Medicare Audit Improvement Act of 2015

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes. The Senate Committee on Health, Education, Labor and Pensions (HELP) June 26 passed the Lower Health Care Costs Act of 2019 (S.1895) Congress should act now to delay the Medicaid DSH cuts that are scheduled to go into effect Nov. 22.

Client expense: Not reported · Firm income: Not reported

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes

Client expense: Not reported · Firm income: Not reported

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes

Client expense: Not reported · Firm income: Not reported

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,050,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,690,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 6 - 21st Century Cures Act S. 995 - Bipartisan Congressional Trade Priorities and Accountability Act of 2015 H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015 S. 149 - Medical Device Access and Innovation Protection Act H.R. 160 - Protect Medical Innovation Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 1268 - Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 1295 - Trade Preferences Extension Act of 2015 H.R. 1190 - Protecting Seniors' Access to Medicare Act of 2015 S. 141 - Protecting Seniors Access to Medicare Act of 2015 H.R.3762 - Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 S.754 - Cybersecurity Information Sharing Act of 2015

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 6 - 21st Century Cures Act S. 995 - Bipartisan Congressional Trade Priorities and Accountability Act of 2015 H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015 S. 149 - Medical Device Access and Innovation Protection Act H.R. 160 - Protect Medical Innovation Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 1268 - Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 1295 - Trade Preferences Extension Act of 2015 H.R. 1190 - Protecting Seniors' Access to Medicare Act of 2015 S. 141 - Protecting Seniors Access to Medicare Act of 2015 H.R.3762 - Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 S.754 - Cybersecurity Information Sharing Act of 2015

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688, H.R. 5273/H.R. 34 - 21st Century Cures Act) Medicare audit contractor program reforms (H.R. 2156, S. 2368) Rural hospital policies (H.R. 663 / S. 332, H.R. 169/S. 258, H.R. 1611/S. 257, S. 1461/H.R. 2878, H.R. 5164, H.R. 5613, CAH cost-based reimbursement) Telehealth, interoperability, health information technology (H.R. 6/H.R. 34 - 21st Century Cures Act, S. 2511, S. 2484/H.R. 4442) Post-Acute Care policies (H.R. 3298), home health prior authorization S. 2108, H.R. 5713 Health Care and Medicaid financing reform (Better Way white paper, Empowering Patients First Act, Patient CARE Act, H.R. 5284/S. 2985) Graduate Medical Education policy (H.R. 2124, S. 1148, H.R 3292, H.R. 6333) HR 976, HR 2513 DSH payment Bundled payment programs Clinical lab payment policy MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies (H.R. 5273/H.R. 34 - 21st Century Cures Act) Stark Law reforms H.R. 4428, H.R. 6399 Star Ratings Medicare Part B drug payment model Medicare Advantage policy

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

no specific bill - Recovery Audit Contracts, program integrity, medicare appeals, improper payments, policy, program waste, fraud and abuse, hospital short stays, durable medical equipment, hospital bill H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1526 - Medicare Audit Improvement Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2652 - Protecting Patients and Physicians Against Coding Act of 2015 S. 861, H.R. 818 - Prime Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 2368 - Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015 H.R. 34 - 21st Century Cures Act

