MEND Act

Opposing Medicare and Medicaid Payment reductions, including those to Graduate Medical Education (H.R. 3292, the Medicare IME Pool Act of 2015), bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) payments, CAH payments, IPPS coding offset, rural hospital payments, hospital outpatient department (HOPD) clinics, and sequestration. Support for changes to site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74) Protecting 340B Drug Pricing Program in regulatory and legislative proposals Support for finalizing Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) 2015-2017 Modifications Rule; support for delaying of Stage 3 Rule Urging Release of New York State Medicaid Vital Access Provider Program Funding Support for changes to liver transplant allocation system 21st Century Cures Act (H.R. 6) and Senate HELP Committee provisions related to interoperability and information blocking Urging release of funding for Ebola preparedness and treatment Support for National Institutes of Health funding Support for Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Support for Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Support for Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Support for Protecting Access to Rural Therapies Act (H.R. 1611/S. 257) Support for Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) Support for Flexibility in Health IT Reporting Act of 2015 (H.R. 270) Support for Resident Physician Shortage Reduction Act of 2015 (H.R. 2124/ S. 1148) Support for Medicare Audit Improvement Act of 2015 (H.R. 2156) Support for Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Support for Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Support for Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227)

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

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

21st Century Cures Act (H.R. 6) and Senate HELP Committee provisions related to interoperability and information blocking Urging release of funding for Ebola preparedness and treatment Support for Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Support for Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Support for Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Support for Protecting Access to Rural Therapies Act (H.R. 1611/S. 257) Support for Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) Support for Flexibility in Health IT Reporting Act of 2015 (H.R. 270) Support for Resident Physician Shortage Reduction Act of 2015 (H.R. 2124/ S. 1148) Support for Medicare Audit Improvement Act of 2015 (H.R. 2156) Support for Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Support for Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Support for Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Protecting 340B Drug Pricing Program in regulatory and legislative proposals Opposing Medicare and Medicaid Payment reductions, including those to Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) payments, CAH payments, IPPS coding offset, rural hospital payments, hospital outpatient department (HOPD) clinics, and sequestration. Support for finalizing Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) 2015-2017 Modifications Rule; support for delaying of Stage 3 Rule Urging Release of New York State Medicaid Vital Access Provider Program Funding Support for changes to liver transplant allocation system

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

Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) 21st Century Cures Act (H.R. 6) Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83) Funding for Ebola preparedness and treatment Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Protecting Access to Rural Therapies Act (H.R. 1611/S. 257) Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) Flexibility in Health IT Reporting Act of 2015 (H.R. 270) Resident Physician Shortage Reduction Act of 2015 (H.R. 2124/ S. 1148) Medicare Audit Improvement Act of 2015 (H.R. 2156) Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Medicare physician fee schedule fix Medicare and Medicaid Recovery Audit Contractor (RAC) Programs 340B Drug Pricing Program Funding for National Institutes of Health Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) Payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, hospital outpatient department (HOPD) clinics, and sequestration. Medicare and Medicaid Electronic Health Record Incentive Payment Programs Medicaid, New York State Medicaid Vital Access Provider Program Liver transplant allocation system FFY 2015 Inpatient Prospective Payment System Proposed Rule (CMS-1607-P) - Two-Midnight Policy

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

Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83) Funding for Ebola preparedness and treatment Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) Flexibility in Health IT Reporting Act of 2015 (H.R. 270) Resident Physician Shortage Reduction Act of 2013 (H.R. 1180/ S. 577) Medicare Audit Improvement Act of 2013 (H.R. 1250/ S.1012) Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Medicare physician fee schedule fix Medicare and Medicaid Recovery Audit Contractor (RAC) Programs Funding for National Institutes of Health Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) Payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, hospital outpatient department (HOPD) clinics, and sequestration. Medicare and Medicaid Electronic Health Record Incentive Payment Programs Medicaid, New York State Medicaid Vital Access Provider Program Liver transplant allocation system FFY 2015 Inpatient Prospective Payment System Proposed Rule (CMS-1607-P) - Two-Midnight Policy

Client expense: $220,000 · Firm income: Not reported

Advocated for healthcare improvements within the CRomnibus. Supported delays to supervision requirements for CAH. Supported development of s short stay payment classification. Advocated for RAC reform. Pursued legislation to resolve payment of MEdicaire pass through fudning for hospital based nursing schools (HR 5227).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), SENATE

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

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Promoted fix for SGR physician payment formula, but without cuts to hospital payment. Argued for extension of Medicare Dependent Hospital payment program and elevated Medicaid payment for primary care physicians. Sought co-sponsors for HR 5227, the "Making the Education of Nurses Dependable for Schools Act," which would allow Medicare pass-through funding for separately incorporated nursing colleges. Promoted reauthorization of the State Children's Health Insurance Program.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

Supported improvements to 2-Midnight Rule (HR 3698) and permanent SGR fix. Opposed changes to 340-B drug discount program and APC payment reductions. Advocated for improvement to CAH 96-Hour rule (HR 3991). Supported changes to ensure Medicare pass-though payments to hospital-based nursing schools (HR 5227).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), SENATE

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

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

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

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

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE