Rural Health Clinic Fairness Act of 2013

Medicare regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Medicare regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Regulations dealing with physician ownership of hospitals Medicare Regulations affecting Rural Health ClinicsLegislation affecting Medicare payments for physician owned hospitals The Rural Health Clinic Patient Access Improvement Act Sequester related reductions in physician and hospital payments Payment equalization between physicians offices and hospital outpatient departments H.R. 986 Rural Health Clincis Fairness Act of 2013 Issues involving legislation to repeal/replace the SGR formula

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

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 S. 1355 and H.R. 3986, the Rural Health Clinic Patient Access Improvement Act of 2009 Proposed Regulations affecting Rural Health ClinicsRegulations establishing standards for the meaningful use of electronic health records Provider enrollment (PECOS) in Medicare and the ability to order or refer patients Possible cuts to Medicare bad debt payments for RHCs Sequestration related cuts in RHC payments H.R. 986: Rural Health Clinics Fairness Act o 2013 H.R. 1331: Electronic Health Records Improvement Act S. 562: Seniors Mental health Access Improvement Act of 2013 Proposed Changes in RHC regulations dealing with employment of PAs and NPs Changes to the RHC manual by CMS Medicaid waiver applications submitted by Arkansas and Iowa Legislation to repeal/replace the SGR formula

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

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

Medicare regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Medicare regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Regulations dealing with physician ownership of hospitals Medicare Regulations affecting Rural Health ClinicsLegislation affecting Medicare payments for physician owned hospitals The Rural Health Clinic Patient Access Improvement Act Sequester related reductions in physician and hospital payments Payment equalization between physicians offices and hospital outpatient departments H.R. 986 Rural Health Clincis Fairness Act of 2013

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

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 S. 1355 and H.R. 3986, the Rural Health Clinic Patient Access Improvement Act of 2009 Proposed Regulations affecting Rural Health ClinicsRegulations establishing standards for the meaningful use of electronic health records Provider enrollment (PECOS) in Medicare and the ability to order or refer patients Possible cuts to Medicare bad debt payments for RHCs Sequestration related cuts in RHC payments H.R. 986: Rural Health Clinics Fairness Act o 2013 H.R. 1331: Electronic Health Records Improvement Act S. 562: Seniors Mental health Access Improvement Act of 2013 Proposed Changes in RHC regulations dealing with employment of PAs and NPs Changes to the RHC manual by CMS Medicaid waiver applications submitted by Arkansas and Iowa

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

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

See Next Page for Narrative.CMS design and implementation of Missouris federally-facilitated health insurance exchange (Marketplace); Preventing and Reducing Improper Medicare and Medicaid Expenditures act of 2013; "Dear Colleague" letter by Congresswoman Jenkins (R-KS) regarding Medicare payments for inpatient rehabilitation services Regulatory standards to create a grace period for the payment of premiums for coverage in a federally-facilitated exchange or qualified health plans; EHR incentives for Rural Health Clinics regarding H.R. 986, the Rural Clinic Fairness Act; Hospital financial performance metrics and trends; Medicare sustainable growth rate formula for determining payments for physician services under the Medicare program; Promote H.R. 1250 and S. 1012, regarding accountability standards for Medicare Recovery Audit Contractors and other program integrity initiatives; Ooppose the DHHS OIGs recommendations for changes in standards for designating critical access hospitals; Promote S. 183 and H.R. 2053, concerning repeal of section 3141 of the Patient Protection and Affordable Care Act of 2010; Oppose legislative proposals to restrict states ability to use provider taxes to fund their Medicaid programs; Promote reauthorization for an additional year of the Medicare Dependent Hospital program; Oppose legislative efforts to limit the scope of the 340B program, which authorizes price discounts on the purchase of pharmaceuticals by designated safety net providers and make them aware of CMS regulatory actions regarding a grace period for the payment of premiums for coverage in a federally-facilitated exchange or qualified health; Responded to a request from a Missouri congressional office to clarify the number of critical access hospitals in Missouri; Letter to oppose the DHHS OIGs recommendations for changes in standards for designating critical access hospitals; Missouri Hospital Association reports entitled A View of Two Missouris How Insurance Coverage Affects the Health and Productivity of Its People