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

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

Plans for repeal and replacement of the Affordable Care Act and its impacts to access to care and payments to hospitals, specifically cuts to hospital payments under the ACA that allowed for greater coverage for individuals Revised 21st Century Cures bill (includes the hospital provisions, including demo project and direct supervision of outpatient therapies for 2016) Regulatory reform for hospitals including many of the issues addressed in the following legislation: Critical Access Hospital (CAH) Relief Act of 2015 (S. 258/H.R. 169) Protecting Access to Rural Therapy Services (PARTS) Act (S. 257/H.R. 1611) Rural Hospital Access Act of 2015 (S. 332/H.R. 663) Community Hospital Demonstration Extension Act of 2015 (S. 607/H.R. 672) Act to Reform Recover Audit Contractors (RACs) (H.R. 2156) Rural Emergency Acute Care Hospital (REACH) Act (S. 1648) Save Rural Hospitals Act (H.R. 3225) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Direct Supervision 2016 Extension of Moratorium (S.3129/H.R. 5613); and H.R. 5614 for permanent moratorium Rural Hospital Regulatory Relief Act (H.R. 5164) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5273) Implementation of MACRA Concerns with implementation of Sec. 603 site-neutral reductions to Iowa hospitals and the CMS interpretation of the legislation in the outpatient prospective payment system proposed rule Concern with Hospital star ratings, and Hospital Quality Rating Transparency Act of 2016 (HR 5927) Iowa's proposed state plan amendment to incorporate intergovernmental transfers Significant concerns with Iowa's proposed transition to Medicaid managed care MedPAC recommendations for cuts to hospital payments avoiding site-neutral cuts recovery audit contractor (RAC) program and needed transparency and changes protecting critical access hospital funding and necessary provider status rural hospitals and access to care in Iowa encouraging value-based purchasing hospital acquired conditions and other quality measures Medicare formula and Iowa's payment compared to payments to other states Iowa hospital's economic impact to communities and the state beneficiary access throughout Iowa and threats from regulatory burdens and changes importance of 340B program to Iowa's hospitals Changes to the definition of patient in the 340B guidance and impact on Iowa hospitals Hospital outpatient department grandfathering provision to include currently planned facilities and acquisitions at time of enactment of H.R.1314 - Bipartisan Budget Act of 2015 (covered in revised and passed 21st Century Cures bill)

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

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

Support for provisions in 21st Century Cures Act (H.R. 34), including establishment of a socio-economic status (SES) risk adjuster for the Medicare Readmissions Reduction Program; changes to site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74) and flexibility in implementation of Section 603 of the law; non-enforcement of the direct supervision rules for CAHs; NIH, mental health, and opioid crisis provisions and funding Protecting 340B Drug Pricing Program in regulatory and legislative proposals Support for changes to liver transplant allocation system Urging modifications to Hospital Compare Star Rating System Support for Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act (H.R. 2745) Addressing concerns related to the Physician Quality Reporting System (PQRS) and reporting mechanisms Encouraging Committees of jurisdiction to examine overlap in Merit-based Incentive Payment System and Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) Urging further flexibility in proposed rule [CMS-5517-P] to implement Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Opposition to redistribution of Medicare DSH payments proposed in FFY 2017 Inpatient Prospective Payment System (IPPS) rule [CMS-1655-P] 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 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 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) Support for emergency funding to address Zika outbreak Encouraging Administration to engage hospital and health system field in discussions to address cybersecurity challenges.

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

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

Advocated for reform of the CMS two-midnight rule, communicated with Congressional offices in support of the Medicare Audit Improvement Act (HR 2156 in 114th Congress)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,970,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

S. 688 Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. All provisions. H.R. 1343 Establishing Beneficiary Equity in Hospital Readmission Program Act of 2015. All provisions. Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter. All Provisions. P.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. H.R. 2156 - Medicare Audit Improvement Act of 2015. All provisions. S. 1148 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 2124 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 3292 - Medicare IME Pool Act of 2015. H.R. 3288 - The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015. H.R. 3291- The Medicare Crosswalk Hospital Code Development Act of 2015. H.R. 4428 - Fair Medicare Hospital Payments Act CMS Hospital Compare star ratings - All provisions Comments invited by House Energy and Commerce Committee concerning Section 603 of the Bipartisan Budget Act of 2015, P.L. 114-74 - Site Neutral payment policy P.L. 114-10 - Medicare Access and CHIP Reauthorization Act of 2015 - Centers for Medicare and Medicaid Proposed Rule. All provisions Centers for Medicare and Medicaid Services Proposed Medicare Part B Drug Payment Model All provisions. H.R. 5723 - Helping Hospital Improve Patient Care Act of 2016. All provisions. Centers for Medicare and Medicaid Services Outpatient Prospective Payment System proposed rule for calendar year 2017 implementing Section 603 of the Bipartisan Budget Act of 2015, "Treatment of Off-Campus Outpatient Departments of a Provider" - All provisions. H.R. 34 - 21st Century Cures Act, All Provisions UNOS Liver Allocation and Transplantation Policy

