Palliative Care and Hospice Education and Training Act

Oppose home health and hospice payment cuts and co-pays. Legislative and regulatory proposals affecting home care and hospice. Fostering Independence Through Technology Act (to be re-filed). S. 578/H.R. 1342, Home Health Care Planning Improvement Act. H.R. 5926/S. 3040, Labor/Health and Human Services/Education Appropriations, FY2017, provisions relating to Lifespan Respite Program, caregiver, and falls prevention matters. Recognition and payment for telehealth services under Medicare and Medicaid. Face to Face Physician Encounter Requirement. Medicare Home Health Rebasing Relief and Reassessment Act (to be re-filed). H.R. 2066, Telehealth Enhancement Act of 2015. H.R. 2948, Medicare Telehealth Parity Act. Home health rural add on payment. H.R. 1202, Medicare Patient Access to Hospice Act of 2015. S. 2389, Preserve Access to Medicare Rural Home Health Services Act of 2015. Value Based Purchasing and Bundling. S. 1650, Home Health Documentation and Program Improvement Act of 2015. Medicare reimbursement of advance care planning services. Appropriations for Family Caregiver Support Programs. H.R. 2208, Hospice Commitment to Accurate and Relevant Encounters Act. S. 1549, Care Planning Act of 2015. H.R. 1202/S. 1354, Medicare Patient Access to Hospice Act of 2015. H.R. 3298, Medicare Post-Acute Value-Based Purchasing Act of 2015. Chronic Care Management Proposals. Case Mix "Creep" Payment cuts Home Health Access Protection Act (draft legislation). S. 2368, Audit and Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015. Medicare Advantage hospice proposals. S. 2416, VERIFI Act. H.R. 2446, to amend the Social Security Act to require the use of electronic visit verification for Medicaid personal care services. H.R. 3119, Palliative Care and Hospice Education and Training Act. S. 2364, Medicare Home Health Flexibility Act of 2015. VA Home Care Services. Home Health Prior Authorization and Pre-Claim review. H.R. 4994 (Public Law 113-185), Improving Medicare Post-Acute Care Transformation (IMPACT) Act. H.R. 4111, Rural Healthcare Connectivity Act. H.R. 2646, Helping Families in Mental Health Crisis Act. H.R. 5799/S. 2786, Rural Access to Hospice Care Act. H.R. 6226, Pre-Claim Undermines Senior's Health (PUSH) Act. S. 2484, CONNECT for Health Care. H.R. 34, 21st Century Cures Act.

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

The Care Planning Act (S. 1549), Home Health Documentation and Program Improvement Act (S. 1650), PCHETA (H.R. 3119/S.2748), Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298), Home Health Planning and Improvement Act (S. 578/H.R. 1342)

Client expense: $15,562 · Firm income: Not reported

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

The Home Health Care Planning Improvement Act of 2015 (H.R. 1342, S. 578) The Care Planning Act (S. 1549), Palliative Care Hospice Education and Training Act (H.R. 3119, S.2748), Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298), Pre-Claims Undermine Seniors' Health Act (H.R. 6226), Home Health Documentation and Program Improvement Act (S. 15650)

Client expense: $15,562 · Firm income: Not reported

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

S. 524 Comprehensive Addiction and Recovery Act of 2016 Senate HELP Committee Innovations Package HR 6 21st Century Cures Act HR 1600 Patients Access to Treatment Act of 2015 HR 2739/S 1566 Cancer Drug Coverage Parity Act HR 3381/S 1883 Childhood Cancer STAR Act HR 3119 Palliative Care Hospice Education and Training Act S 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015 H.R. 2846 Planning Actively for Cancer Treatment (PACT) Act of 2015 S. 2511 Improving Health Information Technology Act Reforms to the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act

Client expense: $65,519 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

21st Century Cures Act (H.R. 34) - Expressed support for the legislation including the comprehensive mental health reform and Medicare readmission program modifications. Rural Community Hospital Demonstration Extension Act (S.607) - Expressed support for the Rural Community Hospital program to provide quality care to the elderly. Mental Health First Aid (H.R. 1877) - Urged Congress for the creation of additional programs to enable greater mental health awareness and access to timely treatment. Family First Prevention Services Act (H.R. 5456) - Promoted family-based care for special needs children. Palliative Care and Hospice Education and Training Act (H.R. 3119) - Urged Congress to support palliative care education for medical providers and reduce barriers to care for patients with serious or life-threatening illnesses. Mental Health Reform Act of 2016 (S. 2680) - Urged Congress to establish new grant programs to strengthen mental health parity. Mental Health Crisis Act (H.R. 2646) - Expressed support for Congress to provide improved crisis response services, increased research and early intervention, and integrated mental health, substance abuse and primary care.

Client expense: $120,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE, White House Office

Hospice Medicare Advantage "carve-in"; S. 1549, Care Planning Act of 2015; S. 2786/H.R. 5799, Rural Access to Hospice Act of 2016; H.R. 1202, Medicare Patient Access to Hospice Act of 2015; H.R. 2208, Hospice CARE Act; H.R. 3037, Hospice Care Access Improvement Act of 2015; H.R. 3119, Palliative Care and Hospice Education and Training Act; H.R. 5555, Personalize Our Care Act 2.0; Notice of election/notice of termination/revocation; Medicare Choices Model

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues relating to health disparities, health care reform, childhood cancer, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, tanning beds, skin cancer, and wellness, including: H.R.3119 & S.2748, the Palliative Care and Hospice Education and Training Act; H.R.716 & S.370, the Breast Density & Mammography Reporting Act; H.R.3381 & S.1883, Childhood Cancer STAR Act; and regulations relating to tanning beds. In addition, regulatory issues before the FDA relating to laboratory developed tests, and any legislation pertaining thereto, suncreens, colorectal cancer screening tests, electronic medical devices, H.R.2739/S.1566 - the Cancer Drug Coverage Parity Act, H.R.2846 - Planning Actively for Cancer Treatment Act, S.1014 - Personal Care Products Safety Act, H.R.1608 - Lymphedema Treatment Act, H.R.2191/S.1170 - the Breast Cancer Research Stamp Reauthorization Act, S.705 - Transportation Alternatives Act, S.540 - School Food Modernization Act, and H.R.644 - America Gives More Act, CDC opioid prescription guidelines, and legislation relating to opioid prescribing, addition and rehabilitation; H.R.5475, the Health Equity and Accountability Act; S.2787, the SAME Act and Senate Amendment 4369 to S.2943, the Senate Defense Authorization bill; and S.3136, H.R.5003 childhood nutrition bill; and H.R.2017 and S.2217, the Common Sense Nutrition Disclosure Act; and S.524 and H.R.953, the Comprehensive Addiction and Recovery Act, and related bills and amendments, S.3077, the Marijuana Effective Drug Studies Act of 2016.

