Medicare Advantage Coverage Transparency Act of 2015

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act S. 2425 - Patient Access and Medicare Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2484 - Connect for Health Act H.R. 5659 - ESRD Choice Act of 2016 H.R. 34 - 21st Century Cures Act ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform, Medicare Advantage Payment Shift Offset, call letter, Puerto Rico and Medicare Advantage

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

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2425 - Patient Access and Medicare Protection Act S. 2484 - Connect For Health Act H.R. 5659 - ESRD Choice Act of 2016 H.R. 34 - 21st Century Cures Act ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual EligH.R. 34 - 21st Century Cures Actibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care, coding intensity

Client expense: Not reported · Firm income: $90,000

H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 5659, ESRD Choice Act (Smith) - option for ESRD patients to enroll in MA plans H.R. 5942, Dialysis PATIENTS Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 6265, Medigap Reforms (McDermott) S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

(1) Issues related to Public Law 111-148 - The Patient Protection and Affordable Care Act (provisions related to Medicaid and Medicare) (2) Issues related to Public Law 111-152 - Health Care and Education Reconciliation Act of 2010 (provisions related to Medicaid and Medicare) (3) Issues pertaining to entitlement reform, Medicare Advantage, Part D, Medicaid Dual Eligibles, and Medicare reimbursement and enrollment (4) Issues related to S.2498 - Medicare Program Linking Uncoordinated Services (PLUS) Act (5) Issues related to H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act (6) Issues related to H.R. 1190 - Protecting Seniors Access to Medicare Act of 2015 (7) Issues related to H.R. 2505 - Medicare Advantage Coverage Transparency Act of 2015 (8) Issues related to H.R. 2506 - Seniors Health Care Plan Protection Act of 2015 (9 Issues related to H.R. 2507 - Increasing Regulatory Fairness Act of 2015 (10)Issues related to H.R. 2579 - Securing Care for Seniors Act of 2015 (11) Issues related to H.R.3244 - Providing Innovative Care for Complex Cases Demonstration Act of 2015 (12) Issues related to H.R.3288 - Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 (13) Issues related to H.R. 4275 - Medicare Advantage Quality Payment Relief Act of 2015 (14) Issues related to H.R.3831 - Securing Fairness in Regulatory Timing Act of 2015 (15) Issues related to H.R.2582 - Seniors' Health Care Plan Protection Act of 2015 (16) Issues related to CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter (17) Issues related to H.R.5659, ESRD Choice Act of 2016

Client expense: $740,000 · Firm income: Not reported

Department of Health & Human Services: Medicare Advantage: operational issues, annual payment updates and policy changes. HR 2505 - Medicare Advantage Coverage Transparency Act of 2015: To amend title XVIII of the Social Security Act to require the annual reporting of data on enrollment in Medicare Advantage plans. Kelly (R-PA) HR 2507 - Increasing Regulatory Fairness Act of 2015: To amend title XVIII of the Social Security Act to establish an annual rulemaking schedule for payment rates under Medicare Advantage. Brady (R-TX) HR 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015: To amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the co-payments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures, and for other purposes. Black (R-TN) HR 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015: To amend title XVIII of the Social Security Act to establish a 3-year demonstration program to test the use of value-based insurance design methodologies under eligible Medicare Advantage plans, to preserve Medicare beneficiary choice under Medicare Advantage, to revise the treatment under the Medicare program of infusion drugs furnished through durable medical equipment, and for other purposes. Brady (R-TX) HR 2582 - Seniors' Health Care Plan Protection Act of 2015: To amend title XVIII of the Social Security Act to delay the authority to terminate Medicare Advantage contracts for MA plans failing to achieve minimum quality ratings, to make improvements to the Medicare Adjustment risk adjustment system, and for other purposes. Buchanan (R-FL) HR 4275 - Medicare Advantage Quality Payment Relief Act of 2015: To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. Kelly (R-PA) HR 5659 - ESRD Choice Act of 2016: To amend title XVIII of the Social Security Act with respect to expanding Medicare Advantage coverage for individuals with end-stage renal disease (ESRD). Smith (R-MO) S 2425 - Patient Access and Medicare Protection Act: To amend titles XVIII and XIX of the Social Security Act to improve payments for complex rehabilitation technology and certain radiation therapy services, to ensure flexibility in applying the hardship exception for meaningful use for the 2015 EHR reporting period for 2017 payment adjustments, and for other purposes. Portman (R-OH) S 2484 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act: To amend titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program through the use of Telehealth and remote patient monitoring services, and for other purposes. Schatz (D-HI)

