Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015

HR 1600; SECTIONS RELATING TO SPECIALTY TIERS, HR 2570; RELATING TO COMPETITIVE BIDDING OF INFUSION PUMPS AND DRUGS, S. 275; SECTIONS RELATING TO COMPETITIVE BIDDING OF INFUSION PUMPS AND DRUGS, ISSUES RELATING TO ORPHAN DRUG DESIGNATIONS, FDA/OMNIBUS APPROPRIATIONS PROVISIONS RELATING TO PLASMA PROTEIN THERAPIES, AFFORDABLE CARE ACT, MEDICARE REIMBURSEMENT, COMMENTS RELATING TO HRSA AND 340B PROGRAM. HRSA NPRM RELATED TO PART B REIMBURSEMENT MODEL.

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

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

Medicare reimbursement relating to plasma protein therapies; H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015, and H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015, provisions related to DME infused drugs; H.R. 6, 21st Century Cures Act, provisions related to DME infusion drugs. Medicare reimbursement methodology for DME infused drugs, generally.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 275-Medicare Home Infusion Site of Care Act of 2015, H.R. 2570-Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015, H.R. 1611-Protecting Access to Rural Therapy Services (PARTS) Act, H.R. 34- 21st Century Cures Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Part D drug coverage and patient access issues and policy ESRD bundling and drug reimbursement issues HCPCS coding and reimbursement decisions Implementation of Patient Protection & Affordable Health Care Act (P.L. 111-148) and Implementation of Health Care and Education Reconciliation Act (P.L. 111-152) Least costly alternative (LCA) policy Changes re: Medicare Part B and Average Sales Price Medicare secondary payor for ESRD services Extension of rebates on Medicare Part D drugs Performance measures for bone and mineral metabolism for ESRD program Implementation of American Taxpayer Relief Act of 2012 H.R. 1416, Cancer Patient Protection Act of 2015 21st Century Cures/Innovation initiatives, including H.R. 6, 21st Century Cures Act S. 506, To amend Part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes H.R. 696, To amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes Medicaid drug rebate, drug coverage and patient access to therapies issues and policy S. 31, Medicare Prescription Drug Price Negotiation Act of 2015 H.R. 1130, Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 S. 598, Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 S. 648, Medicare Formulary Improvement Act of 2015 H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015 H.R.2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare Part B Prescription Drug Models

Client expense: $260,000 · Firm income: Not reported

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

H.R. 1453/S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015 H.R. 1220/S. 624 - Removing Barriers to Colorectal Cancer Screening Act of 2015 H.R. 887/S. 1347 - Electronic Health Fairness Act of 2015 H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 H.R. 2299 - To amend title XVIII of the Social Security Act to provide for site-of-service price transparency under the Medicare program H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 21st Century Cures Act Reform of Medicare payments to ASCs Reform of Medicare regulations dealing with ASCs

Client expense: $206,044 · Firm income: Not reported

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

Issues related to implementation of Section 1557 of ACA HR 793 - Ensuring Seniors Access to Local Pharmacies Act HR 2570-Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 HR 605-Medicare Home Infusion Site of Care Act S 275-Medicare Home Infusion Site of Care Act

Client expense: $2,080,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA)

Medicare Advantage Policy and Reimbursement Part D Policy and Reimbursement Medicaid and Dual Eligible Issues Pharmacy Reimbursement Issues Medicare Access and CHIP Reauthorization Act (MACRA) Implementation Chronic Care Working Group Issues H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors H.R. 2581, Preservation of Access for Seniors in Medicare Advantage 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 Act H.R. 4275, Medicare Advantage Quality Payment Relief Act S. 1913, Stopping Medication Abuse and Protecting Seniors Act S. 524/H.R. 953, Comprehensive Addiction and Recovery Act Opioid and Drug Abuse Issues H.R. 5659, ESRD Choice Act

Client expense: $670,000 · Firm income: Not reported

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

H.R. 34, 21st Century Cures Act (Upton) - Medicare Advantage and Medicaid issues 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 S. 3504, Chronic Care Act (Hatch-Wyden-Isakson-Warner) - chronic care reforms, Medicare Advantage provisions 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. *Add MACPAC to Agency List.