Client expense: $1,620,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), White House Office

Issues relating to health disparities, health care reform, childhood cancer, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, tanning beds, skin cancer, and wellness, including: H.R.3119 & S.2748, the Palliative Care and Hospice Education and Training Act; H.R.716 & S.370, the Breast Density & Mammography Reporting Act; H.R.3381 & S.1883, Childhood Cancer STAR Act; and regulations relating to tanning beds. In addition, regulatory issues before the FDA relating to laboratory developed tests, and any legislation pertaining thereto, suncreens, colorectal cancer screening tests, electronic medical devices, H.R.2739/S.1566 - the Cancer Drug Coverage Parity Act, H.R.2846 - Planning Actively for Cancer Treatment Act, S.1014 - Personal Care Products Safety Act, H.R.1608 - Lymphedema Treatment Act, H.R.2191/S.1170 - the Breast Cancer Research Stamp Reauthorization Act, S.705 - Transportation Alternatives Act, S.540 - School Food Modernization Act, and H.R.644 - America Gives More Act, CDC opioid prescription guidelines, and legislation relating to opioid prescribing, addition and rehabilitation; H.R.5475, the Health Equity and Accountability Act; S.2787, the SAME Act and Senate Amendment 4369 to S.2943, the Senate Defense Authorization bill; and S.3136, H.R.5003 childhood nutrition bill; and H.R.2017 and S.2217, the Common Sense Nutrition Disclosure Act; and S.524 and H.R.953, the Comprehensive Addiction and Recovery Act, and related bills and amendments, S.3077, the Marijuana Effective Drug Studies Act of 2016.

Client expense: $1,630,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), White House Office

Pub. Law No. 111-148, Patient Protection and Affordable Care Act, matters related to the implementation of breast health education, research and clinical trials; S.1566/H.R.2722, Cancer Drug Coverage Parity Act, advocate to require insurance companies cover iv-administered and orally-administered anti-cancer drugs at the same cost to patients; H.R.1600, Patients' Access to Treatment Act, support amending the Public Health Service Act to establish cost-sharing limits for health plans that cover prescription drugs and use a formulary or other tiered cost-sharing structure and prohibits such a health plan from imposing higher cost-sharing requirements, including co-payment and co-insurance, for specialty drugs than for other prescription drugs in a non-preferred brand drug tier; H.R.1608, Lymphedema Treatment Act, support Medicare coverage of certain lymphedema compression treatment items as durable medical equipment; S.370/H.R.716, Breast Density and Mammography Reporting Act, issues related to the information provided to women and doctors on breast density and the potential impact it has on the detection of breast cancer and require the FDA to utilize up to date medical information and direct HHS to focus research on the best screening methods for breast tissue; H.R.1925, Dr. Balazs "Ernie" Bodai Congressional Gold Medal, support the presentation of a congressional gold medal to Dr. Balaz "Ernie" Bodai in recognition of his many outstanding contributions to the nation, including a tireless commitment to breast cancer research; H.R.6, 21st Century Cures Act, issues related to cancer prevention and research funding; S.620/H.R.1189, Preserving Employee Wellness Programs Act, issues related to the Genetic Information Act of 2008 and workplace wellness programs; H.R.2846, Planning Actively for Cancer Treatments Act, support coverage of cancer care planning and coordination services; S.91/H.R.4112, Mobile Mammography Promotion Act, issues related to excluding mobile mammography vehicles from the motor fuel excise tax; H.R.3119, Palliative Care and Hospice Education and Training Act, support federal funding for research, training, education and awareness into palliative care; S.1488/H.R.2624, Part D Beneficiary Appeals Fairness Act, issues related to out-of-pocket costs for prescription drugs.

Client expense: $38,415 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, White House Office