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act S. 2425 - Patient Access and Medicare Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2484 - Connect for Health Act H.R. 5659 - ESRD Choice Act of 2016 ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform, Medicare Advantage Payment Shift Offset, call letter, Puerto Rico and Medicare Advantage

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2425 - Patient Access and Medicare Protection Act S. 2484 - Connect For Health Act H.R. 5659 - ESRD Choice Act of 2016 ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care, coding intensity

Client expense: Not reported · Firm income: $90,000

Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016

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

H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD Draft Bill on Option for ESRD Patients to Enroll in MA Plans (Ways and Means Committee) H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.

(1) Issues related to Public Law 111-148 - The Patient Protection and Affordable Care Act (provisions related to Medicaid and Medicare) (2) Issues related to Public Law 111-152 - Health Care and Education Reconciliation Act of 2010 (provisions related to Medicaid and Medicare) (3) Issues pertaining to entitlement reform, Medicare Advantage, Part D, Medicaid Dual Eligibles, and Medicare reimbursement and enrollment (4) Issues related to S.2498 - Medicare Program Linking Uncoordinated Services (PLUS) Act (5) Issues related to H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act (6) Issues related to H.R. 1190 - Protecting Seniors Access to Medicare Act of 2015 (7) Issues related to H.R. 2505 - Medicare Advantage Coverage Transparency Act of 2015 (8) Issues related to H.R. 2506 - Seniors Health Care Plan Protection Act of 2015 (9 Issues related to H.R. 2507 - Increasing Regulatory Fairness Act of 2015 (10)Issues related to H.R. 2579 - Securing Care for Seniors Act of 2015 (11) Issues related to H.R.3244 - Providing Innovative Care for Complex Cases Demonstration Act of 2015 (12) Issues related to H.R.3288 - Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 (13) Issues related to H.R. 4275 - Medicare Advantage Quality Payment Relief Act of 2015 (14) Issues related to H.R.3831 - Securing Fairness in Regulatory Timing Act of 2015 (15) Issues related to H.R.2582 - Seniors' Health Care Plan Protection Act of 2015 (16) Issues related to CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter

Client expense: $610,000 · Firm income: Not reported

Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act S. 2425 - Patient Access and Medicare Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2484 - Connect for Health Act H.R. 5659 - ESRD Choice Act of 2016 ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform, Medicare Advantage Payment Shift Offset, call letter, Puerto Rico and Medicare Advantage

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2425 - Patient Access and Medicare Protection Act S. 2484 - Connect For Health Act H.R. 5659 - ESRD Choice Act of 2016 ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care

Client expense: Not reported · Firm income: $90,000

Department of Health & Human Services: Medicare Advantage: operational issues, annual payment updates and policy changes. HR 2505 - Medicare Advantage Coverage Transparency Act of 2015: To amend title XVIII of the Social Security Act to require the annual reporting of data on enrollment in Medicare Advantage plans. Kelly (R-PA) HR 2507 - Increasing Regulatory Fairness Act of 2015: To amend title XVIII of the Social Security Act to establish an annual rulemaking schedule for payment rates under Medicare Advantage. Brady (R-TX) HR 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015: To amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the co-payments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures, and for other purposes. Black (R-TN) HR 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015: To amend title XVIII of the Social Security Act to establish a 3-year demonstration program to test the use of value-based insurance design methodologies under eligible Medicare Advantage plans, to preserve Medicare beneficiary choice under Medicare Advantage, to revise the treatment under the Medicare program of infusion drugs furnished through durable medical equipment, and for other purposes. Brady (R-TX) HR 2582 - Seniors' Health Care Plan Protection Act of 2015: To amend title XVIII of the Social Security Act to delay the authority to terminate Medicare Advantage contracts for MA plans failing to achieve minimum quality ratings, to make improvements to the Medicare Adjustment risk adjustment system, and for other purposes. Buchanan (R-FL) HR 4275 - Medicare Advantage Quality Payment Relief Act of 2015: To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. Kelly (R-PA) S 2425 - Patient Access and Medicare Protection Act: To amend titles XVIII and XIX of the Social Security Act to improve payments for complex rehabilitation technology and certain radiation therapy services, to ensure flexibility in applying the hardship exception for meaningful use for the 2015 EHR reporting period for 2017 payment adjustments, and for other purposes. Portman (R-OH) S 2484 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act: To amend titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program through the use of Telehealth and remote patient monitoring services, and for other purposes. Schatz (D-HI)

