SGR Repeal and Medicare Provider Payment Modernization Act of 2014

Lobbied on issues relating to Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program and Early Head Start (EHS) programs. Monitored, and actively lobbied on these issues as related to Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015 and followed the House process. H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014 Monitored H.Con.Res. 96, Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.4015 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014

Client expense: Not reported · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

H.R.1893 - Keeping All Students Safe Act H.R.4015 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014

Client expense: Not reported · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

H.R.5059 - Clay Hunt SAV Act H.R.4015 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R.1893 - Keeping All Students Safe Act H.R.1211 - Mental Health in Schools Act of 2015

Client expense: Not reported · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

Rural health reimbursement; Medicare reimbursement; TRICARE; H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014; and H.R. 4302, the Protecting Access to Medicare Act of 2014; H.R.I. Medicare Access and CHIP Reauthorization Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, 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

TRICARE/Medicare equity. HR 2953, HR 4015, S 2000

Client expense: $523,000 · Firm income: Not reported

Government targets: Air Force, Dept of, Army, Dept of (Corps of Engineers), Army, Dept of (Other), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Congressional Budget Office (CBO), Defense Commissary Agency, Defense Finance & Accounting Service (DFAS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Guard, Natl Oceanic & Atmospheric Administration (NOAA), Navy, Dept of, Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Secretary of Defense, SENATE, Transportation Security Administration (TSA), U.S. Coast Guard (USCG), U.S. Marines, Veterans Affairs, Dept of (VA), Veterans Employment & Training Service

HR 4015/S 2000 SGR Repeal and Medicare Provider Payment Modernization Act of 2014

Client expense: $9,347 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 2000/HR 4015: SGR Repeal and Medicare Provider Payment Modernization Act of 2014. NETWORK supports these bills. The bill would protect doctors who serve Medicare patients from a cut to their payment rate. This is particularly important for rural doctors whose costs are considerably higher.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), SENATE, State, Dept of (DOS), Treasury, Dept of, White House Office

H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) - MA special needs plans H.R. 4998, MA Participant Bill of Rights Act (DeLauro) - MA plan provider networks H.R. 5113, Protecting Seniors' Medicare Choices from Obamacare Act (Coffman) - MA stabilization program H.R. 5183, Value Based Insurance Design for Better Care Act (Black) - MA demonstration to test VBID methodologies H.R. 5364, CHIP Extension and Improvement Act (Pallone) - federal CHIP funding Draft Bill, Protecting the Integrity of Medicare Act (Brady) - preventing fraud in Medicare and Medicaid S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues S. 25 (Hatch) - extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal S. 2361, Stop SCAMS Act (Nelson-Collins) - reducing Medicare fraud S. 2461, CHIP Extension Act (Rockefeller) --- federal CHIP funding S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) - MA plan provider networks S. 2783, Value Based Insurance Design for Better Care Act (Thune) - MA demonstration to test VBID methodologies Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.

Client expense: $2,010,000 · 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), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office

Minimium Essential Coverage Provisions under the ACA Implementation/Expansion of CDC Falls Programs Direct Access under FEHBP Implementation of Affordable Care Act - provisions pertaining to Essential Health Benefits and Health Insurance Exchanges AHRQ provisions pertaining to PT H.R. 1427 Truth in Health Care Marketing Act H.R. 1098 TBI Reauthorization Act H.R. 3113 and S. 1516 ConTACT Act H.R. 3352 and S. 1546 Protecting Student Athletes from Concussions Act H.R. 3334 Medicare Adult Day Services Act H.R. 3221 Adult Day Center Enhancement Act H.R. 2817 Protect Patient Access to Quality Health Professionals Act H.R. 702 Access to Frontline Healthcare Act H.R. 3391 Indian Health Service Health Professionals Tax Fairness Act SGR Repeal or extension Physician Self-referral, S2110 H.R. 4015 and S.2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S.2115 American Cures Act H.R. 3877 Lymphadema Treatment Act White House Healthy Kids and Safe Sports Concussion Summit Health Information Technology Nominations to PCORI Methedology Committees Comments on GAO report on physician self-referral for physical therapy services CRPD Treaty S.2888 Excercise & Fitness for All 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

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

HR 4015/S 2000 SGR Repeal and Medicare Provider Payment Modernization Act of 2014.