Contacts in support of repealing the Patient Protection and Affordable Care Act, Public Law 111-148, because repeal would 1) eliminate the excise tax on high cost employer-sponsored health coverage which would discourage businesses from offering plans less likely to deny lifesaving medical treatment, 2) eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation, 3) eliminate the authority of the Department of Health and Human Services to implement those recommendations by imposing "quality and efficiency" measures on health care providers, limiting the circumstances in which treatments can be given to their patients, and 4) eliminate the requirement that state health insurance exchanges administrators exclude from their exchanges insurance plans offered by any insurers the administrators believe allow their policyholders inside or outside the exchange to spend what the administrators consider an "excessive or unjustified" amount on their own health care, thereby restricting the medical treatment. Contacts in response to inquiries regarding implementation of certain elements of The Patient Protection and Affordable Care Act, Public Law 111-148, related to the denial of life-saving medical treatments. Contacts regarding S. 1549, the Care Planning Act of 2015 because 1) it fails to contain proper safeguards against dissuading patients to reject life-saving treatment they would otherwise want both to cut costs, and also due to a pervasive quality of life ethic 2) it authorizes health care providers to deny life-preserving treatment against the express will of a patient or surrogate invalidating several state protective laws and 3) advance planning documents that may have been filled out in other states are to be implemented removing state power over informed consent requirements surrounding choosing life-saving measures, food and fluids. Contacts in the U.S. Senate in support of S.2297, the Medicare Choices Empowerment and Protection Act, which would give Medicare beneficiaries and others online access to a website with state-specific model advance directives that choose life-saving treatment, food and fluids equally with those that reject them. Contacts in the U.S. House in support of H.R. 4059, the Medicare Choices Empowerment and Protection Act, which would give Medicare beneficiaries and others online access to a website with state-specific model advance directives that choose life-saving treatment, food and fluids equally with those that reject them. Contacts regarding advance care planning legislation (not introduced) 1) ensure the legislation provides for adequate oversight regarding the creation of advance planning materials, websites, etc. in order to protect against the materials being crafted in a way that persuades patients to reject treatment they might otherwise choose, 2) ensure that there are not Federally funded unmonitored practitioner consultations could lead to patients forgoing treatment they would otherwise have wanted, 3) ensure that there are not adverse changes to the Assisted Suicide Funding and Restriction Act 4) include oversight for grant approval for physician orders for lifesustaining treatment and 5) protect the right of states to ensure informed consent in choosing and rejecting treatment. Contacts regarding legislation (not introduced) regarding the Patient Protection and Affordable Care Act, Public Law 111-148, provision related to the excise tax on employer-paid health insurance premiums above a governmentally imposed limit that does not allow for medical inflation because the excess benefits tax will have its intended result of effectively imposing a price control on health insurance premiums. Contacts in the U.S. House in support of H.R. 3251 which would prohibit the coverage of advance care planning services under the Medicare Program because unmonitored advance care planning services can in practice be used to nudge patients to agree to forego life-saving treatment and even assisted feeding through the use of unbalanced, distorted, and even inaccurate information. Contacts regarding H.R. 3119, the "Palliative Care and Hospice Education and Training Act" as to whether provisions of the Assisted Suicide Funding Restriction Act would be revoked. Contacts regarding legislation (not introduced) regarding potential legislation related to strengthening Federal policy against physician assisted suicide. Contacts regarding legislation (not introduced) regarding potential legislation related to the actions of the D.C. council pertaining to the "Death with Dignity Act" (B21-0038) and associated violations of the Assisted Suicide Funding Restriction Act of 1997, Pub. L. No. 105-12. National Right to Life opposes the "Death with Dignity Act" and favors congressional nullification thereof. Contacts in the U.S. House regarding potential CMS action in regards to the advance care planning services that have been added to the list of services in the Physician Fee Schedule payment rule.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3762, Restoring Americans Healthcare Freedom Reconciliation Act H.R. 592/S. 314, Pharmacy and Medically Underserved Areas Enhancement Act H.R. 954, CO-OP Consumer Protection Act of 2016 H.R. 1190/S. 141, The Protecting Seniors Access to Medicare Act of 2015 H.R. 1192, National Clinical Care Commission Act H.R. 1270, Restoring Access to Medication and Improving Health Savings Act H.R. 1427, Medicare CGM Access Act H.R. 1686/S. 3082, Preventing Diabetes in Medicare Act H.R. 1707, Access to Frontline Health Care Act of 2015 H.R. 1726, Access to Quality Diabetes Education Act H.R. 1807, Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2015 H.R. 2102, Medicare Diabetes Prevention Act H.R. 2124/S. 1148, Resident Physician Shortage Act H.R. 2603/S. 1475, Saving Lives, Saving Costs Act H.R. 2646, Helping Families in Mental Crisis Act H.R. 2713/S. 3245, Title VIII Nursing Workforce Reauthorization Act of 2016 H.R. 3081/S. 1778, Telemedicine for Medicare Act H.R. 3119/S. 2748, Palliative Care and Hospice Education and Training Act H.R. 3660/S. 3126,Preventive Health Savings Act H.R. 3952/S. 2248, Congenital Heart Future Reauthorization Act of 2015 H.R. 4212/S. 704, Community Based Independence for Seniors Act of 2015 H.R. 4442/S. 2484, CONNECT for Health Act H.R. 4732/S. 2671, Advancing Medical Resident Training in Community Hospitals Act H.R. 4774, Training Tomorrows Doctors Today Act H.R. 4909/S. 2943, National Defense Authorization Act H.R. 5273, Helping Hospitals Improve Patient Care Act H.R. 5414, FDA Cross-Center Collaboration Act H.R. 5447/S. 3060, The Small Business Health Care Relief Act H.R. 5652,Access to Better Care Act H.R. 5681/S. 3137, Alzheimers Beneficiary and Caregiver Support Act H.R. 5713, Sustaining Healthcare Integrity and Fair Treatment Act of 2016 H.R.5926 - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2017 H.R. 6043/S. 3335, The Fair Accountability and Innovative Research Drug Pricing Act of 2016 H.R. 6109/S. 3371, Medicare Affordability and Enrollment Act S. 524, Comprehensive Addiction and Recovery Act S. 586, National Diabetes Clinical Care Commission Act S. 603, Jobs and Premium Protection Act S. 776,Medication Therapy Management Empowerment Act S. 1077,Advancing Breakthrough Medical Devices for Patients Act S. 1101,Medical Electronic Data Technology Enhancement for Consumers Health (MEDTECH) Act S. 1622,FDA Device Accountability Act S. 2511,Improving Health Information Technology Act S. 2680,Mental Health Reform Act of 2016 S. 2864,Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2016 S. 3326,State Flexibility to Provide Affordable Health Options Act S. 3504, Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2016 Pub. L. 111-5, The American Recovery and Reinvestment Act of 2009 (Health Information Technology for Economic and Clinical Health Act (HITECH) Pub. L. 111-148, Patient Protection and Affordable Care Act (PPACA) Pub. L. 114-10, Medicare Access and CHIP Reauthorization Act (MACRA) Pub. L. 114-255,21st Century Cures Pub. L. 114-270, Expanding Capacity for Health Outcomes Act (ECHO) Pub. L. 114-328, National Defense Authorization Act for Fiscal Year 2017

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

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

H.R. 1190/S. 141, The Protecting Seniors Access to Medicare Act of 2015 H.R. 1270, Restoring Access to Medication and Improving Health Savings Act H.R. 1427, Medicare CGM Access Act H.R. 1686/S. 3082, Preventing Diabetes in Medicare Act H.R. 1707, Access to Frontline Health Care Act of 2015 H.R. 1726, Access to Quality Diabetes Education Act H.R. 2102, Medicare Diabetes Prevention Act H.R. 2124/S. 1148, Resident Physician Shortage Act H.R. 2603/S. 1475, Saving Lives, Saving Costs Act H.R. 3119/S. 2748, Palliative Care and Hospice Education and Training Act H.R. 3660/S. 3126,Preventive Health Savings Act H.R. 3952/S. 2248, Congenital Heart Future Reauthorization Act of 2015 H.R. 4212/S. 704, Community Based Independence for Seniors Act of 2015 H.R. 5273, Helping Hospitals Improve Patient Care Act H.R. 5681/S. 3137, Alzheimers Beneficiary and Caregiver Support Act H.R.5926 - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2017 H.R. 6043/S. 3335, The Fair Accountability and Innovative Research Drug Pricing Act of 2016 H.R. 6109/S. 3371, Medicare Affordability and Enrollment Act S. 776,Medication Therapy Management Empowerment Act S. 1077,Advancing Breakthrough Medical Devices for Patients Act S. 1101,Medical Electronic Data Technology Enhancement for Consumers Health (MEDTECH) Act S. 2864,Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2016 S. 3326,State Flexibility to Provide Affordable Health Options Act Pub. L. 111-5, The American Recovery and Reinvestment Act of 2009 (Health Information Technology for Economic and Clinical Health Act (HITECH) Pub. L. 114-10, Medicare Access and CHIP Reauthorization Act (MACRA) Pub. L. 114-255,21st Century Cures

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

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

S. 1549 - Care Planning Act S. 2748/H.R. 3119-the Palliative Care and Hospice Education and Training Act H.R. 3913-Lifespan Respite Care Reauthorization Act S. 2614-Kevin and Avonte's Law of 2016

Client expense: $29,500 · Firm income: Not reported

Government targets: Administration on Aging, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office