Department of Health & Human Services: Medicare Advantage: operational issues, annual payment updates and policy changes. HR 2505 - Medicare Advantage Coverage Transparency Act of 2015: To amend title XVIII of the Social Security Act to require the annual reporting of data on enrollment in Medicare Advantage plans. Kelly (R-PA) HR 2507 - Increasing Regulatory Fairness Act of 2015: To amend title XVIII of the Social Security Act to establish an annual rulemaking schedule for payment rates under Medicare Advantage. Brady (R-TX) HR 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015: To amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the co-payments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures, and for other purposes. Black (R-TN) HR 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015: To amend title XVIII of the Social Security Act to establish a 3-year demonstration program to test the use of value-based insurance design methodologies under eligible Medicare Advantage plans, to preserve Medicare beneficiary choice under Medicare Advantage, to revise the treatment under the Medicare program of infusion drugs furnished through durable medical equipment, and for other purposes. Brady (R-TX) HR 2582 - Seniors' Health Care Plan Protection Act of 2015: To amend title XVIII of the Social Security Act to delay the authority to terminate Medicare Advantage contracts for MA plans failing to achieve minimum quality ratings, to make improvements to the Medicare Adjustment risk adjustment system, and for other purposes. Buchanan (R-FL) S. 2425 - Patient Access and Medicare Protection Act: To amend titles XVIII and XIX of the Social Security Act to improve payments for complex rehabilitation technology and certain radiation therapy services, to ensure flexibility in applying the hardship exception for meaningful use for the 2015 EHR reporting period for 2017 payment adjustments, and for other purposes. Portman (R-OH) S 2484 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act: To amend titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program through the use of Telehealth and remote patient monitoring services, and for other purposes. Schatz (D-HI)

H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, , enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

(1) Issues related to Public Law 111-148 - The Patient Protection and Affordable Care Act (provisions related to Medicaid and Medicare) (2) Issues related to Public Law 111-152 - Health Care and Education Reconciliation Act of 2010 (provisions related to Medicaid and Medicare) (3) Issues pertaining to entitlement reform, Medicare Advantage, Part D, Medicaid Dual Eligibles, and Medicare reimbursement and enrollment (4) Issues related to S.2498 - Medicare Program Linking Uncoordinated Services (PLUS) Act (5) Issues related to H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act (6) Issues related to H.R. 1190 - Protecting Seniors Access to Medicare Act of 2015 (7) Issues related to H.R. 2505 - Medicare Advantage Coverage Transparency Act of 2015 (8) Issues related to H.R. 2506 - Seniors Health Care Plan Protection Act of 2015 (9 Issues related to H.R. 2507 - Increasing Regulatory Fairness Act of 2015 (10)Issues related to H.R. 2579 - Securing Care for Seniors Act of 2015 (11) Issues related to H.R.3244 - Providing Innovative Care for Complex Cases Demonstration Act of 2015 (12) Issues related to H.R.3288 - Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 (13) Issues related to H.R. 4275 - Medicare Advantage Quality Payment Relief Act of 2015 (14) Issues related to H.R.3831 - Securing Fairness in Regulatory Timing Act of 2015 (15) Issues related to H.R.2582 - Seniors' Health Care Plan Protection Act of 2015 (16) Issues related to CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter

Client expense: $1,090,000 · Firm income: Not reported

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act S. 2425 - Patient Access and Medicare Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2484 - Connect for Health Act ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform, Medicare Advantage Payment Shift Offset, call letter, Puerto Rico and Medicare Advantage

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2425 - Patient Access and Medicare Protection Act S. 2484 - Connect For Health Act ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care, Medicare Advantage Payment Shift Offset