Client expense: $36,316 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), 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

Issues related to Medicaid Reform 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. 4302, Protecting Access to Medicare Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), 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

S. 1759 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. S. 2110 (HR 4015)- Medicare Sustainable Growth Rate: SGR Releal. Meicare reform to raise primary care payment. S. 2694 - Ensuring Access to Primary Care for Women and Children Act: Extending for 2 years the requirement that Medicaid programs pay primary care physicians at least as much as Medicare Does; Advocate for extension of Medicaid parity which expires at the end of 2014; Urge senators to co-sponsor S. 2694. S. 2978 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. S. 2229 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. No Bill Number - Oppose cuts to pre-resident payment for Teaching Health Center GME: Maintain the sustainability of the THCGME program. No Bill Number - Repeal Medicare Sustainable Growth Rate: Repeal SGR. Positive update and higher rate for Primary Care. No Bill Number - Medicare EHR incentive payments: Concerns over attestation process. No Bill Number - Medicare Advance Care Planning - Urge CMS to cover CPT codes for ACP services. No Bill Number - Medicare Physician Payment: Comments on 2015 final payments. No Bill Number - Teaching Health Centers Funding - Opposing reductions in per-resident payments to teaching health centers. No Bill Number - Medicare Evidence Development and Coverage Advisory Committee: Offering names of family physicians who could serve on the committee. No Bill Number - Children's Health Insurance Program - Supporting reauthorization of the Children's Health Insurance Program.

Client expense: $514,251 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, Veterans Affairs, Dept of (VA)

HR 4015, S 2000 - SGR Repeal and Medicare Provider Payment Modernization Act - Repeals SGR formula and establishes new physician payment update system.

Client expense: $277,572 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Implementation of the Medicare Improvements for Patients and Providers Act of 2008, reimbursement for home oxygen therapy. CMS regulations concerning the DMEPOS Competitive Bidding program, inhalation drugs and sleep disorder therapies. Regulatory issues related to Medicare inhalation drug Therapies and oxygen reimbursement, provider enrollment standards, DME Competitive Bidding, CPAP coverage & reimbursement, program integrity.P.L. 112-240, the American Taxpayer Relief Act of 2012 - Potential offsets to nullify Medicare physician payment cuts related to respiratory therapy services. S.2000 - The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 - Medicare DME reimbursement issues. H.R.4015 -The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 - Medicare DME reimbursement issues. Public Law 113-93 - The Protecting Access to Medicare Act of 2014 - Medicare DME reimbursement issues. Participated in discussions with HHS/CMS staff and congressional staff on audit activities and settlement of appeals. Participated in discussions with congressional and HHS/CMS staff about prior authorization and prospective payment reforms affecting DME suppliers. Participated in discussions with HHS/CMS staff concerning Medicare reimbursement for home based International Normalized Ratio (INR) monitoring services.

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

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

Implementation of H.R. 3590-The Patient Protection and Affordable Care Act. Title X, Sec. 10104 (3) Treatment of Qualified Direct Primary Care Medical Home Plans. Title III-Improving the Quality and Efficiency of Health Care; S. 1031/H.R. 2194 The Family Retirement and Health Reinvestment Act of 2013, Sections 116, 203; S. 2000, H.R. 4015 The SGR Repeal and Medicare Provider Payment Modernization Act of 2014.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), Medicare Payment Advisory Commission (MedPAC), Office of Science & Technology Policy (OSTP), SENATE

Implementation of P.L. 111-148, The Patient Protection and Affordable Care Act; Title III-Improving the Quality and Efficiency of Health care; S. 454/H.R. 962, The Medicare Diabetes Prevention Act of 2013; S. 351/H.R. 351, Protecting Seniors Access to Medicare Act of 2013; H.R. 241/S. 1184, Treat and Reduce Obesity Act- All provisions; H.R. 4015/S.2000, The SGR Repeal and Medicare Provider Payment Modernization Act of 2014, all provisions.