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

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

PL 111-148: Patient Protection and Affordable Care Act (ACA) - various provisions including: Medical Device Excise Tax, various reimbursement cuts and policy proposals for medical imaging; remote monitoring technology in the context of accountable care organizations, medical homes and post acute bundling; transparency PL 111-152: Healthcare Education and Reconciliation Act: Imaging cuts, device tax transparency and remote monitoring S.2343 - The Telehealth Innovation and Improvement Act PL 110-275: "Medicare Improvements for Patient and Providers Act" (sec. 135) - Medical imaging accreditations program; medical imaging clinical appropriateness demonstration program Decline in growth rate of Medicare non-hospital imaging services CMS CPAP bundling proposal HR.2396 - The Software Act HR.2437 - To develop and implement a prior authorization process for certain DMEPOS. Fostering Independence Through Technology Act (potential reintroduction) - specifically the telehealth provisions H.R.284/S.128 - The Medicare DMEPOS Competitive Bidding Improvement Act of 2015 Site-neutrality in payments HR 2 - Long-term Sustainable Growth Rate (SGR) replacement legislation Appropriate Use Criteria HR.2066 - Telehealth Enhancement Act of 2015 The Health Care Innovation and Marketplace Technologies Act (potential reintroduction of HR.2363 from 113th Congress) - Telemedicine provisions HR.2948 - The Medicare Telehealth Parity Act (potential reintroduction) HR.2156 - The Medicare Audit Improvement and Reform Act HR.4185 - The Protecting Access Through Competitive Pricing Transition Act of 2015 S.2312 - The DME Access and Stabilization Act S.2736 - Patient Access to Durable Medical Equipment Act of 2016 H.R.5710 - Patient Access to Durable Medical Equipment Act of 2016 S.3195 - The BREATH Act of 2016 HR.6012 - The BREATH Act of 2016 Chronic care Non-invasive ventilators

Client expense: $320,000 · 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), Internal Revenue Service (IRS), SENATE