Client expense: $1,330,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office

H.R. 6, H.R. 34 & Public Law 114-255, 21st Century Cures Act; S. 2700, FDA and NIH Workforce Authorities Modernization Act; H.R. 3381, Childhood Cancer STAR Act; Discussions to clarify or reform the 340B program; Biologics Price Competition and Innovation Act; Public Law 111-148, The Patient Protection and Affordable Care Act; Public Law 111-152, The Health Care and Education Reconciliation Act; H.R. 2228 & S.122, Safe and Affordable Drugs from Canada Act of 2015; Proposals to address prescription drug abuse; Implementation/Reauthorization of The Prescription Drug User Fee Act (PDUFA); Implementation/Reauthorization of The Biosimilars User Fee Act (BsUFA); H.R. 639 & S. 481, Improving Regulatory Transparency for New Medical Therapies; H.R. 2570 & S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act of 2015; H.R. 3012 & S. 2912, Trickett Wendler Right to Try Act of 2016; H.R. 6043 & S. 3335, Fair Accountability and Innovative Research Drug Pricing Act of 2016; S.3239, RACE for Children Act; Expanded Access (legislation not introduced) H.R. 4207, Medicare Fair Drug Pricing Act of 2015; Clinton's 1993 Health Security Act; S. 2023, Prescription Drug Affordability Act of 2015; H.R. 6501, Prescription Drug and Medical Device Price Review Board Act of 2016; S.3455, Pharmaceutical Supply and Value Enhancement Act; Repeal and Replace Proposals for Public Law 111-148, The Patient Protection and Affordable Care Act (no legislation introduced);

Client expense: $1,040,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR)

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)

Client expense: $1,450,000 · Firm income: Not reported

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

Medicare Advantage Policy and Reimbursement. Part D Policy and Reimbursement. Medicaid and Dual Eligible issues. Pharmacy Reimbursement Issues. MACRA Implementation. H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act. H.R. 2507, Increasing Regulatory Fairness Act. H.R. 2582, Seniors' Health Care Plan Protection Act. H.R. 3831, Securing Fairness and Regulatory Timing. H.R. 4275, Medicare Advantage Quality Payment Relief Act. S. 1913, Stopping Medication Abuse and Protecting Seniors ACt. S. 524 and H.R. 953, Comprehensive Addiction and Recovery Act. Opioid and Drug Abuse Issues. H.R. 5659, ESRD Choice Act. H.R. 6, 21st Century Cures Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1416, Cancer Patient Protection Act, regarding all biopharmaceutical related provisions. H.R. 1190 and S. 41, Protecting Seniors' Access to Medicare Act, regarding all biopharmaceutical related provisions. H.R. 2, Medicare Access and CHIP Authorization Act, regarding all biopharmaceutical related provisions H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act, regarding all biopharmaceutical related provisions. No Bill, lobbied on price controls for biopharmaceuticals in government health care programs. No Bill, lobbied on the proposed rule on the CMMI Medicare Part B demonstration project. H.R. 5122, legislation to prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models,regarding all biopharmaceutical related provisions.

Client expense: $560,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, U.S. Trade Representative (USTR)