P.L. 111-375 National Alzheimer's Project Act, All sections H.R. 9/S. 1137, the Innovation Act H.R. 1559/S. 857, the Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act of 2015 H.R. 1468, the Global Brain Health Act of 2015 H.R. 2624/S. 1488, the Part D Beneficiary Appeals Fairness Act H.R. 3090/S. 3113, the Alzheimer's Caregiver Support Act H.R. 3091, the Missing Alzheimer's Disease Patient Alert Program Reauthorization Act H.R. 3092, the Alzheimer's Disease Semipostal Stamp Act H.R. 3099/S. 1719, the RAISE Family Caregivers Act H.R. 3119/S. 2748, the Palliative Care and Hospice Education and Training Act H.R. 3243/S. 1362, the PACE Innovation Act H.R. 3660/S. 3126, the Preventive Health Savings Act H.R. 4708/S.2759, the Credit for Caring Act of 2016 H.R. 4919/S. 2614, Kevin and Avonte's Law of 2016 H.R. 5196/S. 879, the Americans Giving Care to Elders (AGE) Act of 2015 H.R. 5347, the Social Security Disability Fairness Act H.R. 5681/S. 3137, the Alzheimer's Beneficiary and Caregiver Support Act H. Res. 237/S. Res. 74, a resolution declaring that achieving the primary goal of the National Plan to Address Alzheimer's Disease of the Department of Health and Human Services to prevent and effectively treat Alzheimer's disease by 2025 is an urgent national priority S. 192, the Older Americans Act Reauthorization Act of 2015 S. 1549, the Care Planning Act of 2015 S. 2010, the Expedited Disability Insurance Payments for Terminally Ill Individuals Act S. 2961, the Compassionate Care Act S. 3130, the Independence at Home Act of 2016 S. 3270, the Elder Abuse Prevention and Prosecution Act

Client expense: $220,000 · Firm income: Not reported

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

The Home Health Care Planning Improvement Act of 2015 (H.R. 1342, S. 578) The Care Planning Act (S. 1549), Palliative Care Hospice Education and Training Act (H.R. 3119, S.2748), Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298), Pre-Claims Undermine Seniors' Health Act (H.R. 6226)

Client expense: $15,603 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Care Planning Act (S. 1549), Home Health Documentation and Program Improvement Act (S. 1650), PCHETA (H.R. 3119/S.2748), Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298)

Client expense: $15,603 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 524 Comprehensive Addiction and Recovery Act of 2016 Senate HELP Committee Innovations Package HR 6 21st Century Cures Act HR 1600 Patients Access to Treatment Act of 2015 HR 2739/S 1566 Cancer Drug Coverage Parity Act HR 3381/S 1883 Childhood Cancer STAR Act HR 3119 Palliative Care Hospice Education and Training Act S 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015 H.R. 2846 Planning Actively for Cancer Treatment (PACT) Act of 2015 S. 2511 Improving Health Information Technology Act Reforms to the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act

Client expense: $169,982 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Oppose home health and hospice payment cuts and co-pays. Legislative and regulatory proposals affecting home care and hospice. Fostering Independence Through Technology Act (to be re-filed). S. 578/H.R. 1342, Home Health Care Planning Improvement Act. H.R. 5926/S. 3040, Labor/Health and Human Services/Education Appropriations, FY2017, provisions relating to Lifespan Respite Program, caregiver, and falls prevention matters. Recognition and payment for telehealth services under Medicare and Medicaid. Face to Face Physician Encounter Requirement. Medicare Home Health Rebasing Relief and Reassessment Act (to be re-filed). H.R. 2066, Telehealth Enhancement Act of 2015. H.R. 2948, Medicare Telehealth Parity Act. Home health rural add on payment. H.R. 1202, Medicare Patient Access to Hospice Act of 2015. S. 2389, Preserve Access to Medicare Rural Home Health Services Act of 2015. Value Based Purchasing and Bundling. S. 1650, Home Health Documentation and Program Improvement Act of 2015. Medicare reimbursement of advance care planning services. Appropriations for Family Caregiver Support Programs. H.R. 2208, Hospice Commitment to Accurate and Relevant Encounters Act. S. 1549, Care Planning Act of 2015. H.R. 1202/S. 1354, Medicare Patient Access to Hospice Act of 2015. H.R. 3298, Medicare Post-Acute Value-Based Purchasing Act of 2015. Chronic Care Management Proposals. Case Mix "Creep" Payment cuts Home Health Access Protection Act (draft legislation). S. 2368, Audit and Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015. Medicare Advantage hospice proposals. S. 2416, VERIFI Act. H.R. 2446, to amend the Social Security Act to require the use of electronic visit verification for Medicaid personal care services. H.R. 3119, Palliative Care and Hospice Education and Training Act. S. 2364, Medicare Home Health Flexibility Act of 2015. VA Home Care Services. Home Health Prior Authorization and Pre-Claim review. H.R. 4994 (Public Law 113-185), Improving Medicare Post-Acute Care Transformation (IMPACT) Act. H.R. 4111, Rural Healthcare Connectivity Act. H.R. 2646, Helping Families in Mental Health Crisis Act. H.R. 5799/S. 2786, Rural Access to Hospice Care Act. H.R. 6226, Pre-Claim Undermines Senior's Health (PUSH) Act. S. 2484, CONNECT for Health Care.

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

Issues relating to health disparities, health care reform, childhood cancer, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, tanning beds, skin cancer, and wellness, including: H.R.3119 & S.2748, the Palliative Care and Hospice Education and Training Act; H.R.716 & S.370, the Breast Density & Mammography Reporting Act; H.R.3381 & S.1883, Childhood Cancer STAR Act; and regulations relating to tanning beds. In addition, regulatory issues before the FDA relating to laboratory developed tests, and any legislation pertaining thereto, suncreens, colorectal cancer screening tests, electronic medical devices, H.R.2739/S.1566 - the Cancer Drug Coverage Parity Act, H.R.2846 - Planning Actively for Cancer Treatment Act, S.1014 - Personal Care Products Safety Act, H.R.1608 - Lymphedema Treatment Act, H.R.2191/S.1170 - the Breast Cancer Research Stamp Reauthorization Act, S.705 - Transportation Alternatives Act, S.540 - School Food Modernization Act, and H.R.644 - America Gives More Act, CDC opioid prescription guidelines, and legislation relating to opioid prescribing, addition and rehabilitation; H.R.5475, the Health Equity and Accountability Act; S.2787, the SAME Act and Senate Amendment 4369 to S.2943, the Senate Defense Authorization bill; and S.3136, H.R.5003 childhood nutrition bill; and H.R.2017 and S.2217, the Common Sense Nutrition Disclosure Act; and S.524 and H.R.953, the Comprehensive Addiction and Recovery Act, and related bills and amendments, S.3077, the Marijuana Effective Drug Studies Act of 2016.