Client expense: Not reported · Firm income: $90,000

Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - rulemaking schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1314, Bipartisan Budget Act - Medicare Part B premium and deductible, Medicare sequestration cuts H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3696, Protecting Medicare Beneficiaries Act (Titus) - Medicare Part B premiums and deductibles H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3831, Securing Fairness in Regulatory Timing Act (Brady) - revised schedule for MA payment rates H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2148, Protecting Medicare Beneficiaries Act (Wyden) - Medicare Part B premiums and deductibles S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2351, Securing Fairness in Regulatory Timing Act (Isakson) - revised schedule for MA payment rates Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; Center for Medicare and Medicaid Innovation demonstrations for MA and PDP plans; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

(1) Issues related to Public Law 111-148 - The Patient Protection and Affordable Care Act (provisions related to Medicaid and Medicare) (2) Issues related to Public Law 111-152 - Health Care and Education Reconciliation Act of 2010 (provisions related to Medicaid and Medicare) (3) Issues pertaining to entitlement reform, Medicare Advantage, Part D, Medicaid Dual Eligibles, and Medicare reimbursement and enrollment (4) Issues related to H.R. 2712 - Commonsense Reporting and Verification Act of 2015 (5) Issues related to H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act (6) Issues related to H.R. 1190 - Protecting Seniors Access to Medicare Act of 2015 (7) Issues related to H.R. 2505 - Medicare Advantage Coverage Transparency Act of 2015 (8) Issues related to H.R. 2506 - Seniors Health Care Plan Protection Act of 2015 (9 Issues related to H.R. 2507 - Increasing Regulatory Fairness Act of 2015 (10)Issues related to H.R. 2579 - Securing Care for Seniors Act of 2015 (11) Issues related to H.R.3244 - Providing Innovative Care for Complex Cases Demonstration Act of 2015 (12) Issues related to H.R.3288 - Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 (13) Issues related to H.R. 4275 - Medicare Advantage Quality Payment Relief Act of 2015 (14) Issues related to H.R.3831 - Securing Fairness in Regulatory Timing Act of 2015 (15) Issues related to H.R.2582 - Seniors' Health Care Plan Protection Act of 2015

Client expense: $1,010,000 · Firm income: Not reported

Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act S. 2425 - Patient Access and Medicare Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, ICD-10, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform, Medicare Advantage Payment Shift Offset

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2425 - Patient Access and Medicare Protection Act ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care, Medicare Advantage Payment Shift Offset

Client expense: Not reported · Firm income: $90,000

Department of Health & Human Services: Medicare Advantage: operational issues, annual payment updates and policy changes. HR 2505 - Medicare Advantage Coverage Transparency Act of 2015: To amend title XVIII of the Social Security Act to require the annual reporting of data on enrollment in Medicare Advantage plans. Kelly (R-PA) HR 2507 - Increasing Regulatory Fairness Act of 2015: To amend title XVIII of the Social Security Act to establish an annual rulemaking schedule for payment rates under Medicare Advantage. Brady (R-TX) HR 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015: To amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the copayments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures, and for other purposes. Black (R-TN) HR 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015: To amend title XVIII of the Social Security Act to establish a 3-year demonstration program to test the use of value-based insurance design methodologies under eligible Medicare Advantage plans, to preserve Medicare beneficiary choice under Medicare Advantage, to revise the treatment under the Medicare program of infusion drugs furnished through durable medical equipment, and for other purposes. Brady (R-TX) HR 2582 - Seniors' Health Care Plan Protection Act of 2015: To amend title XVIII of the Social Security Act to delay the authority to terminate Medicare Advantage contracts for MA plans failing to achieve minimum quality ratings, to make improvements to the Medicare Adjustment risk adjustment system, and for other purposes. Buchanan (R-FL) S. 2425 - Patient Access and Medicare Protection Act: To amend titles XVIII and XIX of the Social Security Act to improve payments for complex rehabilitation technology and certain radiation therapy services, to ensure flexibility in applying the hardship exception for meaningful use for the 2015 EHR reporting period for 2017 payment adjustments, and for other purposes. Portman (R-OH)