HR 605/S 275 - The Medicare Home Infusion Site of Care Act - Lobbied in support of passage of the legislation to ensure Medicare beneficiaries have access to home infusion. IVIG Coverage Demonstration - Worked with CMS to ensure the IVIG Demonstration is carried out in a manner that is beneficial to Medicare beneficiaries. Medicare Audits and ALJ Hearings - Continued efforts supporting reforms to the Medicare Audits system. Competitive bidding of DMEPOS - worked to ensure competitive bidding does not adversely affect the home infusion industry's ability to provide infusion services. HR 6 / HR 2581 / HR 2570 / S 2409 / HR 4273 / HR 34 - lobbied House and Senate against ASP infusion drug pricing without inclusion of a services payment for home infusion pharmacies under the Medicare DME Program. Lobbied for inclusion of services payment under the legislation. Medicare Program; Part B Drug Payment Model - lobbied House and Senate regarding the effects of the Medicare Program; Part B Drug Payment Model demonstration project released on Friday, March 11, 2016 (81 FR 13229). MLN Learning Matters SE- 1609 and DME MAC Billing Guidance-Billing for External Infusion Pumps and Drugs When Treatment Was Initiated Somewhere Other Than the Beneficiary Home - Lobbied for delay in MLN Learning Matters and a moratorium on the Billing Guidance.

Client expense: $125,000 · Firm income: Not reported

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

PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation, Medicare and Medicaid Reimbursement, Medicaid Rebate 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. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 4273 - Medicare and Medicaid Improvements and Adjustments Act of 2015 S. 2425 - Patient Access and Medicare Protection Act Part B demonstration H.R. 5122 - Part B demonstration ***, no specific bill(s), Medicare and Medicaid Drug Reimbursement, Medicaid Rebate, dual eligibles, Sunshine, discount cards, MedPAC, biosimilars, Alternative Payment Models, Value based Purchasing, coding, CMMI

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

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

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

H.R. 815 and S.1661: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. S. 620 and H.R. 1189: The Preserving Employee Wellness Programs Act, looks to reaffirm existing law allowing employee wellness programs tied to financial awards H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. H.R. 2712 and S. 1996: Commonsense Reporting and Verification Act of 2015, bill to ease PPACA employer reporting requirements. S. 1099: To amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1415: To amend the Internal Revenue Code of 1986 to modify the definition of large employer for purposes of applying the employer mandate. H.R. 879: This bill repeals, effective for taxable years beginning after 2017, the excise tax on the excess benefit portion of high-cost employer-sponsored health care plans. H.R. 2050: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). H.R.2570: Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R. 2911 and S. 1697: To provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market, and for other purposes. House passed budget resolution for upcoming fiscal year S. 2045: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). S. 2075: This bill amends the Internal Revenue Code to repeal, for taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). The bill expresses the sense of the Senate that the revenue loss resulting from the repeal of such excise tax should be offset by corresponding revenue. -H.R.3762: Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 -H.R.2029: The Omnibus Appropriations bill -2015 Reconciliation bill -H.R. 5447 and S. 3060: Small Business Health Care Relief Act of 2016 -H.R. 3463: Aligning Children's Dental Coverage Act (ACDC) -H.R. 5589: To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. -S. 3244: The legislation clarifies that people outside the public Exchanges can have the same choices for dental coverage as people inside the public Exchanges. -H.R. 2488: Medicare Beneficiary Preservation of Choice Act of 2015 -H.R. 6184: legislation that would allow seniors enrolled in COBRA coverage to transition to Medicare Part B without a penalty -H.R 2581: Preservation of Access for Seniors in Medicare Advantage Act of 2015 -H.R.173: A bill to amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage -S.58: A bill to amend the Internal Revenue Code of 1986 to repeal the excise tax on high cost employer-sponsored health coverage. -H.R.246: A bill to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act.

Client expense: $330,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

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

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

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

HR 1600; SECTIONS RELATING TO SPECIALTY TIERS, HR 2570; RELATING TO COMPETITIVE BIDDING OF INFUSION PUMPS AND DRUGS, S. 275; SECTIONS RELATING TO COMPETITIVE BIDDING OF INFUSION PUMPS AND DRUGS, ISSUES RELATING TO ORPHAN DRUG DESIGNATIONS, FDA/OMNIBUS APPROPRIATIONS PROVISIONS RELATING TO PLASMA PROTEIN THERAPIES, AFFORDABLE CARE ACT, MEDICARE REIMBURSEMENT, COMMENTS RELATING TO HRSA AND 340B PROGRAM. HRSA NPRM RELATED TO PART B REIMBURSEMENT MODEL.HR 34, 21st Century Cures Act, sections relating to DME Competitive Bidding and Infusion Drugs