Graduate Medical Education (GME) issues (including Resident Physician Shortage Reduction Act (H.R.2124/S.1148) - support); provided comments to Congress in response to Energy and Commerce Committee request for input on GME; amendments to the Medicare hospital re-admissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.1343/S.688 - support; proposals to amend the 2 midnight policy - support; hospital issues included in President Obama's FY 16 budget - oppose; hospital issues included in H.R.2, the Medicare Access and CHIP Re-authorization Act of 2015 - support; legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; Strengthening Medicare Advantage through Innovation and Transparency for Seniors (H.R.2570) - oppose; Medicare Inpatient Prospective Payment System FY 2016 proposed rule (CMS 1632-P) - detailed comment letter; legislation to improve the recovery audit contractor program (H.R.2156); Audit and Appeal Fairness, Integrity and Reforms in Medicare Act (AFIRM) - provided comments to the Senate Finance Committee; Ensuring Seniors Access to Local Pharmacies Act of 2015 (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Act (S.776) - support; CMS-4159-F2 - comments on daily dispensing fees; Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (P.L.114-39) - support; provided comments on the proposed Medicare outpatient prospective payment system rule (CMS-1633-P); Medicare IME Pool Act of 2015 (H.R.3292) - oppose; Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act (H.R.3288) - oppose; Medicare Crosswalk Hospital Code Development Act (H.R. 3291) - oppose; sign-on letter to CMS urging it to reconsider negative update for CY 2016 (CMS-1633-P) - support; proposed Medicare and Medicaid cuts as offsets to pay for budget increases, raising the debt ceiling, etc. - oppose; site neutral hospital outpatient cuts and other hospital related provisions included in the Bipartisan Budget Act of 2015 (H.R. 1314) - oppose; legislative proposals (H.R. 5273)and Congressional letters to amend the Bipartisan Budget Acts site neutral hospital outpatient payment cut to grandfather sites under development as well as other legislative changes (support) - advocated for their inclusion in the Consolidated Appropriations Act of 2016 (Omnibus legislation/Senate amendment to H.R. 2029); provided comments to Congress regarding provisions in the Mental Health Reform Act of 2015 (S. 1945), that would reform how health care information for substance abuse patients is shared; met with HHS officials on Medicare and Medicaid issues of importance to the Commonwealth of Puerto Rico and Puerto Rican health care providers; submitted comments on Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (CMS-3260-P); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913) - support (with some concerns about pharmacy lock-in policy); hospital issues included in House FY 17 budget - oppose; hosptial issues included in President Obama's FY 17 budget proposal - oppose; provided comments in response to Energy and Commerce Committee request for input on hospital site-neutral issues; Medicaid provisions included in the Common Sense Savings Act of 2016 (H.R.4725) - oppose; provided comments to CMS and Congress regarding the Hospital Compare Star Ratings for hospitals - support for delay and fixing measures; The Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) - oppose; provided comments to CMS on hospital site-neutral proposals - argued for flexibility in the anticipated OPPS proposed rule; provided comments to CMS on the FY 17 IPPS proposed rule (CMS-1655-P) with a focus on opposition to the proposed Medicare DSH policy and provided input to Capitol Hill and the Administration;submitted comments on Medicaid Program,Covered Outpatient Drugs (CMS-2345-FC); asked Congressional members to urge CMS to finalize its 2014 proposed guidance to Part D drug plans and PBMs regarding consistent reporting of Direct and Indirect Remuneration (DIR); Improving Transparency & Accuracy in Medicare Part D Spending (S.3308/H.R.5957) - support; testified at House Ways and Means Health Subcommittee hearing entitled "Incentivizing Quality Outcomes in Medicare Part A" in support of streamlining hospital measures and reporting; provided comments regarding the Medicare OPPS CY2017 proposed rule (81 FR 45603), in particular in opposition to implementation of site-neutral proposals; provided comments on Merit Based Incentive Payment System (MIPS)and Alternative Payment Models (APMs) under MACRA 2015 (81 FR 28161); discussions with CMS regarding priority categories for redistribution of Medicare-funded residency slots; discussions with CMS to encourage consistency in hospital surveys; submitted comments on the Part B Drug Payment Model proposed rule (CMS-1670-P) - serious concerns; submitted comments on the SNF PPS proposed rule (CMS-1645-P) - serious concerns; Texas proposed Medicaid State Plan Amendment (15-005) in response to the CMS Covered Outpatient Drug Rule (CMS-2345-FC) - concerns; submitted comments to CMS about its proposal to expand testing of mandatory, risk-based bundled payments for acute episodes of care - oppose; 21st Century Cures Act (H.R. 34, now P.L.114-255) provisions that apply to site neutral, readmissions, and other hospital reimbursement issue - support.

Client expense: $400,000 · Firm income: Not reported

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

Provider access to substance use claims data, efforts to oppose site-neutral Medicare payments, S.688 - the Establishing Beneficiary Equity in the Hospital Readmission Program Act, H.R.2156 - the Medicare Audit Improvement Act, S.1148, the Resident Physician Shortage Reduction Act, H.R. 1604, the Affordable Care Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.2; S.141; S.298/H.R.546; H.B.169/S.258; S.257; S.313; H.R.2156/S.2368; S.257/H.R.1611; S.578/H.R.1342

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 6 - 21st Century Cures Act S. 995 - Bipartisan Congressional Trade Priorities and Accountability Act of 2015 H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015 S. 149 - Medical Device Access and Innovation Protection Act H.R. 160 - Protect Medical Innovation Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 1268 - Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 1295 - Trade Preferences Extension Act of 2015 H.R. 1190 - Protecting Seniors' Access to Medicare Act of 2015 S. 141 - Protecting Seniors Access to Medicare Act of 2015 H.R.3762 - Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 S.754 - Cybersecurity Information Sharing Act of 2015

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 6 - 21st Century Cures Act S. 995 - Bipartisan Congressional Trade Priorities and Accountability Act of 2015 H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015 S. 149 - Medical Device Access and Innovation Protection Act H.R. 160 - Protect Medical Innovation Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 1268 - Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 1295 - Trade Preferences Extension Act of 2015 H.R. 1190 - Protecting Seniors' Access to Medicare Act of 2015 S. 141 - Protecting Seniors Access to Medicare Act of 2015 H.R.3762 - Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 S.754 - Cybersecurity Information Sharing Act of 2015

