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Seniors' Health Care Plan Protection Act of 2015
Legislative Progress
Momentum (last 30 days)
0
score
0 actions · 0 new cosponsors · 0 votes
Speed vs cohort
59pct
20d open
vs 6,526 other HR bills in the 114th — cohort avg 56d
Senior's Health Care Plan Protection Act of 2015 (Sec. 2) It is the intent of Congress to: (1) continue to study and request input on the effects of socioeconomic status and dual-eligible populations on the five-star quality rating system for Medicare Advantage (MA) plans before reforming it, and, pending study and input results, (2) delay Centers for Medicare & Medicaid (CMS) authority to terminate MA plan contracts solely on the basis of performance under the five-star rating system. The Department of Health and Human Services (HHS) may not, through the end of plan year 2018, terminate a contract with respect to the offering of an MA plan by an MA organization solely because the plan has failed to achieve a minimum quality rating under the five-star rating system. (Sec. 3) This bill amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act (SSAct) to direct HHS (in effect, CMS) to revise for 2017, and periodically afterwards, the system for risk adjustments to payments to Medicare+Choice organizations so that an individual's risk score takes into account the number of chronic conditions with which the individual has been diagnosed. HHS must, including an actuarial opinion of the CMS Chief Actuary, evaluate the impacts of: including two years of data to compare the models used to determine the risk scores for 2013 and 2014, removing the diagnosis codes related to chronic kidney disease in the 2014 risk adjustment model, and including 10% of encounter data in computing payment for 2016 and CMS readiness to incorporate encounter data in risk scores. HHS shall also analyze the best practices of MA plans to slow disease progression related to chronic kidney disease. HHS shall then, if appropriate, make revisions to the risk adjustment system, based on such an evaluation or analysis, to better reflect and appropriately weight for the population served. (Sec. 4) Congress declares that: the five-star quality rating system for MA plans lacks proper accounting for the socioeconomic status of plan enrollees and the extent to which those plans serve individuals also eligible for medical assistance under SSAct title XIX (Medicaid); and Congress will work with CMS and stakeholders, including beneficiary groups and managed care organizations, to ensure that the five-star quality rating system for MA plans properly accounts for the socioeconomic status of plan enrollees and the extent to which plans serve them. (Sec. 5) It is also the sense of Congress that HHS should: periodically monitor and improve the risk adjustment model for payments to MA organizations to ensure that it accurately accounts for beneficiary risk; closely examine and adjust as necessary the current MA risk adjustment methodology to ensure that plans enrolling beneficiaries with the greatest health care needs receive adequate reimbursement to deliver high-quality care and other services to help beneficiaries avoid costly complications and further progression of chronic conditions; and reconsider the implementation of changes in the MA risk adjustment methodology finalized for 2016 and, to the extent appropriate, use the risk methodology finalized in 2015 for one additional year.
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Filing registrants (13)
Received in the Senate and Read twice and referred to the Committee on Finance.
The title of the measure was amended. Agreed to without objection.
Motion to reconsider laid on the table Agreed to without objection.
On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H4485-4486)
Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote.(text: CR H4485-4486)
DEBATE - The House proceeded with forty minutes of debate on H.R. 2582.
Considered under suspension of the rules. (consideration: CR H4485-4487)
Mr. Brady (TX) moved to suspend the rules and pass the bill, as amended.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Bills with similar content found using semantic analysis.
