Preservation of Access for Seniors in Medicare Advantage Act of 2015

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

Implementation of P.L. 111-148, The Patient Protection and Affordable Care Act. Issues relating to healthcare and health insurance policy, tax policy, Medicare Advantage and general Medicare policy, legislation and regulations that impact health insurance brokers. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015. H.R. 6184, Medicare Enrollment Protections Act.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), 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: $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

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

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

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

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

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

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

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

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

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. 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

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

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of

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

Implementation of P.L. 111-148, The Patient Protection and Affordable Care Act. Issues relating to healthcare and health insurance policy, tax policy, Medicare Advantage and general Medicare policy, legislation and regulations that impact health insurance brokers. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015. H.R. 6184, Medicare Enrollment Protections Act.

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

Government targets: HOUSE OF REPRESENTATIVES, 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.

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

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

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

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of

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

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

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

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

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

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

Implementation of P.L. 111-148, The Patient Protection and Affordable Care Act. Issues relating to healthcare and health insurance policy, tax policy, Medicare Advantage and general Medicare policy, legislation and regulations that impact health insurance brokers. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

Client expense: $490,000 · 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

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: $160,000 · 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

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.

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

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) 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: $160,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), 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) 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: $370,000 · 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 Medicare Physician Payment Reform 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 in Regulatory Timing Act H.R. 4275, Medicare Advantage Quality Payment Relief Act S. 1913, Stopping Medication Abuse and Protecting Seniors Act S. 524, Comprehensive Addiction and Recovery Act

Client expense: $600,000 · 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

Implementation of P.L. 111-148, The Patient Protection and Affordable Care Act. Issues relating to healthcare and health insurance policy, tax policy, Medicare Advantage and general Medicare policy, legislation and regulations that impact health insurance brokers. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

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

Client expense: $2,210,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), 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), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office

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

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of

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

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

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

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

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

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

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

Client expense: Not reported · Firm income: Not reported

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

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

Client expense: Not reported · Firm income: Not reported

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

Medicare Advantage. Health reform implementation. Medicare Reform. 2016-2017 Medicare Advantage Payment Rates. H. Con Res 27 and S. Con Res 11, Budget for the U.S. Government for FY2016. H.R. 2, The Medicare Access and CHIP Reauthorization Act of 2015. H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015. H.R. 2507, Increasing Regulatory Fairness Act of 2015. H.R. 2582, Seniors' Health Care Plan Protection Act of 2015. H.R. 3831, Securing Fairness and Regulatory Timing.

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

Government targets: HOUSE OF REPRESENTATIVES, 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).

Client expense: $140,000 · 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

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

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

Client expense: $2,470,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), 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), Patent & Trademark Office (PTO), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office

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

Client expense: $1,850,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), 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), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office

Medicare Advantage Policy and Reimbursement Part D Policy and Reimbursement Medicaid and Dual Eligible Issues Pharmacy Reimbursement Issues Medicare Physician Payment Reform 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 in Regulatory Timing Act H.R. 2029, Consolidated Appropriations Act H.R. 4275, Medicare Advantage Quality Payment Relief Act

Client expense: $600,000 · 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

Possible changes to the coverage of Medigap insurance (PL 114-10) and the reimbursement rates for Medicare Advantage plans (H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015; H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of

Discussed Affordable Care Act Medicaid expansion issues, including AARP comments on state 1115 waiver proposals to expand Medicaid. H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015 - Discussed Sustainable Growth Rate with Hill staffers. Discussed Medicare Supplemental Insurance with Hill staffers. (no bill) Discussed the Affordable Care Act with Hill staffers. (no bill) Discussed Medicare Advantage with Hill staffers. (no bill) S.Con.Res.11, Budget Resolution, FY 2016 - Lobbied to protect various programs serving Americans age 50 and above, including employment training, health and human services, and energy assistance for seniors, the disabled and other low-income assistance. H.R. 2029,H.J.Res.75, H.J.Res.78, Labor, HHS, Education and Related Agencies Appropriations, FY2016 - Lobbied to protect and enhance funding for various programs serving older and low-income Americans. Also lobbied to protect access to affordable health care and financial security, including support of DOL's conflict of interest rulemaking. H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 - staff discussions. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015 - staff discussion. H.R. 588, Medicare Beneficiary Preservation of Choice Act of 2015 - staff discussions. Sent email communication about AARP paper on generic drug prices. Sent email communication on the 21st Century Cures legislation. Sent invitation for the AARP Foundation and Feeding Americas Facing Hunger After Fifty briefing. HR 1270, S.709 - Restoring Access to Medication Act - meetings, calls and emails urging support. H.R. 3590, Helping Every American Limit Their Health Expenses Act - Provided feedback to members offices. S.1397, Value Based Insurance Design Seniors Copayment Reduction Act of 2015 - met with Senate Finance Committee D and R Staff and spoke with personal staff on both sides. Reached out to W&M staff on Cadillac Tax. Provided feedback to staff on draft bill to provide safe harbor to HSA use in high-deductible health plans. Discussed Medicare-Medicaid integration efforts and financial alignment demonstrations, other CMS demonstration initiatives. (no bill) S. 192, Discussed Older Americans Act reauthorization legislation. Discussed older worker employment programs including the Senior Community Service Employment Program (SCSEP) under the Older Americans Act. Discussed nutrition programs including the Supplemental Nutrition Assistance Program (SNAP). H.R.1220, S.624, Discussed the removing barriers to Colorectal Cancer Screening Act. H.R. 815, Discussed Access to Professional Health Insurance Act of 2015.

Client expense: $1,880,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Congressional Budget Office (CBO), Consumer Financial Protection Bureau (CFPB), Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), White House Office

Implementation of P.L. 111-148, The Patient Protection and Affordable Care Act. Issues relating to healthcare and health insurance policy, tax policy, Medicare Advantage and general Medicare policy, legislation and regulations that impact health insurance brokers. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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