Client expense: $50,000 · Firm income: Not reported

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

Independence at Home Act of 2016 (S. 3130), Value-based Insurance Design Seniors Copayment Reduction Act of 2015 (S.1396), Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 205 (H.R. 2570) (Value-Based Insurance Design in Medicare Advantage), dental coverage in the Medicare program

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6, 21st Century Cures Act S. 2700, FDA and NIH Workforce Authorities Modernization Act; H.R. 3381, Childhood Cancer STAR Act; Discussions to clarify or reform the 340B program; Biologics Price Competition and Innovation Act; H.R. 1101 & S. 1287, Viral Hepatitis Testing Act; Public Law 111-148, The Patient Protection and Affordable Care Act; H.R. 471 & S. 483, Ensuring Patient Access and Effective Drug Enforcement of 2015; H.R. 1725 & S. 480, National All Schedules Prescription Electronic Reporting Reauthorization of 2015; H.R. 2228 & S.122, Safe and Affordable Drugs from Canada Act of 2015; Proposals to address prescription drug abuse; Implementation of The Prescription Drug User Fee Act (PDUFA); Implementation of The Biosimilars User Fee Act (BsUFA); Public Law 113-54, Drug Quality & Security Act; H.R. 639 & S. 481, Improving Regulatory Transparency for New Medical Therapies; H.R. 2570 & S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act of 2015; H.R. 3677 Opioid Abuse Prevention and Treatment Act of 2015; S. 524, Comprehensive Addiction and Recovery Act of 2016;

Client expense: $2,610,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Security Council (NSC), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA)

Part D drug coverage and patient access issues and policy ESRD bundling and drug reimbursement issues HCPCS coding and reimbursement decisions Implementation of Patient Protection & Affordable Health Care Act (P.L. 111-148) and Implementation of Health Care and Education Reconciliation Act (P.L. 111-152) Least costly alternative (LCA) policy Changes re: Medicare Part B and Average Sales Price Medicare secondary payor for ESRD services Extension of rebates on Medicare Part D drugs Performance measures for bone and mineral metabolism for ESRD program Implementation of American Taxpayer Relief Act of 2012 H.R. 1416, Cancer Patient Protection Act of 2015 21st Century Cures/Innovation initiatives, including H.R. 6, 21st Century Cures Act S. 506, To amend Part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes H.R. 696, To amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes Medicaid drug rebate, drug coverage and patient access to therapies issues and policy S. 31, Medicare Prescription Drug Price Negotiation Act of 2015 H.R. 1130, Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 S. 598, Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 S. 648, Medicare Formulary Improvement Act of 2015 H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015 H.R.2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare Part B Prescription Drug Models

Client expense: $270,000 · Firm income: Not reported

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

H.R. 1453/S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015 H.R. 1220/S. 624 - Removing Barriers to Colorectal Cancer Screening Act of 2015 H.R. 887/S. 1347 - Electronic Health Fairness Act of 2015 H.R. 1314 - Bipartisan Budget Act of 2015 H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 H.R. 2299 - To amend title XVIII of the Social Security Act to provide for site-of-service price transparency under the Medicare program H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 Reform of Medicare payments to ASCs Reform of Medicare regulations dealing with ASCs

Client expense: $201,900 · Firm income: Not reported

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

HR 793 - Ensuring Seniors Access to Local Pharmacies Act HR 4062 - Protecting Seniors Access to Proper Care Act of 2015 HR 2570-Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 HR 605-Medicare Home Infusion Site of Care Act S 275-Medicare Home Infusion Site of Care Act H.R. 5951-Improving Transparency and Accuracy in Medicare Part D Spending Act