H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - rulemaking schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/ S. 688) Medicare audit contractor program reforms (H.R. 2156, AFIRM Act) Flexibility in Health IT (H.R. 270, H.R. 3309) Medicare Access and CHIP Reauthorization Act (H.R. 2) Patient status notification (H.R. 876, S. 1349) Rural hospital policies (H.R. 663 / S. 332, H.R. 169 / S. 258, H.R. 1611 / S. 257, S. 1461 / H.R. 2878) Telehealth, interoperability (H.R. 6) Medicare Advantage (H.R. 2505, H.R. 2506, H.R. 2507, H.R. 2579, H.R. 2581) Physician self-referral (H.R. 2027, H.R. 976) Hospital Improvements for Payment Act (H.R. 3291) Post-Acute Care policies (H.R. 1458, H.R. 3298) Graduate Medical Education policy reforms (H.R. 2124, S. 1148, H.R 3292) DSH payment (H.R. 3288) ICD-10

Client expense: $67,490 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

(1) Issues related to Public Law 111-148 - The Patient Protection and Affordable Care Act (provisions related to Medicaid and Medicare); (2) Issues related to Public Law 111-152 - Health Care and Education Reconciliation Act of 2010 (provisions related to Medicaid and Medicare); (3) Issues pertaining to entitlement reform, Medicare Advantage, Part D, Medicaid Dual Eligibles, and Medicare reimbursement and enrollment; (4) Issues related to H.R. 6 - 21st Century Cures Act (5) Issues related to H.R. 2712 - Commonsense Reporting and Verification Act of 2015 (6) Issues related to H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act (7) Issues related to H.R. 1190 - Protecting Seniors Access to Medicare Act of 2015 (8) Issues related to H.R. 2505 - Medicare Advantage Coverage Transparency Act of 2015 (9) Issues related to H.R. 2506 - Seniors Health Care Plan Protection Act of 2015 (10 Issues related to H.R. 2507 - Increasing Regulatory Fairness Act of 2015 (11)Issues related to H.R. 2579 - Securing Care for Seniors Act of 2015 (12)Issues related to CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2015 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter (13) Issues related to CMS Final 2015 Medicare Advantage and Part D Call Letter and Payment Rates (14) Issues related to H.R.3244 - Providing Innovative Care for Complex Cases Demonstration Act of 2015

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

Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Use of psychotropic drugs in Medicaid Medicaid DOC Act S.2104

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act Medicare Advantage Payment Shift Offset ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, ICD-10, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act Medicare Advantage Payment Shift Offset ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care

Client expense: Not reported · Firm income: $90,000

Department of Health & Human Services: Medicare Advantage: operational issues, annual payment updates and policy changes. HR 2505 - Medicare Advantage Coverage Transparency Act of 2015: To amend title XVIII of the Social Security Act to require the annual reporting of data on enrollment in Medicare Advantage plans. Kelly (R-PA) HR 2507 - Increasing Regulatory Fairness Act of 2015: To amend title XVIII of the Social Security Act to establish an annual rulemaking schedule for payment rates under Medicare Advantage. Brady (R-TX) HR 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015: To amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the copayments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures, and for other purposes. Black (R-TN) HR 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015: To amend title XVIII of the Social Security Act to establish a 3-year demonstration program to test the use of value-based insurance design methodologies under eligible Medicare Advantage plans, to preserve Medicare beneficiary choice under Medicare Advantage, to revise the treatment under the Medicare program of infusion drugs furnished through durable medical equipment, and for other purposes. Brady (R-TX) HR 2582 - Seniors' Health Care Plan Protection Act of 2015: To amend title XVIII of the Social Security Act to delay the authority to terminate Medicare Advantage contracts for MA plans failing to achieve minimum quality ratings, to make improvements to the Medicare Adjustment risk adjustment system, and for other purposes. Buchanan (R-FL)

H.R. 1190- Protecting Seniors' Access to Medicare Act of 2015 S. 141 - Protecting Seniors' Access to Medicare Act of 2015 H.R. 2505 - the Medicare Advantage Coverage Transparency Act H.R. 3288 - Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act- H.R. 3291 - Medicare Crosswalk Hospital Code Development Act H.R. 3292 - the Medicare IME Pool Act of 2015 H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act S. 804 -Medicare CGM Access Act of 2015 H.R. 1427 - Medicare CGM Access Act of 2015 S. 1131- Medicare Diabetes Prevention Act of 2015 H.R. 2102 - Medicare Diabetes Prevention Act of 2015