Client expense: $1,200,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), White House Office

Hospice Medicare Advantage "carve-in"; S. 1549, Care Planning Act of 2015; S. 2786/H.R. 5799, Rural Access to Hospice Act of 2016; H.R. 1202, Medicare Patient Access to Hospice Act of 2015; H.R. 2208, Hospice CARE Act; H.R. 3037, Hospice Care Access Improvement Act of 2015; H.R. 3119, Palliative Care and Hospice Education and Training Act; H.R. 5555, Personalize Our Care Act 2.0; Notice of election/notice of termination/revocation; Medicare Choices Model

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Pub. Law No. 111-148, Patient Protection and Affordable Care Act, matters related to the implementation of breast health education, research and clinical trials; S.1566/H.R.2722, Cancer Drug Coverage Parity Act, advocate to require insurance companies cover iv-administered and orally-administered anti-cancer drugs at the same cost to patients; H.R.1600, Patients' Access to Treatment Act, support amending the Public Health Service Act to establish cost-sharing limits for health plans that cover prescription drugs and use a formulary or other tiered cost-sharing structure and prohibits such a health plan from imposing higher cost-sharing requirements, including co-payment and co-insurance, for specialty drugs than for other prescription drugs in a non-preferred brand drug tier; H.R.1608, Lymphedema Treatment Act, support Medicare coverage of certain lymphedema compression treatment items as durable medical equipment; S.370/H.R.716, Breast Density and Mammography Reporting Act, issues related to the information provided to women and doctors on breast density and the potential impact it has on the detection of breast cancer and require the FDA to utilize up to date medical information and direct HHS to focus research on the best screening methods for breast tissue; H.R.1925, Dr. Balazs "Ernie" Bodai Congressional Gold Medal, support the presentation of a congressional gold medal to Dr. Balaz "Ernie" Bodai in recognition of his many outstanding contributions to the nation, including a tireless commitment to breast cancer research; H.R.6, 21st Century Cures Act, issues related to cancer prevention and research funding; S.620/H.R.1189, Preserving Employee Wellness Programs Act, issues related to the Genetic Information Act of 2008 and workplace wellness programs; H.R.2846, Planning Actively for Cancer Treatments Act, support coverage of cancer care planning and coordination services; S.91/H.R.4112, Mobile Mammography Promotion Act, issues related to excluding mobile mammography vehicles from the motor fuel excise tax; H.R.3119, Palliative Care and Hospice Education and Training Act, support federal funding for research, training, education and awareness into palliative care; S.1488/H.R.2624, Part D Beneficiary Appeals Fairness Act, issues related to out-of-pocket costs for prescription drugs.

Client expense: $39,585 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, White House Office

Contacts in support of repealing the Patient Protection and Affordable Care Act, Public Law 111-148, because repeal would 1) eliminate the excise tax on high cost employer-sponsored health coverage which would discourage businesses from offering plans less likely to deny life-saving medical treatment, 2) eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation, 3) eliminate the authority of the Department of Health and Human Services to implement those recommendations by imposing quality and efficiency measures on health care providers, limiting the circumstances in which treatments can be given to their patients, 4) eliminate the requirement that state health insurance exchanges administrators exclude from their exchanges insurance plans offered by any insurers the administrators believe allow their policyholders inside or outside the exchange to spend what the administrators consider an excessive or unjustified amount on their own health care, thereby restricting the medical treatment, and 5) eliminate the provisions related to shared decisionmaking because they are likely to be used, on balance, to dissuade patients from choosing life-saving treatment. Contacts in response to inquiries regarding implementation of certain elements of The Patient Protection and Affordable Care Act, Public Law 111-148, related to the denial of life-saving medical treatments. Contacts regarding S. 1549, the Care Planning Act of 2015 because 1) it fails to contain proper safeguards against dissuading patients to reject life-saving treatment they would otherwise want both to cut costs, and also due to a pervasive quality of life ethic 2) it authorizes health care providers to deny life-preserving treatment against the express will of a patient or surrogate invalidating several state protective laws and 3) advance planning documents that may have been filled out in other states are to be implemented removing state power over informed consent requirements surrounding choosing life-saving measures, food and fluids. Contacts in the U.S. Senate in support of S.2297, the Medicare Choices Empowerment and Protection Act, which would give Medicare beneficiaries and others online access to a website with state-specific model advance directives that choose life-saving treatment, food and fluids equally with those that reject them. Contacts in the U.S. House in support of H.R. 4059, the Medicare Choices Empowerment and Protection Act, which would give Medicare beneficiaries and others online access to a website with state-specific model advance directives that choose life-saving treatment, food and fluids equally with those that reject them. Contacts regarding advance care planning legislation (not introduced) 1) ensure the legislation provides for adequate oversight regarding the creation of advance planning materials, websites, etc. in order to protect against the materials being crafted in a way that persuades patients to reject treatment they might otherwise choose, 2) ensure that there are not Federally funded unmonitored practitioner consultations could lead to patients forgoing treatment they would otherwise have wanted, 3) ensure that there are not adverse changes to the Assisted Suicide Funding and Restriction Act 4) include oversight for grant approval for physician orders for life-sustaining treatment and 5) protect the right of states to ensure informed consent in choosing and rejecting treatment. Contacts regarding legislation (not introduced) regarding the Patient Protection and Affordable Care Act, Public Law 111-148, provision related to the excise tax on employer-paid health insurance premiums above a governmentally-imposed limit that does not allow for medical inflation because the excess benefits tax will have its intended result of effectively imposing a price control on health insurance premiums. Contacts in the U.S. House in support of H.R. 3251 which would prohibit the coverage of advance care planning services under the Medicare Program because unmonitored advance care planning services can in practice be used to nudge patients to agree to forego life-saving treatment and even assisted feeding through the use of unbalanced, distorted, and even inaccurate information. Contacts regarding H.R. 3119, the "Palliative Care and Hospice Education and Training Act" as to whether provisions of the Assisted Suicide Funding Restriction Act would be revoked. Contacts regarding legislation (not introduced) regarding potential legislation related to strengthening Federal policy against physician assisted suicide. Contacts in the U.S. House regarding potential CMS action in regards to the advance care planning services that have been recently added to the list of services in the Physician Fee Schedule payment rule.

Client expense: $60,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Rural Community Hospital Demonstration Extension Act (S.607) - Expressed support for the Rural Community Hospital program to provide quality care to the elderly. Mental Health First Aid (H.R. 1877) - Urged Congress for the creation of additional programs to enable greater mental health awareness and access to timely treatment. Family First Prevention Services Act (H.R. 5456) - Promoted family-based care for special needs children. Expressed support for S.3129/H.R. 5613, providing for the extension of the enforcement moratorium on direct supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2016. Palliative Care and Hospice Education and Training Act (H.R. 3119) - Urged Congress to support palliative care education for medical providers and reduce barriers to care for patients with serious or life-threatening illnesses. Mental Health Reform Act of 2016 (S. 2680) - Urged Congress to establish new grant programs to strengthen mental health parity. Mental Health Crisis Act (H.R. 2646) - Expressed support for Congress to provide improved crisis response services, increased research and early intervention, and integrated mental health, substance abuse and primary care.

