend for one year the hold harmless provision for small rural hospitals and sole community hospitals under the Medicare prospective payment system for hospital outpatient department services related to enhanced physician supervision requirements; AHA submitted a statement to the Health Care Quality: The Path Forward hearing in support of improving transparency for the public, continuing and enhancing support of efforts to improve the safety and quality of the care delivered, and reduce unnecessary hospital expenditures; Support HR 2931 Fairness in Health Care Claims, Guidance and Investigations Act, a bill to amend the false claims provisions of title 31, United States Code, with respect to health care programs; Request additional guidance on and delay of two-midnight rule from CMS; Request issue corrected data on OPPS proposed rule and delay comment period from CMS; Discussion of ACAs patient safety evaluation system with CMS; Discussed the improvements to the National Practitioner Data Bank and new compliance efforts at HRSA; Discussions of Medicaid presumptive eligibility; Medicaid DSH; and request release of DSH audit rule with CMS; Follow up on GPO exclusion related to 340(b) entities; discussions to help shape upcoming proposed rule on 340B with HRSA; Discussed the Qualified Health Plans (QHP) 90day grace period with HHS and its implications for hospitals.

H.R. 1250/S. 1012, The Medicare Audit Improvement Act of 2013 H.R. 1920/S. 1555, The DSH Reduction Relief Act H.R. 2810, The Medicare Patient Access and Quality Improvement Act of 2013 H.R. 2801/S. 1143, The Protecting Access to Rural Therapy Services Act of 2013H.R. 2869 Medicare Patient Access to Cancer Treatment Act of 2013 H.R. 2931 Fairness in Health Care Claims, Guidance, and Investigations Act H.J. Res. 59 Continuing Appropriations Resolution, 2014 CMS1448P Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2014, Proposed Rule, (Federal Register Vol. 78, No. 89, May 8, 2013) CMS3255P Medicare and Medicaid Programs; Survey, Certification and Enforcement Procedures, Proposed Rule (Federal Register, Vol. 78, No. 66, April 5, 2013) REG10649912 Community Health Needs Assessments for Charitable Hospitals, Notice of Proposed Rulemaking (Federal Register Vol. 78, No. 66, April 5, 2013) CMS2367P Medicaid Program; State Disproportionate Share Hospital Allotment Reductions, Proposed Rule (Federal Register, Vol. 78, No. 94, May 15, 2013) CMS1601P Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Hospital Value- Based Purchasing Program; Organ Procurement Organizations; Quality Improvement Organizations; Electronic Health Records (EHR) Incentive Program; Provider Reimbursement Determinations and Appeals. Proposed Rule (Federal Register, Vol. 78, No. 139, July 19, 2013) CMS1450P Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014, Home Health Quality Reporting Requirements, and Cost Allocation of Home Health Survey Expenses, Proposed Rule (Federal Register, Vol. 78, No. 128, July 3, 2013) CMS1600P Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule & Other Revisions to Part B for CY 2014, Proposed Rule (Federal Register, Vol. 78, No. 139, July 19, 2013)

Building a Health Care Workforce for the Future Act (S. 1152) Fairness in Health Care Claims, Guidance and Investigations Act (H.R. 2931) Training Tomorrows Doctors Today Act (H.R. 1201) Trauma Relief Access for Universal Medical Assistance Act (H.R. 2660)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Budget Negotiations FY2014: Sequestration-GME and Medicaid provider tax program GME:Medicaid Provider Tax; Bad Debt SGR-Outpatient HOPD spending cuts/Repeal Medicare reform proposalsMedicare Physician Payments Patient Protection and Affordability Care Act IPAB Repeal Medicaid Reform Proposals Residency Slot Increases Changes to Medicaid 340 (b) Drug Discount Program Medicare Audit Improvement Act (H.R.1250; S1012) DSH Reductions Relief Act (H.R.1920) Fairness in Health Care Claims, Guidance and Investigations Act (H.R.2931) CMS implementation of "two midnight" policy regarding patient status Meaningful Use Stage 2 modifications CMS policy on rebilling Medicare Part A claims CR-Debt Ceiling Negotiations (pay-fors related to health care)

Client expense: $145,000 · Firm income: Not reported

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

Budget Negotiations FY2014 Graduate Medical Education Medicaid Provider Tax: Bad Debt Medicare reform proposalsMedicaid 340(b) Drug Discount Program Medicaid Graduate Medical Education (GME) funding reductions IPAB Repeal SGR-Outpatient HOPD spending cuts/repeal Medicaid Reform Proposals Residency Slot Increases Medicare Audit Improvement Act (H.R.1250; S1012) DSH Reductions Relief Act (H.R.1920) Fairness in Health Care Claims, Guidance and Investigations Act (H.R.2931) CMS implementation of "two midnight" policy regarding patient status Meaningful Use Stage 2 modifications CMS policy on rebilling Medicare Part A claims CR-Debt Ceiling Negotiations (pay-fors related to health care)

Client expense: $25,000 · Firm income: Not reported

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