Client expense: $140,000 · Firm income: Not reported

H.R. 2, Medicare Access and CHIP Reauthorization Act - Medicare physician payment reform, CHIP funding, Medigap, Medicare Advantage Special Needs Plans, Medicare Cost Plans, fraud provisions, QI and TMA programs H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1892, Trade Adjustment Assistance Reauthorization Act (Reichert) - Medicare sequestration cuts H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - rulemaking schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.Con.Res. 27, Budget Resolution (Price) - Medicare, Medicaid, health policy issues S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1268, Trade Adjustment Assistance Reauthorization Act (Hatch) - Medicare sequestration cuts S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S.Con.Res. 11, Budget Resolution (Enzi) - Medicare, Medicaid, health policy issues Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, Recovery Audit Contractor (RAC) audits, Part D prescriber enrollment requirement, and provider directories and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); ICD-10; Value-Based Insurance Design; Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

Department of Health & Human Services: Medicare Advantage: operational issues, annual payment updates and policy changes. HR 2 - Medicare Access and CHIP Re-authorization Act. Burgess (R-TX) HR 2505 - Medicare Advantage Coverage Transparency Act of 2015: To amend title XVIII of the Social Security Act to require the annual reporting of data on enrollment in Medicare Advantage plans. Kelly (R-PA) HR 2507 - Increasing Regulatory Fairness Act of 2015: To amend title XVIII of the Social Security Act to establish an annual rulemaking schedule for payment rates under Medicare Advantage. Brady (R-TX) HR 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015: To amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the copayments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures, and for other purposes. Black (R-TN) HR 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015: To amend title XVIII of the Social Security Act to establish a 3-year demonstration program to test the use of value-based insurance design methodologies under eligible Medicare Advantage plans, to preserve Medicare beneficiary choice under Medicare Advantage, to revise the treatment under the Medicare program of infusion drugs furnished through durable medical equipment, and for other purposes. Brady (R-TX) HR 2582 - Seniors' Health Care Plan Protection Act of 2015: To amend title XVIII of the Social Security Act to delay the authority to terminate Medicare Advantage contracts for MA plans failing to achieve minimum quality ratings, to make improvements to the Medicare Adjustment risk adjustment system, and for other purposes. Buchanan (R-FL)

(1) Issues related to Public Law 111-148 - The Patient Protection and Affordable Care Act (provisions related to Medicaid and Medicare); (2) Issues related to Public Law 111-152 - Health Care and Education Reconciliation Act of 2010 (provisions related to Medicaid and Medicare); (3) Issues pertaining to entitlement reform, Medicare Advantage, Part D, Medicaid Dual Eligibles, and Medicare reimbursement and enrollment; (4) Issues related to H.R. 6 - 21st Century Cures Act (5) Issues related to H.R. 2712 - Commonsense Reporting and Verification Act of 2015 (6) Issues related to H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act (7) Issues related to H.R. 1190 - Protecting Seniors Access to Medicare Act of 2015 (8) Issues related to H.R. 2505 - Medicare Advantage Coverage Transparency Act of 2015 (9) Issues related to H.R. 2506 - Seniors Health Care Plan Protection Act of 2015 (10 Issues related to H.R. 2507 - Increasing Regulatory Fairness Act of 2015 (11)Issues related to H.R. 2579 - Securing Care for Seniors Act of 2015 (12)Issues related to CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2015 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter (13) Issues related to CMS Final 2015 Medicare Advantage and Part D Call Letter and Payment Rates