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

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

Implementation of H.R. 3590- The Patient Protection and Affordable Care Act, Title X., Sec. 10104 (3) Treatment of Qualified Direct Primary Care Medical Home Plans, Title III - Improving the Quality and Efficiency of Health Care; S. 1031/H.R. 2194 The Family Retirement and Health Reinvestment Act of 2013, Sections 116, 203; S. 2000, H.R. 4015 The SGR Repeal and Medicare Provider Payment Modernization Act of 2014.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), Office of Science & Technology Policy (OSTP), SENATE

Implementation of H.R. 3590, the Patient Protection and Affordable Care Act Sections (P.L. 111-148) Title III- Improving the Quality and Efficiency of Health Care, and H.R. 3590 provisions relating to Health Information Technology; Implementation of The American Recover and Reinvestment Act of 2009, P.L. 111-15) Title XIII the Health Information Technology Act of 2013, all provisions; H.R. 4015/S.2000 SGR Repeal and Medicare Provider Payment Modernization Act of 2014, all provisions, H.R. 3303, The Software Act, all provisions.

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

HR 4015/S 2000 SGR Repeal and Medicare Provider Payment Modernization Act of 2014

Client expense: $10,098 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4015/S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Legislation to repeal and replace Medicare's sustainable growth rate (SGR) payment system.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4015/S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Legislation to repeal and replace Medicare's sustainable growth rate (SGR) payment system.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S 367/HR 713 - Medicare Access to Rehabilitation Services Act: Advocate for removal of cap on occupational therapy services and passage. HR 942/S 948 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013: Advocate for inclusion of occupational therapy professionals as providers of complex rehabilitation technology. No bill# - Educate about role of occupational therapy in primary care. HR 2810 - The Medicare Patient Access and Quality Improvement Act of 2013: Advocated regarding sustainable growth rate and educate about the role of occupational therapy in health care and need for improving Medicare to assure that patients receive appropriate care, especially occupational therapy services, and that payment is fair and equitable. No bill# - Multiple Procedure Payment Reduction (MPPR): Advocate the separation of occupational therapy from physical therapy/speech language pathology in application of MPPR policy. No bill# - Manual Medicare Review (MMR: Advocate for improved MMR procedures including electronic submission and 10 day turn around. S 1871/S 2110 - the Sustainable Growth Rate (SGR) Repeal and Medicare Beneficiary Access Improvement Act of 2013 AND HR 4015/S 2000 - SGR Repeal and Medicare Provider payment Modernization Act of 2014: Advocated for improvements to the bills that address policies that pertain to beneficiaries' access to occupational therapy services and how occupational therapy services are reimbursed under the Medicare program. Advocate for repeal of the Medicare Part B outpatient therapy cap on occupational therapy services. HR 3749 - The Medicare Demonstration of Coverage for Low Vision Devices Act: Support for greater attention to low vision coverage and highlight role of occupational therapy in ensuring the devices are utilized properly and to their full potential. S 1932/HR 3890 - Better Care, Lower Cost Act: Educate about role of occupational therapy in helping people with chronic conditions. Support including occupational therapy in the chronic care innovation centers. HR 4994/S 2553 0 The Improving Medicare post-Acute Care transformation Act of 2014 "IMPACT Act of 2014": Advocated for improvements in the bill that would help ensure Medicare beneficiaries' access to quality post-acute care in the right setting is preserved. Advocated to ensure data collection program includes elements that reflect the contributions of occupational therapy across the various post-acute settings. HR 5380 - Medicare Telehealth Parity Act: Support passage and inclusion of occupational therapy services. HR 3306 - The Telehealth Enhancement Act of 2013: educate about how occupational therapy can be utilized in telehealth. HR 3877 - Lymphedema Treatment Act: Support passage and educate about role of occupational therapy services. No. bill# (PL 113-93) - Advocate for inclusion of occupational therapy in the Excellence in Mental Health Act's Medicaid Demonstration by encouraging Members of Congress to send a letter of support to the Substance Abuse and Mental Health Administration. HR 5547/S 2515 - Community Integration Act: Discussed Act's aims to strengthen Medicaid beneficiaries' opportunities to receive home and community-based services. Met with staff from the Health Resources and Services Administration (HRSA), including Dr. Marcia Brand, HRSA Deputy Administrator, along with other representatives of allied health professionals, to discuss recent restructuring of HRSA that appears to deemphasize allied health professions and lack of funding for allied health training programs. Also discussed the need to clearly define "allied health professionals" both for existing policies and new programs being developed at the Centers for Medicare and Medicaid Innovation; and the role of allied health professionals in the changing health care landscape.