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

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

H.R.1559 - Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act of 2015 S.192 - Older Americans Act Reauthorization Act of 2015 S. 1549 - Care Planning Act FY 2017 Appropriations (HHS, FDA, ACL and DoJ) S.1719 - RAISE Family Caregivers Act S. 2067/H.R. 5073-the Ensuring Useful Research Expenditures is Key for Alzheimers (EUREKA) Act S. 2748/H.R. 3119-the Palliative Care and Hospice Education and Training Act H.R. 3913-Lifespan Respite Care Reauthorization Act S. 2614-Kevin and Avonte's Law of 2016

Client expense: $28,000 · Firm income: Not reported

Government targets: Administration on Aging, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office

The Care Planning Act (S. 1549), Home Health Documentation and Program Improvement Act (S. 1650), PCHETA (H.R. 3119/S.2748)

Client expense: $12,982 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Home Health Care Planning Improvement Act of 2015 (H.R. 1342, S. 578) The Care Planning Act (S. 1549), Palliative Care Hospice Education and Training Act (H.R. 3119, S.2748)

Client expense: $12,982 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

P.L. 111-375 National Alzheimer's Project Act, All sections H.R. 9/S. 1137, the Innovation Act H.R. 1559/S. 857, the Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act of 2015 H.R. 1468, the Global Brain Health Act of 2015 H.R. 2624/S. 1488, the Part D Beneficiary Appeals Fairness Act H.R. 3090/S. 3113, the Alzheimer's Caregiver Support Act H.R. 3091, the Missing Alzheimer's Disease Patient Alert Program Reauthorization Act H.R. 3092, the Alzheimer's Disease Semipostal Stamp Act H.R. 3099/S. 1719, the RAISE Family Caregivers Act H.R. 3119/S. 2748, the Palliative Care and Hospice Education and Training Act H.R. 3243/S. 1362, the PACE Innovation Act H.R. 3660, the Preventive Health Savings Act H.R. 4708/S.2759, the Credit for Caring Act of 2016 H.R. 4919/S. 2614, Kevin and Avonte's Law of 2016 H.R. 5196/S. 879, the Americans Giving Care to Elders (AGE) Act of 2015 H. Res. 237/S. Res. 74, a resolution declaring that achieving the primary goal of the National Plan to Address Alzheimer's Disease of the Department of Health and Human Services to prevent and effectively treat Alzheimer's disease by 2025 is an urgent national priority S. 192, the Older Americans Act Reauthorization Act of 2015 S. 1549, the Care Planning Act of 2015 S. 2961, the Compassionate Care Act S. 3130, the Independence at Home Act of 2016

Client expense: $180,000 · Firm income: Not reported

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

Oppose home health and hospice payment cuts and co-pays. Legislative and regulatory proposals affecting home care and hospice. Fostering Independence Through Technology Act (to be re-filed). S. 578/H.R. 1342, Home Health Care Planning Improvement Act. Labor/Health and Human Services/Education Appropriations, FY2016, provisions relating to Lifespan Respite Program, caregiver, and falls prevention matters. Recognition and payment for telehealth services under Medicare and Medicaid. Face to Face Physician Encounter Requirement. Medicare Home Health Rebasing Relief and Reassessment Act (to be re-filed). H.R. 2066, Telehealth Enhancement Act of 2015. H.R. 2948, Medicare Telehealth Parity Act. Home health rural add on payment. H.R. 1202, Medicare Patient Access to Hospice Act of 2015. S. 2389, Preserve Access to Medicare Rural Home Health Services Act of 2015. Value Based Purchasing and Bundling. S. 1650, Home Health Documentation and Program Improvement Act of 2015. Medicare reimbursement of advance care planning services. Appropriations for Family Caregiver Support Programs. H.R. 2208, Hospice Commitment to Accurate and Relevant Encounters Act. S. 1549, Care Planning Act of 2015. H.R. 1202/S. 1354, Medicare Patient Access to Hospice Act of 2015. S. 141/H.R. 1190, Protecting Seniors' Access to Medicare Act. H.R. 3298, Medicare Post-Acute Value-Based Purchasing Act of 2015. Chronic Care Management Proposals. Case Mix "Creep" Payment cuts Home Health Access Protection Act (draft legislation). S. 2368, Audit and Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015. Medicare Advantage hospice proposals. S. 2416, VERIFI Act. H.R. 2446, to amend the Social Security Act to require the use of electronic visit verification for Medicaid personal care services. H.R. 3119, Palliative Care and Hospice Education and Training Act. S. 2364, Medicare Home Health Flexibility Act of 2015. VA Home Care Services. Home Health Prior Authorization and Pre-Claim review. H.R. 2 (Public Law 114-10), Medicare Access & CHIP Reauthorization Act. H.R. 4994 (Public Law 113-185), Improving Medicare Post-Acute Care Transformation (IMPACT) Act. H.R. 4111, Rural Healthcare Connectivity Act. H.R. 2646, Helping Families in Mental Health Crisis Act. S. 2786, Rural Access to Hospice Care Act.

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

Issues relating to health disparities, health care reform, childhood cancer, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, tanning beds, skin cancer, and wellness, including: H.R.3119 & S.2748, the Palliative Care and Hospice Education and Training Act; H.R.716 & S.370, the Breast Density & Mammography Reporting Act; H.R.3381 & S.1883, Childhood Cancer STAR Act; and regulations relating to tanning beds. In addition, regulatory issues before the FDA relating to laboratory developed tests, and any legislation pertaining thereto, suncreens, colorectal cancer screening tests, electronic medical devices, H.R.2739/S.1566 - the Cancer Drug Coverage Parity Act, H.R.2846 - Planning Actively for Cancer Treatment Act, S.1014 - Personal Care Products Safety Act, H.R.1608 - Lymphedema Treatment Act, H.R.2191/S.1170 - the Breast Cancer Research Stamp Reauthorization Act, S.705 - Transportation Alternatives Act, S.540 - School Food Modernization Act, and H.R.644 - America Gives More Act, CDC opioid prescription guidelines, and legislation relating to opiod prescribing, addition and rehabilitation; H.R.5475, the Health Equity and Accountability Act; S.2787, the SAME Act and Senate Amendment 4369 to S.2943, the Senate Defense Authorization bill; and S.3136, H.R.5003 childhood nutrition bill; and H.R.2017 and S.2217, the Common Sense Nutrition Disclosure Act; and S.524 and H.R.953, the Comprehensive Addiction and Recovery Act, and related bills and amendments.