Client expense: $1,320,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

Medicare Advantage Policy and Reimbursement Part D Policy and Reimbursement Medicaid and Dual Eligible Issues Pharmacy Reimbursement Issues Medicare Access and CHIP Reauthorization Act (MACRA) Implementation Chronic Care Working Group Issues H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors H.R. 2581, Preservation of Access for Seniors in Medicare Advantage 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 Act H.R. 4275, Medicare Advantage Quality Payment Relief Act S. 1913, Stopping Medication Abuse and Protecting Seniors Act S. 524/H.R. 953, Comprehensive Addiction and Recovery Act Opioid and Drug Abuse Issues H.R. 5659, ESRD Choice Act

Client expense: $480,000 · Firm income: Not reported

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

H.R. 6, 21st Century Cures Act; S. 2700, FDA and NIH Workforce Authorities Modernization Act; Discussions to clarify or reform the 340B program; Biologics Price Competition and Innovation Act; H.R. 1101 & S. 1287, Viral Hepatitis Testing Act; Public Law 111-148, The Patient Protection and Affordable Care Act; H.R. 2228 & S.122, Safe and Affordable Drugs from Canada Act of 2015; Proposals to address prescription drug abuse; Implementation/Reauthorization of The Prescription Drug User Fee Act (PDUFA); Implementation/Reauthorization of The Biosimilars User Fee Act (BsUFA); H.R. 639 & S. 481, Improving Regulatory Transparency for New Medical Therapies; H.R. 2570 & S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act of 2015; H.R. 3677 Opioid Abuse Prevention and Treatment Act of 2015; S. 524, Comprehensive Addiction and Recovery Act of 2016; H.R. 3012 & S. 2912, Trickett Wendler Right to Try Act of 2016; H.R. 6043 & S. 3335, Fair Accountability and Innovative Research Drug Pricing Act of 2016; H.R. 6174, Closing Loopholes for Orphan Drugs Act; S.3239, RACE for Children Act; Expanded Access (legislation not introduced); H.R. 4207, Medicare Fair Drug Pricing Act of 2015; Clinton's 1993 Health Security Act;

Client expense: $1,920,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR)

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.

Client expense: $1,710,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office

H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors; S. 275 / H.R. 605, The Medicare Home Infusion Site of Care Act of 2015 and issues related to reimbursement for infused drugs administered through DME. Issues related to pharmaceutical prices, including the Part B Demonstration.

Client expense: Not reported · Firm income: $52,500

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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)

Client expense: $145,000 · Firm income: Not reported

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

HR 605/S 275 - The Medicare Home Infusion Site of Care Act - Lobbied in support of passage of the legislation to ensure Medicare beneficiaries have access to home infusion. IVIG Coverage Demonstration - Worked with CMS to ensure the IVIG Demonstration is carried out in a manner that is beneficial to Medicare beneficiaries. Medicare Audits and ALJ Hearings - Continued efforts supporting reforms to the Medicare Audits system. Competitive bidding of DMEPOS - worked to ensure competitive bidding does not adversely affect the home infusion industry's ability to provide infusion services. HR 6 / HR 2581 / HR 2570 / S 2409 / HR 4273 - lobbied House and Senate against ASP infusion drug pricing without inclusion of a services payment for home infusion pharmacies under the Medicare DME Program. Medicare Program; Part B Drug Payment Model - lobbied House and Senate regarding the effects of the Medicare Program; Part B Drug Payment Model demonstration project released on Friday, March 11, 2016 (81 FR 13229). MLN Learning Matters SE- 1609 and DME MAC Billing Guidance-Billing for External Infusion Pumps and Drugs When Treatment Was Initiated Somewhere Other Than the Beneficiary Home - Lobbied for delay in MLN Learning Matters and a moratorium on the Billing Guidance.