- Discussed with CMS staff the design and implementation of Missouri's federally-facilitated health insurance exchange ("Marketplace") - Responded to congressional request for review of the "Preventing and Reducing Improper Medicare and Medicaid Expenditures act of 2013"- Asked members of Missouris congressional delegation in the U.S. House of Representatives to consider endorsing a Dear Colleague letter by Congresswoman Jenkins (R-KS) regarding Medicare payments for inpatient rehabilitation services - Provided the Missouri congressional delegation with a letter to CMS from the Missouri Hospital Association and the Missouri State Medical Association regarding regulatory standards to create a grace period for the payment of premiums for coverage in a federally-facilitated exchange or qualified health plans - Invited staff of the Missouri congressional delegation to attend a briefing on EHR incentives for Rural Health Clinics regarding H.R. 986, the Rural Clinic Fairness Act - Met with staff of Missouris congressional delegation to discuss statewide and district-specific information compiled by the Missouri Hospital Association regarding hospital financial performance metrics and trends - Discussed legislation to revamp the Medicare sustainable growth rate formula for determining payments for physician services under the Medicare program - Met with and/or provided information to Missouris congressional delegation to: * promote H.R. 1250 and S. 1012, regarding accountability standards for Medicare Recovery Audit Contractors and other program integrity initiatives * ask for endorsement of a delegation letter to congressional committee leaders to oppose the DHHS OIGs recommendations for changes in standards for designating critical access hospitals * promote S. 183 and H.R. 2053, concerning repeal of section 3141 of the Patient Protection and Affordable Care Act of 2010 * oppose legislative proposals to restrict states ability to use provider taxes to fund their Medicaid programs * promote reauthorization for an additional year of the Medicare Dependent Hospital program * oppose legislative efforts to limit the scope of the 340B program, which authorizes price discounts on the purchase of pharmaceuticals by designated safety net providers * make them aware of CMS regulatory actions regarding a grace period for the payment of premiums for coverage in a federally-facilitated exchange or qualified health - Responded to a request from a Missouri congressional office to clarify the number of critical access hospitals in Missouri - Communicated with various Missouri congressional staff regarding a joint delegation letter congressional committee leaders to oppose the DHHS OIGs recommendations for changes in standards for designating critical access hospitals - Distributed to the Missouri congressional delegation a report by the Missouri Hospital Association entitled A View of Two Missouris How Insurance Coverage Affects the Health and Productivity of Its People

Medicare regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Medicare regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Regulations dealing with physician ownership of hospitals Medicare Regulations affecting Rural Health ClinicsLegislation affecting Medicare payments for physician owned hospitals The Rural Health Clinic Patient Access Improvement Act Sequester related reductions in physician and hospital payments Payment equalization between physician offices and hospital outpatient departments H.R.986, Rural Health Clinic Fairness Act of 2013

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

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010 Proposed Regulations affecting Rural Health Clinics Changes to RHC manual by CMSRegulations establishing standards for the meaningful use of electronic health records Provider enrollment (PECOS) in Medicare and the ability to order or refer patients Possible cuts to Medicare bad debt payments to RHCs Sequestration related cuts in RHC payments H.R.986 : Rural Health Clinic Fairness Act of 2013 H.R.1331 : Electronic Health Records Improvement Act S.562 : Seniors Mental Health Access Improvement Act of 2013

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

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

Health Care Reform Implementation; CMS and CMMI Demonstration Projects; Rural Health Clinic Fairness Act HR 986; Health Information Technology; Training Tomorrow's Doctors Act HR 1201; Training Tomorrow's Doctor's Act-GME Funding HR 1201

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), SENATE