Sources: Congress.gov
2018 · second_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; H.R. 2506 Seniors Health Care Plan Protection Act of 2015; H.R. 2582 Seniors Health Care Plan Protection Act of 2015; H.R. 3717 Helping Families in Mental Health Crisis Act; Medicare and Medicaid plan contracting issues;
Client expense: Not reported · Firm income: $40,000
Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Office of Natl Drug Control Policy (NDCP), SENATE
2018 · first_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; H.R. 2506 Seniors Health Care Plan Protection Act of 2015; H.R. 2582 Seniors Health Care Plan Protection Act of 2015; H.R. 3717 Helping Families in Mental Health Crisis Act; Medicare and Medicaid plan contracting issues;
Client expense: Not reported · Firm income: $40,000
Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Office of Natl Drug Control Policy (NDCP), SENATE
2017 · fourth_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; H.R. 2506 Seniors Health Care Plan Protection Act of 2015; H.R. 2582 Seniors Health Care Plan Protection Act of 2015; H.R. 3717 Helping Families in Mental Health Crisis Act; Medicare and Medicaid plan contracting issues;
Client expense: Not reported · Firm income: $40,000
Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Office of Natl Drug Control Policy (NDCP), SENATE
2017 · third_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; H.R. 2506 Seniors Health Care Plan Protection Act of 2015; H.R. 2582 Seniors Health Care Plan Protection Act of 2015; H.R. 3717 Helping Families in Mental Health Crisis Act; Medicare and Medicaid plan contracting issues; Medicare and Medicaid provisions in Graham Cassidy Substitute Amendment
Client expense: Not reported · Firm income: $40,000
Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, SENATE
2017 · second_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; H.R. 2506 Seniors Health Care Plan Protection Act of 2015; H.R. 2582 Seniors Health Care Plan Protection Act of 2015; H.R. 3717 Helping Families in Mental Health Crisis Act; Medicare and Medicaid plan contracting issues; Medicare and Medicaid provisions in H.R. 1628, the American Health care Act
Client expense: Not reported · Firm income: $40,000
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congress.gov source codes: H11100, H11100-A
Introduced in House
Congress.gov source codes: 1000, Intro-H
| Democratic |
| GA |
| David W. Jolly | Republican | FL |
| Diane Black | Republican | TN |
| Earl Blumenauer | Democratic | OR |
| Mario Diaz-Balart | Republican | FL |
| Marsha Blackburn | Republican | TN |
| Steve Womack | Republican | AR |
Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), 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 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: $620,000 · 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
2016 · fourth_quarter · Medicare/Medicaid
Medicare Advantage Policy and Reimbursement Part D Policy and Reimbursement Medicaid and Dual Eligible Issues Pharmacy Reimbursement Issues Medicare Access and CHIP Reauthorization Act (MACRA) Implementation Chronic Care Working Group Issues H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act H.R. 2507, Increasing Regulatory Fairness Act H.R. 2582, Seniors' Health Care Plan Protection Act H.R. 3831, Securing Fairness in Regulatory Timing Act H.R. 4275, Medicare Advantage Quality Payment Relief Act S. 1913, Stopping Medication Abuse and Protecting Seniors Act S. 524/H.R. 953, Comprehensive Addiction and Recovery Act Opioid and Drug Abuse Issues H.R. 5659, ESRD Choice Act
Client expense: $670,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
2016 · fourth_quarter · Medicare/Medicaid
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
2016 · fourth_quarter · Medicare/Medicaid
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
2016 · fourth_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; HR 2506 - Seniors Health Care Plan Protection Act of 2015 and HR 2582 - Seniors Health Care Plan Protection Act of 2015; Medicare and Medicaid Plan contracting issues; HR 3717 Helping Families in Mental Health Crisis Act
Client expense: Not reported · Firm income: $30,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2016 · fourth_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; HR 2506 - Seniors Health Care Plan Protection Act of 2015 and HR 2582 - Seniors Health Care Plan Protection Act of 2015; Medicare and Medicaid Plan contracting issues; HR 3717 Helping Families in Mental Health Crisis Act
Client expense: Not reported · Firm income: $30,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2016 · fourth_quarter · Medicare/Medicaid
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
2016 · fourth_quarter · Medicare/Medicaid
PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act S. 2425 - Patient Access and Medicare Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2484 - Connect for Health Act H.R. 5659 - ESRD Choice Act of 2016 H.R. 34 - 21st Century Cures Act ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform, Medicare Advantage Payment Shift Offset, call letter, Puerto Rico and Medicare Advantage
Client expense: Not reported · Firm income: $100,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2016 · fourth_quarter · Medicare/Medicaid
PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2425 - Patient Access and Medicare Protection Act S. 2484 - Connect For Health Act H.R. 5659 - ESRD Choice Act of 2016 H.R. 34 - 21st Century Cures Act ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual EligH.R. 34 - 21st Century Cures Actibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care, coding intensity
Client expense: Not reported · Firm income: $90,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office
H.R. 711: Equal Treatment of Public Servants Act of 2015 ERISA Fiduciary duties Medicare: Part B Rx Drugs H.R. 5952: Strengthen Social Security Act DOL/EBSA Proposed rule on 5500 filing RX drug prices: HR 4207 Medicare FAIR drug pricing Act Budget reform: social security HR 6489: Social Security reform act of 2016 Social Security public trustee nominations Rewrite of congressional budget process Social Security public trustee nominations Social security and student loan debt Social Security cost of living for 2017 SSA Administrative funding HR 2582: Seniors' Health Care Plan Protection Act of 2015: Regulatory reform legislation possible CRA actions-General discussion of legislation
Client expense: $540,000 · Firm income: Not reported
Government targets: Defense, Dept of (DOD), Export-Import Bank of the United States (EXIM Bank), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Occupational Safety & Health Administration (OSHA), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR)
2016 · third_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; HR 2506 - Seniors Health Care Plan Protection Act of 2015 and HR 2582 - Seniors Health Care Plan Protection Act of 2015; Medicare and Medicaid Plan contracting issues; HR 3717 Helping Families in Mental Health Crisis Act
Client expense: Not reported · Firm income: $30,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2016 · third_quarter · Medicare/Medicaid
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
2016 · third_quarter · Medicare/Medicaid
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
2016 · third_quarter · Medicare/Medicaid
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
2016 · third_quarter · Medicare/Medicaid
PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act S. 2425 - Patient Access and Medicare Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2484 - Connect for Health Act H.R. 5659 - ESRD Choice Act of 2016 ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform, Medicare Advantage Payment Shift Offset, call letter, Puerto Rico and Medicare Advantage
Client expense: Not reported · Firm income: $100,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2016 · third_quarter · Medicare/Medicaid
PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2425 - Patient Access and Medicare Protection Act S. 2484 - Connect For Health Act H.R. 5659 - ESRD Choice Act of 2016 ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care, coding intensity
Client expense: Not reported · Firm income: $90,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office
2016 · third_quarter · Medicare/Medicaid
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
2016 · second_quarter · Medicare/Medicaid
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
2016 · second_quarter · Medicare/Medicaid
PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act S. 2425 - Patient Access and Medicare Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2484 - Connect for Health Act H.R. 5659 - ESRD Choice Act of 2016 ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform, Medicare Advantage Payment Shift Offset, call letter, Puerto Rico and Medicare Advantage
Client expense: Not reported · Firm income: $100,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2016 · second_quarter · Medicare/Medicaid
PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2425 - Patient Access and Medicare Protection Act S. 2484 - Connect For Health Act H.R. 5659 - ESRD Choice Act of 2016 ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care
Client expense: Not reported · Firm income: $90,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office
2016 · second_quarter · Medicare/Medicaid
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
2016 · second_quarter · Medicare/Medicaid
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
2016 · second_quarter · Medicare/Medicaid
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
2016 · second_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; HR 2506 - Seniors Health Care Plan Protection Act of 2015 and HR 2582 - Seniors Health Care Plan Protection Act of 2015; Medicare and Medicaid Plan contracting issues; HR 3717 Helping Families in Mental Health Crisis Act
Client expense: Not reported · Firm income: $30,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2016 · first_quarter · Medicare/Medicaid
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
2016 · first_quarter · Medicare/Medicaid
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
2016 · first_quarter · Medicare/Medicaid
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
2016 · first_quarter · Medicare/Medicaid
Issues related to Medicare Advantage Stars Quality measurements and risk adjustment and Medicare Advantage payment policy, including S.2104, the Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; H.R.2582 Seniors' Health Care Plan Protection Act of 2015; H.R.2506 Seniors' Health Care Plan Protection Act of 2015; H.R.2579 Securing Care for Seniors Act of 2015; and issues related to plan contracting arrangements with Medicare and Medicaid.