Client expense: $150,000 · Firm income: Not reported

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

H.R. 1416, Cancer Patient Protection Act, regarding all biopharmaceutical related provisions. H.R. 1190 and S. 41, Protecting Seniors' Access to Medicare Act, regarding all biopharmaceutical related provisions. H.R. 2, Medicare Access and CHIP Authorization Act, regarding all biopharmaceutical related provisions H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act, regarding all biopharmaceutical related provisions. No Bill, lobbied on price controls for biopharmaceuticals in government health care programs. No Bill, lobbied on the proposed rule on the CMMI Medicare Part B demonstration project. H.R. 5122, legislation to prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models,regarding all biopharmaceutical related provisions.

Client expense: $810,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, U.S. Trade Representative (USTR)

PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation, Medicare and Medicaid Reimbursement, Medicaid Rebate 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. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 4273 - Medicare and Medicaid Improvements and Adjustments Act of 2015 S. 2425 - Patient Access and Medicare Protection Act Part B demonstration H.R. 5122 - Part B demonstration ***, no specific bill(s), Medicare and Medicaid Drug Reimbursement, Medicaid Rebate, dual eligibles, Sunshine, discount cards, MedPAC, biosimilars, Alternative Payment Models, Value based Purchasing, coding

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

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

S. 275-Medicare Home Infusion Site of Care Act of 2015, H.R. 2570-Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015, H.R. 1611-Protecting Access to Rural Therapy Services (PARTS) Act

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

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 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

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

HR 1600; SECTIONS RELATING TO SPECIALTY TIERS, HR 2570; RELATING TO COMPETITIVE BIDDING OF INFUSION PUMPS AND DRUGS, S. 275; SECTIONS RELATING TO COMPETITIVE BIDDING OF INFUSION PUMPS AND DRUGS, ISSUES RELATING TO ORPHAN DRUG DESIGNATIONS, FDA/OMNIBUS APPROPRIATIONS PROVISIONS RELATING TO PLASMA PROTEIN THERAPIES, AFFORDABLE CARE ACT, MEDICARE REIMBURSEMENT, COMMENTS RELATING TO HRSA AND 340B PROGRAM. HRSA NPRM RELATED TO PART B REIMBURSEMENT MODEL.

Client expense: $50,000 · Firm income: Not reported

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

HR 2570; RELATING TO COMPETITIVE BIDDING OF INFUSION PUMPS AND DRUGS, S.275; SECTIONS RELATING TO COMPETITIVE BIDDING OF INFUSION PUMPS AND DRUGS, ISSUES RELATING TO ORPHAN DRUG DESIGNATIONS, FDA/OMNIBUS APPROPRIATIONS AND PROVISIONS RELATING TO PLASMA PROTEIN THERAPIES, AFFORDABLE CARE ACT, MEDICARE REIMBURSEMENT, COMMENTS SUBMITTED TO CMS AND HRSA RELATING TO HRSA AND 340B PROGRAM. NPRM CONCERNING PART B REIMBURSEMENT.

Client expense: $50,000 · Firm income: Not reported

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

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

Medicare Advantage Policy and Reimbursement. Part D Policy and Reimbursement. Medicaid and Dual Eligible issues. Pharmacy Reimbursement Issues. MACRA Implementation. H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act. H.R. 2507, Increasing Regulatory Fairness Act. H.R. 2582, Seniors' Health Care Plan Protection Act. H.R. 3831, Securing Fairness and Regulatory Timing. H.R. 4275, Medicare Advantage Quality Payment Relief Act. S. 1913, Stopping Medication Abuse and Protecting Seniors ACt. S. 524 and H.R. 953, Comprehensive Addiction and Recovery Act. Opioid and Drug Abuse Issues. H.R. 5659, ESRD Choice Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 815 and S.1661: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. S. 620 and H.R. 1189: The Preserving Employee Wellness Programs Act, looks to reaffirm existing law allowing employee wellness programs tied to financial awards H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. H.R. 2712 and S. 1996: Commonsense Reporting and Verification Act of 2015, bill to ease PPACA employer reporting requirements. S. 1099: To amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1415: To amend the Internal Revenue Code of 1986 to modify the definition of large employer for purposes of applying the employer mandate. H.R. 879: This bill repeals, effective for taxable years beginning after 2017, the excise tax on the excess benefit portion of high-cost employer-sponsored health care plans. H.R. 2050: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). H.R.2570: Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R. 2911 and S. 1697: To provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market, and for other purposes. House passed budget resolution for upcoming fiscal year S. 2045: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). S. 2075: This bill amends the Internal Revenue Code to repeal, for taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). The bill expresses the sense of the Senate that the revenue loss resulting from the repeal of such excise tax should be offset by corresponding revenue. -H.R.3762: Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 -H.R.2029: The Omnibus Appropriations bill -2015 Reconciliation bill -H.R. 5447 and S. 3060: Small Business Health Care Relief Act of 2016 -H.R. 3463: Aligning Children's Dental Coverage Act (ACDC) -H.R. 5589: To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. -S. 3244: The legislation clarifies that people outside the public Exchanges can have the same choices for dental coverage as people inside the public Exchanges. -H.R. 2488: Medicare Beneficiary Preservation of Choice Act of 2015 -H.R. 6184: legislation that would allow seniors enrolled in COBRA coverage to transition to Medicare Part B without a penalty -H.R 2581: Preservation of Access for Seniors in Medicare Advantage Act of 2015