Client expense: $1,250,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), White House Office

S. 524 Comprehensive Addiction and Recovery Act of 2016 Senate HELP Committee Innovations Package HR 6 21st Century Cures Act HR 1600 Patients Access to Treatment Act of 2015 HR 2739/S 1566 Cancer Drug Coverage Parity Act HR 3381/S 1883 Childhood Cancer STAR Act HR 3119 Palliative Care Hospice Education and Training Act S 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015 H.R. 2846 Planning Actively for Cancer Treatment (PACT) Act of 2015 S. 2511 Improving Health Information Technology Act Reforms to the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act

Client expense: $92,141 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. Provided education to members of Congress and their staff about the importance of adequate funding for the Hospital Preparedness Program. Worked with members of Congress and staff on proposals for combating the Zika virus and encouraged adequate funding of these plans. H.R. 2646 - Helping Families in Mental Health Crisis Act of 2016 - Would make a variety of sweeping changes to the mental health infrastructure and while also reforming provider outreach, community-based treatment options, and justice system reform. - Discussed with staff how THA support the overall direction this bill would take the mental health system, and encouraged the use of community care in reforming the way we address mental health issues. Encouraged congressional staff to approve the bill, but expressed concern for lack of funding. Without adequate funding, states cannot properly implement the programs in the legislation. S.524 Comprehensive Addiction and Recovery Act (CARA) - wound enact policies intended to re-engineer how health care providers, communities and the criminal justice system coordinates care to treat addiction. - Expressed support for the overall goals of the bill and the programs to be established by the legislation, but THA is concerned with the lack of funding in the legislation. Without funding, states and localities cannot adequately address and combat the opioid addiction crisis. H.R.5273 - Helping Hospitals Improve Patient Care Act of 2016 - Would provide some relief to hospitals in site-neutral payments, readmissions adjustments and other polices. Discussed with congressional staff about the bills limited impact to Texas hospitals in relation to hospital outpatient departments. Encouraged additional work in the Senate to help a broader range of hospitals who had their payment structure changed without notice. H.R.2745 - Standard Merger and Acquisition Reviews Through Equal Rules Act of 2015 - Would standardize the merger review process for the Department of Justice (DOJ) and Federal Trade Commission (FTC). Met with congressional staff on how the merger review process impacts hospital mergers and how this legislation would eliminate disparities between the two reviewing agencies. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. H.R.1343/S.688 - Would require CMS to take into account patients' sociodemographic status when imposing financial penalties for excessive hospital readmissions for Medicare patients. - Met with congressional staff on how socioeconomic status impacts health and the importance of this legislation, especially to large safety net hospitals. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. Discussed with members of Congress and staff the implications, concerns with and the misguided policies in the proposed rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. H.R.5273 - Helping Hospitals Improve Patient Care Act of 2016 - Would provide some relief to hospitals in site-neutral payments, readmissions adjustments and other polices. Discussed with congressional staff about the bills limited impact to Texas hospitals in relation to hospital outpatient departments. Encouraged additional work in the Senate to help a broader range of hospitals that had their payment structure changed without notice. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Contacts in support of repealing the Patient Protection and Affordable Care Act, Public Law 111-148, because repeal would 1) eliminate the excise tax on high cost employer-sponsored health coverage which would discourage businesses from offering plans less likely to deny life-saving medical treatment, 2) eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation, 3) eliminate the authority of the Department of Health and Human Services to implement those recommendations by imposing quality and efficiency measures on health care providers, limiting the circumstances in which treatments can be given to their patients, 4) eliminate the authority of the Center for Medicare and Medicaid Services effectively to limit the amount of funds senior citizens may voluntarily add on top of the government contribution in order to obtain Medicare Advantage private-fee-for-service health insurance less likely to deny care and more likely to offer health care providers reimbursement rates high enough to induce them to accept Medicare patients, 5) eliminate the requirement that state health insurance exchanges administrators exclude from their exchanges insurance plans offered by any insurers the administrators believe allow their policyholders inside or outside the exchange to spend what the administrators consider an "excessive or unjustified" amount on their own health care, thereby restricting the medical treatment, and 6) eliminate the provisions related to "shared decisionmaking" because they are likely to be used, on balance, to dissuade patients from choosing life-saving treatment. Contacts in response to inquiries regarding implementation of certain elements of The Patient Protection and Affordable Care Act, Public Law 111-148, related to the denial of life-saving medical treatments. Contacts regarding S. 1549, the Care Planning Act of 2015 because 1) it fails to contain proper safeguards against dissuading patients to reject life-saving treatment they would otherwise want both to cut costs, and also due to a pervasive quality of life ethic 2) it authorizes health care providers to deny life-preserving treatment against the express will of a patient or surrogate invalidating several state protective laws and 3) advance planning documents that may have been filled out in other states are to be implemented removing state power over informed consent requirements surrounding choosing life-saving measures, food and fluids. Contacts in the U.S. Senate in support of S.2297, the Medicare Choices Empowerment and Protection Act, which would Give Medicare beneficiaries and others online access to a website with state-specific model advance directives that choose life-saving treatment, food and fluids equally with those that reject them. Contacts in the U.S. House in support of H.R. 4059, the Medicare Choices Empowerment and Protection Act, which would Give Medicare beneficiaries and others online access to a website with state-specific model advance directives that choose life-saving treatment, food and fluids equally with those that reject them. Contacts regarding advance care planning legislation (not introduced) 1) ensure the legislation provides for adequate oversight regarding the creation of advance planning materials, websites, etc. in order to protect against the materials being crafted in a way that persuades patients to reject treatment they might otherwise choose, 2) ensure that there are not Federally funded unmonitored practitioner consultations could lead to patients forgoing treatment they would otherwise have wanted, 3) ensure that there are not adverse changes to the Assisted Suicide Funding and Restriction Act 4) include oversight for grant approval for physician orders for life-sustaining treatment and 5) protect the right of states to ensure informed consent in choosing and rejecting treatment. Contacts regarding legislation (not introduced) regarding the Patient Protection and Affordable Care Act, Public Law 111-148, provision related to the excise tax on employer-paid health insurance premiums above a governmentally imposed limit that does not allow for medical inflation because the excess benefits tax will have its intended result of effectively imposing a price control on health insurance premiums. Contacts in the U.S. House in support of H.R. 3251 which would prohibit the coverage of advance care planning services under the Medicare Program because unmonitored advance care planning services can in practice be used to nudge patients to agree to forego life-saving treatment and even assisted feeding through the use of unbalanced, distorted, and even inaccurate information. Contacts regarding H.R. 3119, the "Palliative Care and Hospice Education and Training Act" as to whether provisions of the Assisted Suicide Funding Restriction Act would be revoked.