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

S. 1759 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. S. 2110 (HR 4015)- Medicare Sustainable Growth Rate: SGR Releal. Meicare reform to raise primary care payment. S. 2694 - Ensuring Access to Primary Care for Women and Children Act: Extending for 2 years the requirement that Medicaid programs pay primary care physicians at least as much as Medicare Does; Advocate for extension of Medicaid parity which expires at the end of 2014; Urge senators to co-sponsor S. 2694. S. 2978 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. S. 2229 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. No Bill Number - Oppose cuts to pre-resident payment for Teaching Health Center GME: Maintain the sustainability of the THCGME program. No Bill Number - Repeal Medicare Sustainable Growth Rate: Repeal SGR. Positive update and higher rate for Primary Care. No Bill Number - Medicare EHR incentive payments: Concerns over attestation process. No Bill Number - Medicare Advance Care Planning - Urge CMS to cover CPT codes for ACP services. No Bill Number - Medicare Physician Payment: Comments on 2015 final payments. No Bill Number - Teaching Health Centers Funding - Opposing reductions in per-resident payments to teaching health centers. No Bill Number - Medicare Evidence Development and Coverage Advisory Committee: Offering names of family physicians who could serve on the committee. No Bill Number - Children's Health Insurance Program - Supporting reauthorization of the Children's Health Insurance Program.

Client expense: $514,251 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, Veterans Affairs, Dept of (VA)