Client expense: $510,000 · Firm income: Not reported

SBE Council continues to advocate for tax system reform and making temporary and extended measures permanent. In addition to broad regulatory reform that includes cost-benefit analysis, small business input, and greater transparency and accountability, SBE Council continues to weigh in on specific regulatory proposals and actions at various agencies (for example, various EPA proposals). SBE Council has continued to push for trade agreements and TPA for the President. Specific bills on a wide range of issues, supported by SBE Council over the past three months, include the following: Tax Reform and Relief: S. 860 and H.R. 1105 Death Tax Repeal Act, support both bills, and supported House passage of H.R. 1105. H.R. 880, American Research and Competitiveness Act, support. H.R. 160, Protect Medical Innovation Act of 2015, supported House passage. S.149, Medical Device Access and Innovation Protection Act of 2015 (medical device tax repeal), support. Continue to support Tax Reform and work of Senate Finance Committee working groups in crafting tax reform to ensure rate reduction and parity for small business taxpayers. Affordable Health Coverage and Health Care Reform: S. 141 & H.R. 1190, Protect Seniors Access to Medicare Act (IPAB Repeal), support and supported House passage. H.R. 2505, Medicare Advantage Coverage Transparency Act, support. H.R. 1624 and S. 1099, Protecting Affordable Coverage for Employees Act, support. H.R. 2400 and S. 1368, Special Inspector General for Monitoring the Affordable Care Act, support. H.R. 1190, Repeal of Independent Payment Advisory Board, supported House passage. Continue to advocate for various changes to the Affordable Care Act (ACA), including repeal of employer mandate, changes to the 30 hour rule to 40 hours, and allowing employers to contribute to employees' health care expenses. Trade: Trade Promotion Authority (TPA), supported House and Senate passage of Bipartisan Congressional Trade Priorities and Accountability Act (legislation giving the president TPA). H.R. 2587, State Trade Coordination Act, support. H.R. 2586, Export Coordination Act, support. Energy: S.1312, Energy Supply and Distribution Act of 2015 (repeals crude oil export ban), support. H.R. 1734, Improving Coal Combustion Residuals Regulatory Act of 2015, support. H.R. 2042, Ratepayer Protection Act of 2015, supported House passage. Continue to voice support for LNG exports, and taxes and new regulations that would impose barriers and costs on U.S. energy development and production. Entrepreneurship, Innovation and the Internet, Telecommunications: H.R. 962, Startup Act of 2015, support. H.R. 805, DOTCOM Act, supported House passage. Continue to express concern about FCC Title II regulation to Congress and the need for reform legislation that pulls back on the commissions open internet rules. Regulation, Regulatory Reform and Transparency: Senate Resolution: Regulation Sensibility Through Oversight Regulation, support. H.R. 1732, Regulatory Integrity and Protection Act, supported House passage. H.R. 1195, Bureau of Consumer Financial Protection Advisory Boards Act, supported House passage. H.R. 1759, All Economic Regulations are Transparent Act, support. H.R. 1155, Searching for and Cutting Regulations that are Unnecessarily Burdensome (SCRUB) Act, support. S.554, The Secret Science Reform Act, support. H.R. 1732, Regulatory Integrity and Protection Act, supported House passage. H.R. 1265, The Bureau Advisory Commission Transparency Act, support. Regulatory Comments: Department of Labors New Proposed Definition of Fiduciary: Comment period extension request. Continue to educate about, and advocate against, EPAs proposed ozone rule, power plant rules, and the need to repeal the U.S. Waters rule. Also continue to advocate for a more open and inclusive regulatory process at the EPA. Transportation: Modernizing truck and freight regulations to allow for longer trucks, support action by the Congress as included in the House Transportation, Housing and Urban Development Appropriations Bill. Government Reform: H.R. 1295, Improves the Process for 501c4 Organizations, supported House passage. H.R. 709, Prevent Targeting at the IRS, supported House passage. H.R. 1026, Taxpayer Knowledge of IRS Investigation Act of 2015, supported House passage. H.R. 1562 & 1563, Contracting and Tax Accountability Act, and Federal Employee Tax Accountability Act, supported House passage. H.R. 1314, Appeals process for organizations denied tax-exempt status, support.