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,050,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Funding for 340B Drug Pricing Program Critical Access Hospital Relief Act (S. 258; H.R. 169) Support for changes to site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74) and flexibility in implementation of Section 603 of the law. Protecting 340B Drug Pricing Program in regulatory and legislative proposals Support for Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act (H.R. 2745) Encouraging Committees of jurisdiction to examine overlap in Merit-based Incentive Payment System and Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) Urging further flexibility in proposed rule [CMS-5517-P] to implement Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Support for Rural Hospital Access Act of 2015 (H.R. 663/S. 332) 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)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688, H.R. 5273) Medicare audit contractor program reforms (H.R. 2156, S. 2368) Rural hospital policies (H.R. 663 / S. 332, H.R. 169/S. 258, H.R. 1611/S. 257, S. 1461/H.R. 2878, H.R. 5164, H.R. 5613, CAH cost-based reimbursement) Telehealth, interoperability, health information technology (H.R. 6, S. 2511, S. 2484/H.R. 4442) Post-Acute Care policies (H.R. 3298), home health prior authorization S. 2108, H.R. 5713 Graduate Medical Education policy (H.R. 2124, S. 1148, H.R 3292) HR 976, HR 2513 DSH payment Bundled payment programs Clinical lab payment policy MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies (H.R. 5273) Stark Law reforms H.R. 4428 Star Ratings Medicare Part B drug payment model Medicare Advantage

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 688 Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. All provisions. H.R. 1343 Establishing Beneficiary Equity in Hospital Readmission Program Act of 2015. All provisions. Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter. All Provisions. P.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. H.R. 2156 - Medicare Audit Improvement Act of 2015. All provisions. S. 1148 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 2124 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 3292 - Medicare IME Pool Act of 2015. H.R. 3288 - The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015. H.R. 3291- The Medicare Crosswalk Hospital Code Development Act of 2015. H.R. 4428 - Fair Medicare Hospital Payments Act CMS Hospital Compare star ratings - All provisions Comments invited by House Energy and Commerce Committee concerning Section 603 of the Bipartisan Budget Act of 2015, P.L. 114-74 - Site Neutral payment policy P.L. 114-10 - Medicare Access and CHIP Reauthorization Act of 2015 - Centers for Medicare and Medicaid Proposed Rule. All provisions Centers for Medicare and Medicaid Services Proposed Medicare Part B Drug Payment Model All provisions. H.R. 5723 - Helping Hospital Improve Patient Care Act of 2016. All provisions. Centers for Medicare and Medicaid Services Outpatient Prospective Payment System proposed rule for calendar year 2017 implementing Section 603 of the Bipartisan Budget Act of 2015, "Treatment of Off-Campus Outpatient Departments of a Provider" - All provisions.

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

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

Support for changes to site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74) and flexibility in implementation of Section 603 of the law. Protecting 340B Drug Pricing Program in regulatory and legislative proposals 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 modifications to Hospital Compare Star Rating System Support for National Institutes of Health funding Support for Standard Merger and Acquisition Reviews Through Equal Rules (SMARTER) Act (H.R. 2745) Addressing concerns related to the Physician Quality Reporting System (PQRS) and reporting mechanisms Encouraging Committees of jurisdiction to examine overlap in Merit-based Incentive Payment System and Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) Urging further flexibility in proposed rule [CMS-5517-P] to implement Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Opposition to redistribution of Medicare DSH payments proposed in FFY 2017 Inpatient Prospective Payment System (IPPS) rule [CMS-1655-P] 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) and inclusion of similar provision in Helping Hospitals Improve Patient Care Act (H.R. 5273) 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 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) Support for emergency funding to address Zika outbreak Support for authorization of new programs as well as increased funding to improve and expand access to mental health treatment services and substance use disorders. Encouraging Administration to engage hospital and health system field in discussions to address cybersecurity challenges.