HR 487, Primary Care Workforce Access Improvement Act; pilot test alternatives to GME payment in order to increase primary care physician training.HR 2415, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. HR 3230, Veterans Access, Choice and Accountablility Act; Support for allowing family physicians to provide health care to veterans paid for by the VHA. HR 4015, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. HR 4292, The Underserved Veterans Access to Healthcare Act; support for primary care residency positionsin VA health system. HR 5481, Health IT-FLEX-IT Act, Urge leadership and member offices to support bill during lame duck session- bill would shorten 2015 reporting period for meaningful use. HR 5498, Primary Care Physician Reentry Act, Facillitate reentry into practice for primary care physicians. HJ Res. 124, the Continuing Resolution; Support for continued funding for Health Professions Grants and other discretionary programs for primary care. S. 1184, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. S. 1759, Reauthorizing Teaching Health Center GME Program, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1932, the Better Care at Lower Cost Act, Support for chronic care management. S. 1978, Reauthorizing Teaching Health Center GME Program, Reauthorize the Teaching Health Centers Graduate Medical Education program; Increasing Primary Care access Act, Family physician workforce. S. 2000, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. S. 2229, Reauthorizing Teaching Health Center GME Program, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 2694, Medicaid Parity for Primary care, including S. 2694, advocate for extension of parity which expires at the end of 2014; urge Senators to co-sponsor S. 2694. S. 2728, Extending and increasing funding for grants to teaching health centers. No Bill Number, Graduate Medical Education, Explain and advocate for AAFP's newly released policy proposals on GME; Support for primary care residency slots in non-hospital; settings. 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, National Health Service Corps trust fund reauthorization, appropriation, NHSC provides scholarships & debt relief as well as physicians for underserved communities. No Bill Number, Patient Safety and Primary Care Research, Patient safety and primary care research at AHRQ. No Bill Number, FY funding increses in AHRQ, Title VII 747, NHSC, Teaching Health Center planning grants, Federal spending priorities to support workforce, research. No Bill Number, Advisory Committee on Training in Primary Care Medicine and Dentistry, Federal spending on primary care medicine training grants. No Bill Number, Increased funding for Title 747, Federal spending on primary care medicine training grants. No Bill Number, Joining Forces Mental Health Convening, mental health care for returning service members & families. No Bill Number, Increased funding for AHRQ, Federal spending on patient safety primary care research. No Bill Number, Ebola Public Health Threat, Family Physician Kent Brantly testified at Senate hearing. No Bill Number, Medicare EHR incentive payments, Concerns over attestation process. No Bill Number, Infection Advisory, Nominated a FP to a panel. No Bill Number, Medicare physician payment, Comments of 2015 proposed payments. No Bill Number, Medicaid advisory panel, Nomiated FPs to MACPAC. No Bill Number, Physician relative value units, Comments on proposed review of RVUs by CMS. No Bill Number, Tobacco delivery devices, Urged FDA to assert authority. No Bill Number, Continuing Medical Education, Urged CMS to not change Open Payment CME policy. No Bill Number, Food Safety Modernization Act, Support for regulation to prevent food-borne illnesses. No Bill Number, Adult Pneumococcal Vaccine, Support for Medicare payment to administer PCV13.No Bill Number, Health Insurance Marketplace Issues & Provider Involvement with Patient Enrollment, Network adequacy,Patient Enrollment in Marketplaces. No Bill Number, E-Cigarettes, Support of FDA proposed rule giving the agency authority to regulate e-cigarettes. No Bill Number, Medicare Physician Payment Proposed Rule; Support for payment strategies that recognize primary care and care coordination.

Client expense: $666,947 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

HR 487, Primary Care Workforce Access Improvement Act, pilot test alternatives to GME payment to increase PCP training.HR 2415, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. HR 5481, Health IT-FLEX-IT Act, Urge leadership and member offices to support bill during lame duck session- bill would shorten 2015 reporting period for meaningful use. HR 4015, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. S. 1184, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. S. 1759, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 1978, Increasing Primary Care Access Act, Family physician workforce, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1932, the Better Care at Lower Cost Act, Support for chronic care management. S. 2000, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. S. 2229, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 2694, Medicaid Parity for Primary care, including S. 2694, advocate for extension of parity which expires at the end of 2014; urge Senators to co-sponsor S. 2694; Ensuring Access to Primary Care for Women and Children Act, Prevent Medicaid primary care physician pay cut; Support for extension of this provision to pay primary care physicians for primary care services; extend increase in Medicaid payments for primary care services to Medicare levels beyond 2015; Seek House companion legislation. S. 2728, Community-based Medical Education Act of 2014, Medicare GME reform and THC GME reauthorization; Extending and increasing funding for grants to teaching health centers. 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, Graduate Medical Education, Explain and advocate for AAFP's newly released policy proposals on GME. No Bill Number, Medicare Graduate Medical Education, Medicare GME Reform. No Bill Number, Medicare EHR incentive payments, Concerns over attestation process. No Bill Number, Medicare physician payment, Comments of 2015 proposed payments. No Bill Number, Medicare Physician Payment Proposed Rule; Support for payment strategies that recognize primary care and care coordination. No Bill Number, Graduate Medical Education, Support for primary care residency slots in non-hospital settings. No Bill Number, Adult Pneumococcal Vaccine, Support for Medicare payment to administer PCV13. No Bill Number, Pharmaceutical Companies' Payments to Physicians; Support for keeping payments for continuing education excluded from reporting. No Bill Number, Meaningful Use of Health Information Technology Requirements, Support for 90-day EHR reporting period for 2015. No Bill Number, Narrow Networks, Support for restricting health plans' ability to disassociate with primary care physicians. No Bill Number, Repeal SGR, Positive update and higher rate for primary care.