Client expense: $330,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

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

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

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

Part D drug coverage and patient access issues and policy ESRD bundling and drug reimbursement issues HCPCS coding and reimbursement decisions Implementation of Patient Protection & Affordable Health Care Act (P.L. 111-148) and Implementation of Health Care and Education Reconciliation Act (P.L. 111-152) Least costly alternative (LCA) policy Changes re: Medicare Part B and Average Sales Price Medicare secondary payor for ESRD services Extension of rebates on Medicare Part D drugs Performance measures for bone and mineral metabolism for ESRD program Implementation of American Taxpayer Relief Act of 2012 H.R. 1416, Cancer Patient Protection Act of 2015 21st Century Cures/Innovation initiatives, including H.R. 6, 21st Century Cures Act S. 506, To amend Part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes H.R. 696, To amend part B of title XVIII of the Social Security Act to exclude customary prompt pay discounts from manufacturers to wholesalers from the average sales price for drugs and biologicals under Medicare, and for other purposes Medicaid drug rebate, drug coverage and patient access to therapies issues and policy S. 31, Medicare Prescription Drug Price Negotiation Act of 2015 H.R. 1130, Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 S. 598, Chronic Kidney Disease Improvement in Research and Treatment Act of 2015 S. 648, Medicare Formulary Improvement Act of 2015 H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015 H.R.2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare Part B Prescription Drug Models

Client expense: $280,000 · Firm income: Not reported

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

Issues related to smoking cessation, Medicare Part D and anti-PBM legislation. Other issues include health care delivery system reforms including telehealth, chronic care, Innovation Initiative & health IT, cost containment and medication adherence. HR 793 - Ensuring Seniors Access to Local Pharmacies Act HR 2570-Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 HR 605-Medicare Home Infusion Site of Care Act S 275-Medicare Home Infusion Site of Care Act HR 2029-Consolidated Appropriations Act of 2016 S 2141-Transparent Ratings on Usability & Security to Transform Information Technology H.R. 2712,Commonsense Reporting and Verification Act of 2015 S. 1996, Commonsense Reporting Act of 2015

Client expense: $1,158,247 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of, Veterans Affairs, Dept of (VA)

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.

Client expense: $1,710,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office

PL 111-148 - The Patient Protection and Affordable Care Act, PL 111-152 - The Reconciliation Act of 2010, implementation, Medicare and Medicaid Reimbursement, Medicaid Rebate 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. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 4273 - Medicare and Medicaid Improvements and Adjustments Act of 2015 S. 2425 - Patient Access and Medicare Protection Act Part B demonstration H.R. 5122 - Part B demonstration ***, no specific bill(s), Medicare and Medicaid Drug Reimbursement, Medicaid Rebate, dual eligibles, Sunshine, discount cards, MedPAC, biosimilars

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

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