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

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

no specific bill - Recovery Audit Contracts, program integrity, medicare appeals, improper payments, policy, program waste, fraud and abuse, hospital short stays, durable medical equipment, hospital bill H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1526 - Medicare Audit Improvement Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2652 - Protecting Patients and Physicians Against Coding Act of 2015 S. 861, H.R. 818 - Prime Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 2368 - Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015

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

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

PL 111-148: Patient Protection and Affordable Care Act (ACA) - various provisions including: Medical Device Excise Tax, various reimbursement cuts and policy proposals for medical imaging; remote monitoring technology in the context of accountable care organizations, medical homes and post acute bundling; transparency PL 111-152: Healthcare Education and Reconciliation Act: Imaging cuts, device tax transparency and remote monitoring S.2343 - The Telehealth Innovation and Improvement Act PL 110-275: "Medicare Improvements for Patient and Providers Act" (sec. 135) - Medical imaging accreditations program; medical imaging clinical appropriateness demonstration program Decline in growth rate of Medicare non-hospital imaging services CMS CPAP bundling proposal HR.2396 - The Software Act HR.2437 - To develop and implement a prior authorization process for certain DMEPOS. Fostering Independence Through Technology Act (potential reintroduction) - specifically the telehealth provisions H.R.284/S.128 - The Medicare DMEPOS Competitive Bidding Improvement Act of 2015 Site-neutrality in payments HR 2 - Long-term Sustainable Growth Rate (SGR) replacement legislation Appropriate Use Criteria HR.2066 - Telehealth Enhancement Act of 2015 The Health Care Innovation and Marketplace Technologies Act (potential reintroduction of HR.2363 from 113th Congress) - Telemedicine provisions HR.2948 - The Medicare Telehealth Parity Act (potential reintroduction) HR.2156 - The Medicare Audit Improvement and Reform Act HR.4185 - The Protecting Access Through Competitive Pricing Transition Act of 2015 S.2312 - The DME Access and Stabilization Act S.2736 - Patient Access to Durable Medical Equipment Act of 2016 H.R.5710 - Patient Access to Durable Medical Equipment Act of 2016 S.3195 - The BREATH Act of 2016 HR.6012 - The BREATH Act of 2016 Chronic care Non-invasive ventilators

Client expense: $320,000 · 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), Internal Revenue Service (IRS), SENATE