Client expense: $666,947 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

HR 4015, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. S. 2000, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems.No Bill Number, Narrow Networks, Support for restricting helath plans' ability to dissassociate with promary care physicians.

Client expense: $666,947 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), 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 offices to sponsor bill; urge W&M offices to discuss during March 2014 budget hearing, GME reform increase primary care physician training, pilot test alternatives to GME payment to increase PCP training.HR 2305, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 2810, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 2867, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 2969, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 3306, Telehealth Enhancement Act, Defining the home base for telehealth reimbursement to incluse family medicine offices. HR 4015, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 4209, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 4302, Medicare Payment Reform, Repeal SGR. Positive update and higher rate for primary care. HR 4418, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 4543, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1123, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1184, Treat and Reduce Obesity Act, Seeking House and Senate cosponsors for obesity legislation. S. 1318, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1759, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 1769, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1871, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1978, Increasing Primary Care Access Act, Family physician workforce, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program, increase family physician workforce. S. 2000, Medicare Payment Reform, Repeal SGR. Positive update and higher rate for primary care. S. 2110, Medicare Payment Reform, Repeal SGR. Positive update and higher rate for primary care. S. 2122, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 2229, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 2415, Seeking House and Senate cosponsors for obesity legislation. 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, Medicare Primary Care Incentive Payment, Urge Ways and Means members to discuss at annual MedPac hearing. No Bill Number, Telemedicine,advocate for AAFP policies to be included in a potential bipartisan telehealth bill. No Bill Number, Medicare Site Neutral Payments; advocate for AAFP policies to be included in conncection with MedPac hearing. 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, Direct Primary Care, Primary care model of retainer-based practice. No Bill Number, Medicare physician payment reform of the SGR, 2014 converstion factor. No Bill Number, Repeal SGR, Positive update and higher rate for primary care.No Bill Number, Site-neutral payment for medical services, Support site-neutral payment by CMS for medical services. No Bill Number, First Fridays Meetings, Provider outreach group for Affordable Care Act, provider and open enrollment issues.

Client expense: $627,558 · Firm income: Not reported

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

S. 1759 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. S. 2110 (HR 4015)- Medicare Sustainable Growth Rate: SGR Releal. Meicare reform to raise primary care payment. S. 2694 - Ensuring Access to Primary Care for Women and Children Act: Extending for 2 years the requirement that Medicaid programs pay primary care physicians at least as much as Medicare Does; Advocate for extension of Medicaid parity which expires at the end of 2014; Urge senators to co-sponsor S. 2694. S. 2978 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. S. 2229 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. No Bill Number - Oppose cuts to pre-resident payment for Teaching Health Center GME: Maintain the sustainability of the THCGME program. No Bill Number - Repeal Medicare Sustainable Growth Rate: Repeal SGR. Positive update and higher rate for Primary Care. No Bill Number - Medicare EHR incentive payments: Concerns over attestation process. No Bill Number - Medicare Advance Care Planning - Urge CMS to cover CPT codes for ACP services. No Bill Number - Medicare Physician Payment: Comments on 2015 final payments. No Bill Number - Teaching Health Centers Funding - Opposing reductions in per-resident payments to teaching health centers. No Bill Number - Medicare Evidence Development and Coverage Advisory Committee: Offering names of family physicians who could serve on the committee. No Bill Number - Children's Health Insurance Program - Supporting reauthorization of the Children's Health Insurance Program.