Client expense: Not reported · Firm income: $90,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2016 · first_quarter · Medicare/Medicaid
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
2016 · first_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; HR 2506 - Seniors Health Care Plan Protection Act of 2015 and HR 2582 - Seniors Health Care Plan Protection Act of 2015; Medicare and Medicaid Plan contracting issues
Client expense: Not reported · Firm income: $30,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2016 · first_quarter · Medicare/Medicaid
PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act S. 2425 - Patient Access and Medicare Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2484 - Connect for Health Act ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform, Medicare Advantage Payment Shift Offset, call letter, Puerto Rico and Medicare Advantage
Client expense: Not reported · Firm income: $100,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2016 · first_quarter · Medicare/Medicaid
PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing S. 2425 - Patient Access and Medicare Protection Act S. 2484 - Connect For Health Act ***, no specific bill(s), Medicare, Medicare and Medicaid Fraud, Medicare Advantage, Medicare Part D, Medicaid, Electronic Prescribing, Dual Eligibles, Medigap reform, claims resolution, risk adjustment, Delivery System Reform, Special Needs Plans, Star Ratings, call letter, program integrity, Alzheimer's care, telehealth, chronic care, Medicare Advantage Payment Shift Offset
Client expense: Not reported · Firm income: $90,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office
2015 · third_quarter · Medicare/Medicaid
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
2015 · fourth_quarter · Medicare/Medicaid
Medicare Advantage quality assessment measures and health disparities; HR 2506 - Seniors Health Care Plan Protection Act of 2015 and HR 2582 - Seniors Health Care Plan Protection Act of 2015; Medicare and Medicaid Plan contracting issues
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2015 · fourth_quarter · Medicare/Medicaid
Advocated for fairness is Medicare Advantage Stars Quality measurements. H.R. 2582, the Seniors Health Care Plan Protection Act. S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015. Opposed cuts to Medicare Advantage and Part D rates. H.R. 1343/S. 688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. H.R. 928/S. 193, to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act. H.R. 2029, Consolidated Appropriations Act, 2016, provisions to delay the annual fee on health insurance providers enacted in the Affordable Care Act by one year (2017). Advocated for a system that incorporates more chronic codes under the risk adjustment methodology. Advocated for transparency in the methodology surrounding the calculation of the Fee-for-Service error rate in Medicare Advantage Risk Adjustment Data-Validation. H.R. 2646, Helping Families in Mental Health Crisis Act of 2015. S. 1945, Mental Health Reform Act of 2015. Medicare and Medicaid plan contracting issues.
Client expense: $540,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2015 · fourth_quarter · Medicare/Medicaid
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
2015 · fourth_quarter · Medicare/Medicaid
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
2015 · fourth_quarter · Medicare/Medicaid
Issues related to Medicare Advantage Stars Quality measurements and risk adjustment and Medicare Advantage payment policy, including S.2104, the Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; H.R.2582 Seniors' Health Care Plan Protection Act of 2015; H.R.2506 Seniors' Health Care Plan Protection Act of 2015; H.R.2579 Securing Care for Seniors Act of 2015; and issues related to plan contracting arrangements with Medicare and Medicaid.
Client expense: Not reported · Firm income: $90,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2015 · fourth_quarter · Medicare/Medicaid
Ongoing implementation of payment and regulatory issues for the Medicare Advantage program, including H.R. 2570 and H.R. 2582. Issues relating to the Medicare Part D prescription drug program, various CMS demonstration programs and of P.L. 111-148 (Patient Protection and Affordable Care Act). Issues relating to Medigap insurance, and H.R. 2, The Medicare Access and CHIP Re authorization Act of 2015. Issues relating to H.R. 1600, the Patient's Access to Treatments Act of 2015. Issues relating to H.R. 2298, Medicare Patient Safety and Drug Abuse Prevention Act, and H.R. 2579 - Securing Care for Seniors Act of 2015. Issues related to the introduction of S. 2104, A bill to amend title XVIII of the Social Security Act to provide relief to Medicare Advantage plans with a significant number of dually eligible or low-income subsidy beneficiaries and to prevent the termination of two star plans.
Client expense: $1,550,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of
(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
2015 · fourth_quarter · Medicare/Medicaid
Medicare Advantage. Health reform implementation. Medicare Reform. 2015-2016 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
2015 · fourth_quarter · Medicare/Medicaid
PL 111-148 - The Patient Protection and Affordable Care Act, implementation H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency For Seniors H.R. 2948 - Medicare Telehealth Parity Act of 2015 H.R. 2505 - Medicare Advantage Coverage Transparency Act H.R. 2507 - Increasing Regulatory Fairness Act H.R. 2582 - Seniors Health Care Plan Protection Act S. 2425 - Patient Access and Medicare Protection Act H.R. 3831 - Securing Fairness in Regulatory Timing ***, no specific bill(s), Medicare, Medicare Fraud, Medicare Advantage, Medicaid, Electronic Prescribing, Health Care Reform Implementation, Medigap reform, Physician Payment Reform, Delivery System Reform, medical review, ICD-10, Benefit design, prescription drug safety, Regional PPOs, chronic care, CHIP Reform, Medicare Advantage Payment Shift Offset
Client expense: Not reported · Firm income: $100,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office