Graduate Medical Education (GME) issues (including Resident Physician Shortage Reduction Act (H.R.2124/S.1148) - support); provided comments to Congress in response to Energy and Commerce Committee request for input on GME; amendments to the Medicare hospital re-admissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.1343/S.688 - support; proposals to amend the 2 midnight policy - support; hospital issues included in President Obama's FY 16 budget - oppose; hospital issues included in H.R.2, the Medicare Access and CHIP Re-authorization Act of 2015 - support; legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; Strengthening Medicare Advantage through Innovation and Transparency for Seniors (H.R.2570) - oppose; Medicare Inpatient Prospective Payment System FY 2016 proposed rule (CMS 1632-P) - detailed comment letter; legislation to improve the recovery audit contractor program (H.R.2156); Audit and Appeal Fairness, Integrity and Reforms in Medicare Act (AFIRM) - provided comments to the Senate Finance Committee; Ensuring Seniors Access to Local Pharmacies Act of 2015 (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Act (S.776) - support; CMS-4159-F2 - comments on daily dispensing fees; Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (P.L.114-39) - support; provided comments on the proposed Medicare outpatient prospective payment system rule (CMS-1633-P); Medicare IME Pool Act of 2015 (H.R.3292) - oppose; Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act (H.R.3288) - oppose; Medicare Crosswalk Hospital Code Development Act (H.R. 3291) - oppose; sign-on letter to CMS urging it to reconsider negative update for CY 2016 (CMS-1633-P) - support; proposed Medicare and Medicaid cuts as offsets to pay for budget increases, raising the debt ceiling, etc. - oppose; site neutral hospital outpatient cuts and other hospital related provisions included in the Bipartisan Budget Act of 2015 (H.R. 1314) - oppose; legislative proposals (H.R. 5273)and Congressional letters to amend the Bipartisan Budget Acts site neutral hospital outpatient payment cut to grandfather sites under development as well as other legislative changes (support) - advocated for their inclusion in the Consolidated Appropriations Act of 2016 (Omnibus legislation/Senate amendment to H.R. 2029); provided comments to Congress regarding provisions in the Mental Health Reform Act of 2015 (S. 1945), that would reform how health care information for substance abuse patients is shared; met with HHS officials on Medicare and Medicaid issues of importance to the Commonwealth of Puerto Rico and Puerto Rican health care providers; submitted comments on Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (CMS-3260-P); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913) - support (with some concerns about pharmacy lock-in policy); hospital issues included in House FY 17 budget - oppose; hosptial issues included in President Obama's FY 17 budget proposal - oppose; provided comments in response to Energy and Commerce Committee request for input on hospital site-neutral issues; Medicaid provisions included in the Common Sense Savings Act of 2016 (H.R.4725) - oppose; provided comments to CMS and Congress regarding the Hospital Compare Star Ratings for hospitals - support for delay and fixing measures; The Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) - oppose; provided comments to CMS on hospital site-neutral proposals - argued for flexibility in the anticipated OPPS proposed rule; provided comments to CMS on the FY 17 IPPS proposed rule (CMS-1655-P) with a focus on opposition to the proposed Medicare DSH policy and provided input to Capitol Hill and the Administration;submitted comments on Medicaid Program,Covered Outpatient Drugs (CMS-2345-FC); asked Congressional members to urge CMS to finalize its 2014 proposed guidance to Part D drug plans and PBMs regarding consistent reporting of Direct and Indirect Remuneration (DIR); Improving Transparency & Accuracy in Medicare Part D Spending (S.3308/H.R.5957) - support; testified at House Ways and Means Health Subcommittee hearing entitled "Incentivizing Quality Outcomes in Medicare Part A" in support of streamlining hospital measures and reporting; provided comments regarding the Medicare OPPS CY2017 proposed rule (81 FR 45603), in particular in opposition to implementation of site-neutral proposals; provided comments on Merit Based Incentive Payment System (MIPS)and Alternative Payment Models (APMs) under MACRA 2015 (81 FR 28161); discussions with CMS regarding priority categories for redistribution of Medicare-funded residency slots; discussions with CMS to encourage consistency in hospital surveys; submitted comments on the Part B Drug Payment Model proposed rule (CMS-1670-P) - serious concerns; submitted comments on the SNF PPS proposed rule (CMS-1645-P) - serious concerns; Texas proposed Medicaid State Plan Amendment (15-005) in response to the CMS Covered Outpatient Drug Rule (CMS-2345-FC) - concerns.

Client expense: $410,000 · Firm income: Not reported

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

Critical Access Hospital (CAH) Relief Act of 2015 (S. 258/H.R. 169) Protecting Access to Rural Therapy Services (PARTS) Act (S. 257/H.R. 1611) Rural Hospital Access Act of 2015 (S. 332/H.R. 663) Community Hospital Demonstration Extension Act of 2015 (S. 607/H.R. 672) Act to Reform Recover Audit Contractors (RACs) (H.R. 2156) Rural Emergency Acute Care Hospital (REACH) Act (S. 1648) Save Rural Hospitals Act (H.R. 3225) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Direct Supervision 2016 Extension of Moratorium (S.3129/H.R. 5613); and H.R. 5614 for permanent moratorium Rural Hospital Regulatory Relief Act (H.R. 5164) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5273) Proposed rule on implementation of MACRA Proposed FY2017 Hospice Wage Index Comments regarding the HHS budget proposal to change payment of CAH from 101% to 100% of costs Concerns with implementation of Sec. 603 site-neutral reductions to Iowa hospitals and the CMS interpretation of the legislation in the outpatient prospective payment system proposed rule Concern with Hospital star ratings, and Hospital Quality Rating Transparency Act of 2016 (HR 5927) Significant concerns with Iowa's proposed transition to Medicaid managed care Medicare reduction proposals in President Obama's budget released 2015 MedPAC recommendations for cuts to hospital payments avoiding site-neutral cuts recovery audit contractor (RAC) program and needed transparency and changes protecting critical access hospital funding and necessary provider status rural hospitals and access to care in Iowa encouraging value-based purchasing hospital acquired conditions and other quality measures Medicare formula and Iowa's payment compared to payments to other states Iowa hospital's economic impact to communities and the state beneficiary access throughout Iowa and threats from regulatory burdens and changes importance of 340B program to Iowa's hospitals Changes to the definition of patient in the 340B guidance and impact on Iowa hospitals Extension of sequestration against Medicare and the inclusion of the "site neutral" hospital outpatient department payment change in H.R.1314 - Bipartisan Budget Act of 2015 Hospital outpatient department grandfathering provision to include currently planned facilities and acquisitions at time of enactment of H.R.1314 - Bipartisan Budget Act of 2015 Concerns about processing and preauthorization, access to care issues with the Veteran's Choice program.