Actuarial soundness Amendment to S.Con.Res.11 regarding continuous enrollment in Medicaid Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs CHIP funding extension Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015 H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Marketing rule consistency across Medicaid and the Exchange Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid PCP rate increase Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act SNP reauthorization 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 HR 546/S 298 Medicaid eligibility programs including TMA and QI

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

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act Medicare Advantage Payment Shift Offset ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care

Client expense: Not reported · Firm income: $90,000

PL 111-148 - The Patient Protection and Affordable Care Act, implementation 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. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act Medicare Advantage Payment Shift Offset ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, ICD-10, Benefit design, prescription drug safety, Regional PPOs, chronic care

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

50th Anniversary of Medicaid; Actuarial soundness; Appropriate payment, including risk adjustment, for D-SNPs and MMPs; Appropriate quality measurement for D-SNPs and MMPs; Capped Medicaid Funding Proposals; Changes to Medicare/Medicaid programs as part of entitlement reform and deficit reduction efforts; CHIP funding extension; Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles; Fraud, waste, and abuse issues for Medicare and Medicaid; H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015; H.R. 2505, Medicare Advantage Coverage Transparency Act of 2015; H.R. 2506, Seniors' Health Care Plan Protection Act of 2015; H.R. 2507, Increasing Regulatory Fairness Act of 2015; H.R. 2579, Securing Care for Seniors Act of 2015; H.R. 546 and S. 298, The Advancing Care for Exceptional (ACE) Kids Act of 2015; H.R. 700, Stabilize Medicaid and CHIP Coverage Act; High cost specialty medications; Impact of significant budget cuts in Medicaid; Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs; Medicaid and Medicare reform discussions with MACPAC and MedPAC; Medicaid eligibility and enrollment issues; Medicaid eligibility programs including TMA and QI; Medicaid health plans serving as qualified health plans in the Exchange; Medicaid managed care best practices; Medicaid managed care regulations; Medicaid PCP rate increase; Medicaid quality measurement and improvement; Medical loss ratio for Medicaid managed care plans; Mental Health Parity; Network adequacy; Protecting Medicaid from reductions made during budget reconciliation; Regulatory and systematic impact of Medicaid continuous coverage; Risk adjustment; S. 428, Stabilize Medicaid and CHIP Coverage Act; SNP reauthorization; SNP sustainability and improvements to MMPs

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/ S. 688) Medicare audit contractor program reforms (H.R. 2156, AFIRM Act) Flexibility in Health IT Reporting Act (H.R. 270) Medicare Access and CHIP Reauthorization Act (H.R. 2) Patient status notification (H.R. 876, S. 1349) Rural hospital policies (H.R. 663 / S. 332, H.R. 169 / S. 258, H.R. 1611 / S. 257, S. 1461 / H.R. 2878) Telehealth, interoperability (H.R. 6) Medicare Advantage (H.R. 2505, H.R. 2506, H.R. 2507, H.R. 2579, H.R. 2581) Physician self-referral (H.R. 2027, H.R. 976) Hospital Improvements for Payment Act Post Acute Care policies (H.R. 1458) Graduate Medical Education policy reforms (H.R. 2124, S. 1148) ICD-10

Client expense: $74,950 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2 Medicare Access and CHIP Reauthorization Act H.R. 876 NOTICE Act H.R. 887 Electronic Health Fairness Act H.R. 1021 Protecting the Integrity of Medicare Act H.R. 1117 Creating Access to Residency Education (CARE) Act of 2015 H.R. 1686 Preventing Diabetes in Medicare Act of 2015 H.R. 1726 Access to Quality Diabetes Education Act of 2015 H.R.2247 ICD-TEN Act H.R. 2505 the Medicare Advantage Coverage Transparency Act of 2015 H.R. 2506 the Seniors Health Care Plan Protection Act of 2015 H.R. 2507 the Increasing Regulatory Fairness Act of 2015 H.R.2570 Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R.2579 Securing Care for Seniors Act of 2015 H.R.2581 Preservation of Access for Seniors in Medicare Advantage Act of 2015 S. 776 Medication Therapy Management Empowerment Act S. 804 Medicare CGM (continuous glucose monitoring) Access Act of 2015 S. 141/H.R. 1190 Protecting Seniors Access to Medicare Act of 2015 S. 314/H.R. 592 Pharmacy and Medically Underserved Areas Enhancement Act S. 704/H.R. 2704 Community Based Independence for Seniors Act S. 1131/H.R. 2102 Medicare Diabetes Prevention Act of 2015 S. 1148/H.R. 2124 Resident Physician Shortage Reduction Act of 2015 S. 1509/H.R. 2404 Treat and Reduce Obesity Act of 2015 S.1531/H.R. 2756, the Patient Freedom Act of 2015

Client expense: $140,000 · Firm income: Not reported