Client expense: $2,438,717 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, Veterans Affairs, Dept of (VA)

Post-acute care policy. Medicare reimbursement. H.R. 4994, IMPACT Act of 2014. H.R.647, Achieving a Better Life Experience (ABLE) Act of 2014.H.R. 3245, Medicare Home Health Fraud Reduction Act. H.R. 5780, Protecting the Integrity of the Medicare Act of 2014. S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013 H.R.4015 / S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Repeal Medicare Sustainable Growth Rate formula; Monitor implementation, P.L. 111-148; Extend Section 3111, P.L. 111-148; H.R. 4015 / S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act; H.R. 2810, Medicare Patient Access and Quality Improvement Act of 2013; S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013; H.R. 4302, Protecting Access to Medicare Act; H.R. 1416, Cancer Patient Protection Act; H.R. 2305 / S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act; H.R. 5481, To continue the use of a 3-month quarter EHR reporting period for health care providers to demonstrate meaningful use for 2015 under EHR incentive payment programs; H.R. 800, To exclude prompt pay discounts from ASP formula

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

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

Preventing reductions to Medicare physician payment; Reforming the sustainable growth rate formula: "The SGR Repeal and Medicare Provider Payment Modernization Act of 2014" (S 2000/HR 4015); Preventing cuts to Medicare Graduate Medical Education and Disproportionate Share Hospital Payments; Preventing reductions to Hospital Inpatient and Outpatient PPS Payments; Provider reimbursements for end of life care counseling: "Personalize Your Care Act of 2013" (HR 1173); Medicare reimbursements for molecular diagnostics; Medicare coding & reimbursement associated with Screening, Brief Invention and Referral to Treatment; Additional Medicare support for Medicare Graduate Medical Education by expanding Medicare resident limits: "Training Tomorrows Doctors Today Act" (HR 1201), "The Resident Physician Shortage Reduction Act of 2013" (HR 1180), "The Resident Physician Shortage Reduction Act of 2013" (S 577), "Community-Based Medical Education Act of 2014 (S 2728); Allowing nurse practitioners, certified nurse-midwives, and clinical nurse specialists to certify home health services for Medicare patients: "Home Health Care Planning Improvement Act (HR 2504, S 1332); Medicare payment for chronic care: "Better Care, Lower Cost Act of 2014" (S 1932); Medicare payment for short hospital stays: "Two- Midnight Rule Coordination and Improvement Act of 2014" (S 2082); Critical Access Hospital Relief Act (HR 3991/S. 2037); Improving the Medicare hospital readmissions program: "The Establishing Beneficiary Equity in the Hospital Readmission Program Act" (HR 4188); Preventing reductions to the Medicaid program including the provider tax; Improvements to the Medicaid program for medically complex children, "Advancing Care for Exceptional Kids Act of 2014" (HR 4930).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support legislation to eliminate the Independent Payment Advisory Board (S.351, H.R. 351, Protecting Seniors' Access to Medicare Act of 2013). Support legislation to increase residency slots for Graduate Medical Education (H.R. 1201, Training Tomorrow's Doctors Today Act). Lobby in support of legislation to enact a permanent repeal to the Medicare sustainable growth rate (S.2000/H.R. 4015; SGR Repeal and Medicare Provider Payment Modernization Act of 2014 ). Lobby in support of a cap on the amount CMS can decrease payment to physician services in a given year. (related provision included in S.2000/H.R. 4015; SGR Repeal and Medicare Provider Payment Modernization Act of 2014 and H.R. 4302, Protecting Access to Medicare Act). Lobby Congress in opposition to proposed legislation to repeal in-office ancillary and physician services for anatomic pathology services (H.R. 2914, Promoting Integrity in Medicare Act of 2013, FY 15 President's Budget). Lobby Congress on impact of Health Information Technology. Lobby Congress to stop sequestration cuts to Medicare physician payments (Bipartisan Budget Act of 2013). Lobby in support of increased transparency and adequate response time from CMS when setting values for misvalued codes. Oppose legislation allowing non-physician providers direct access to Medicare patients without a referral (H.R. 5304, Audiology Patient Choice Act of 2014). Advocate on issues related to waste, fraud and abuse in Medicare. Lobby in support of legislation to extend the 90 day reporting period for demonstration meaningful use in 2015 (H.R. 5481, Flexibility in Health IT Reporting (Flex-IT) Act) Lobby Congress to rescind or delay policy in the 2015 Final Medicare Physician Fee Schedule Rule to transition 10- and 90-day global period codes to 0-day global period codes in 2017 and 2018. Advocate for adequate and accurate network coverage for dermatologic care within Medicare Advantage and health insurance exchange networks (S. 2552/H.R. 4998, Medicare Advantage Participant Bill of Rights Act of 2014). Lobby Congress on issues related to telemedicine (H.R. 5380, the Medicare Telehealth Parity Act).