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

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

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169 / S. 258: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Opposition to site-neutral payments, appropriations for medical error reduction research; legislation to alter Section 603 of the Bipartisan Budget Act of 2015, H.R.2156 - the Medicare Audit Improvement Act, the Hospital Compare Star Rating System, Stark Law H.R. 5273 - the Helping Hospitals Improve Patient Care Act of 2016

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Opposition to site-neutral payments, appropriations for medical error reduction research; legislation to alter Section 603 of the Bipartisan Budget Act of 2015 H.R.2156 - the Medicare Audit Improvement Act, the Hospital Compare Star Rating System, Stark Law H.R. 5273 - the Helping Hospitals Improve Patient Care Act of 2016

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.2; S.141; S.298/H.R.546; H.B.169/S.258; S.257; S.313; H.R.2156/S.2368; S.257/H.R.1611; S.578/H.R.1342

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocated for reform of the CMS two-midnight rule, communicated with Congressional offices in support of the Medicare Audit Improvement Act (HR 2156 in 114th Congress)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Critical Access Hospital (CAH) Relief Act of 2015 (S. 258/H.R. 169) Protecting Access to Rural Therapy Services (PARTS) Act (S. 257/H.R. 1611) Rural Hospital Access Act of 2015 (S. 332/H.R. 663) Community Hospital Demonstration Extension Act of 2015 (S. 607/H.R. 672) Act to Reform Recover Audit Contractors (RACs) (H.R. 2156) Rural Emergency Acute Care Hospital (REACH) Act (S. 1648) Save Rural Hospitals Act (H.R. 3225) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Direct Supervision 2016 Extension of Moratorium (S.3129/H.R. 5613) Rural Hospital Regulatory Relief Act (H.R. 5164) Critical Access and Rural Equity (CARE) Act (H.R. 4553) Proposed rule on implementation of MACRA Proposed FY2017 Hospice Wage Index Comments regarding the HHS budget proposal to change payment of CAH from 101% to 100% of costs Significant concerns with Iowa's proposed transition to Medicaid managed care Medicare reduction proposals in President Obama's budget released 2015 MedPAC recommendations for cuts to hospital payments avoiding site-neutral cuts recovery audit contractor (RAC) program and needed transparency and changes protecting critical access hospital funding and necessary provider status rural hospitals and access to care in Iowa encouraging value-based purchasing hospital acquired conditions and other quality measures Medicare formula and Iowa's payment compared to payments to other states Iowa hospital's economic impact to communities and the state beneficiary access throughout Iowa and threats from regulatory burdens and changes importance of 340B program to Iowa's hospitals sustainable growth rate fix and impact on hospitals in Iowa Meaningful use in EHR Changes to the definition of patient in the 340B guidance and impact on Iowa hospitals Extension of sequestration against Medicare and the inclusion of the "site neutral" hospital outpatient department payment change in H.R.1314 - Bipartisan Budget Act of 2015 Clarifying amendment to hospital outpatient department grandfathering provision to include currently planned facilities and acquisitions at time of enactment of H.R.1314 - Bipartisan Budget Act of 2015 Concerns about processing and preauthorization, access to care issues with the Veteran's Choice program.

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

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

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,690,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office