Client expense: $307,164 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support legislation to enact medical liability reform (H.R. 1473, the Standard of Care Protection Act). Support inclusion of standard of care provisions similar to H.R. 1473 in S.2000/H.R. 4015.

Client expense: $307,164 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1759 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. S. 2110 (HR 4015)- Medicare Sustainable Growth Rate: SGR Releal. Meicare reform to raise primary care payment. S. 2694 - Ensuring Access to Primary Care for Women and Children Act: Extending for 2 years the requirement that Medicaid programs pay primary care physicians at least as much as Medicare Does; Advocate for extension of Medicaid parity which expires at the end of 2014; Urge senators to co-sponsor S. 2694. S. 2978 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. S. 2229 - Teaching Health Center Reauthorization Act GME program: Teaching Health Centers Graduate Medication Education. No Bill Number - Oppose cuts to pre-resident payment for Teaching Health Center GME: Maintain the sustainability of the THCGME program. No Bill Number - Repeal Medicare Sustainable Growth Rate: Repeal SGR. Positive update and higher rate for Primary Care. No Bill Number - Medicare EHR incentive payments: Concerns over attestation process. No Bill Number - Medicare Advance Care Planning - Urge CMS to cover CPT codes for ACP services. No Bill Number - Medicare Physician Payment: Comments on 2015 final payments. No Bill Number - Teaching Health Centers Funding - Opposing reductions in per-resident payments to teaching health centers. No Bill Number - Medicare Evidence Development and Coverage Advisory Committee: Offering names of family physicians who could serve on the committee. No Bill Number - Children's Health Insurance Program - Supporting reauthorization of the Children's Health Insurance Program.

Client expense: Not reported · Firm income: $2,438,717

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, Veterans Affairs, Dept of (VA)

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013, entire bill 7. S. 740, Medicare Drug Savings Act of 2013, entire bill 8. H.R. 1588, Medicare Drug Savings Act of 2013, entire bill 9. S. 1198, Medicare Fair Share Act of 2013, entire bill 10. H.R. 4015, SGR Repeal and Medicare Provider Modernization Act of 2014, entire bill 11. H.R. 4302, Protecting Access to Medicare Act of 2014, entire bill 12. H.R. 1179, Improving Access to Medicare Coverage Act of 2013, entire bill 13. S. 569, Improving Access to Medicare Coverage Act of 2013, entire bill

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

Implementation of H.R. 3590, the Patient Protection and Affordable Care Act. CMMI Demonstration Program. Medicare Advantage in general. S. 1405, Medicare Ambulance Access Act of 2013. Medicare reimbursements, including reforms on sustainable growth rate. S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013. H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014. H.R. 4302, Protecting Access to Medicare Act of 2014. H.R. 4930, ACE Kids Act of 2014.S. 2082, Two-Midnight Rule Coordination and Improvement Act of 2014. Medicare Part D payment and hospice. H.R. 5460 Medicare Ambulance Access, Fraud Prevention and Reform Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)