Client expense: $60,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Hospice Medicare Advantage "carve-in"; S. 1549, Care Planning Act of 2015; S. 2786, Rural Access to Hospice Act; H.R. 1202, Medicare Patient Access to Hospice Act of 2015; H.R. 2208, Hospice CARE Act; H.R. 3037, Hospice Care Access Improvement Act of 2015; H.R. 3119, Palliative Care and Hospice Education and Training Act; H.R. 5555, Personalize our Care Act 2.0; Access to physicians in rural health clinics (RHCs) and Federally Qualified Health Centers (FQHCs); Notice of election/notice of termination/revocation; Medicare Choices Model

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Pub. Law No. 111-148, Patient Protection and Affordable Care Act, matters related to the implementation of breast health education, research and clinical trials; S.1566/H.R.2722, Cancer Drug Coverage Parity Act, advocate to require insurance companies cover iv-administered and orally-administered anti-cancer drugs at the same cost to patients; H.R.1600, Patients' Access to Treatment Act, support amending the Public Health Service Act to establish cost-sharing limits for health plans that cover prescription drugs and use a formulary or other tiered cost-sharing structure and prohibits such a health plan from imposing higher cost-sharing requirements, including co-payment and co-insurance, for specialty drugs than for other prescription drugs in a non-preferred brand drug tier; H.R.1608, Lymphedema Treatment Act, support Medicare coverage of certain lymphedema compression treatment items as durable medical equipment; S.370/H.R.716, Breast Density and Mammography Reporting Act, issues related to the information provided to women and doctors on breast density and the potential impact it has on the detection of breast cancer and require the FDA to utilize up to date medical information and direct HHS to focus research on the best screening methods for breast tissue; H.R.1925, Dr. Balazs "Ernie" Bodai Congressional Gold Medal, support the presentation of a congressional gold medal to Dr. Balaz "Ernie" Bodai in recognition of his many outstanding contributions to the nation, including a tireless commitment to breast cancer research; H.R.6, 21st Century Cures Act, issues related to cancer prevention and research funding; S.620/H.R.1189, Preserving Employee Wellness Programs Act, issues related to the Genetic Information Act of 2008 and workplace wellness programs; H.R.2846, Planning Actively for Cancer Treatments Act, support coverage of cancer care planning and coordination services; S.91/H.R.4112, Mobile Mammography Promotion Act, issues related to excluding mobile mammography vehicles from the motor fuel excise tax; H.R.3119, Palliative Care and Hospice Education and Training Act, support federal funding for research, training, education and awareness into palliative care; S.1488/H.R.2624, Part D Beneficiary Appeals Fairness Act, issues related to out-of-pocket costs for prescription drugs.

Client expense: $100,208 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, White House Office

H.R.1559 - Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act of 2015 S.192 - Older Americans Act Reauthorization Act of 2015 S. 1549 - Care Planning Act FY 2017 Appropriations (HHS, FDA, ACL and DoJ) S.1719 - RAISE Family Caregivers Act S. 2067/H.R. 5073-the Ensuring Useful Research Expenditures is Key for Alzheimers (EUREKA) Act S. 2748/H.R. 3119-the Palliative Care and Hospice Education and Training Act H.R. 3913-Lifespan Respite Care Reauthorization Act S. 2614-Kevin and Avonte's Law of 2016

Client expense: $29,500 · Firm income: Not reported

Government targets: Administration on Aging, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office

Issues relating to health disparities, health care reform, childhood cancer, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, tanning beds, skin cancer, and wellness, including: H.R.3119, the Palliative Care and Hospice Education and Training Act; H.R.716 & S.370, the Breast Density & Mammography Reporting Act; and regulations relating to tanning beds. In addition, regulatory issues before the F.D.A relating to laboratory developed tests, suncreens, colorectal cancer screening tests, electronic medical devices, H.R.2739/S.1566 - the Cancer Drug Coverage Parity Act, H.R.2846 - Planning Actively for Cancer Treatment Act, S.1014 - Personal Care Products Safety Act, H.R.1608 - Lymphedema Treatment Act, H.R.2191/S.1170 - the Breast Cancer Research Stamp Reauthorization Act, S.705 - Transportation Alternatives Act, S.540 - School Food Modernization Act, H.R.644 - America Gives More Act; and CDC opioid prescription guidelines.

Client expense: $760,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), White House Office

P.L. 111-375 National Alzheimer's Project Act, All sections H.R. 9/S. 1137, the Innovation Act H.R. 1559/S. 857, the Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act of 2015 H.R. 1468, the Global Brain Health Act of 2015 H.R. 2624/S. 1488, the Part D Beneficiary Appeals Fairness Act H.R. 3090, the Alzheimer's Caregiver Support Act H.R. 3091, the Missing Alzheimer's Disease Patient Alert Program Reauthorization Act H.R. 3092, the Alzheimer's Disease Semipostal Stamp Act H.R. 3099/S. 1719, the RAISE Family Caregivers Act H.R. 3119/S. 2748, the Palliative Care and Hospice Education and Training Act H.R. 3243/S. 1362, the PACE Innovation Act H.R. 3660, the Preventive Health Savings Act H.R. 4919/S. 2614, Kevin and Avonte's Law of 2016 H. Res. 237/S. Res. 74, a resolution declaring that achieving the primary goal of the National Plan to Address Alzheimer's Disease of the Department of Health and Human Services to prevent and effectively treat Alzheimer's disease by 2025 is an urgent national priority S. 192, the Older Americans Act Reauthorization Act of 2015 S. 1549, the Care Planning Act of 2015

Client expense: $190,000 · Firm income: Not reported

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

Oppose home health and hospice payment cuts and co-pays. Legislative and regulatory proposals affecting home care and hospice. Fostering Independence Through Technology Act (to be re-filed). S. 578/H.R. 1342, Home Health Care Planning Improvement Act. Labor/Health and Human Services/Education Appropriations, FY2016, provisions relating to Lifespan Respite Program, caregiver, and falls prevention matters. Recognition and payment for telehealth services under Medicare and Medicaid. Face to Face Physician Encounter Requirement. Medicare Home Health Rebasing Relief and Reassessment Act (to be re-filed). H.R. 1458, BACPAC Act of 2015. H.R. 2066, Telehealth Enhancement Act of 2015. H.R. 2948, Medicare Telehealth Parity Act. Home health rural add on payment. H.R. 1021, Protecting the Integrity of Medicare Act (PIMA) of 2015, provisions on home health surety bond. H.R. 1202, Medicare Patient Access to Hospice Act of 2015. S. 2389, Preserve Access to Medicare Rural Home Health Services Act of 2015. Value Based Purchasing and Bundling. S. 1650, Home Health Documentation and Program Improvement Act of 2015. Medicare reimbursement of advance care planning services. Appropriations for Family Caregiver Support Programs. H.R. 2208, Hospice Commitment to Accurate and Relevant Encounters Act. S. 1549, Care Planning Act of 2015. H.R. 1202/S. 1354, Medicare Patient Access to Hospice Act of 2015. S. 141/H.R. 1190, Protecting Seniors' Access to Medicare Act. H.R. 3298, Medicare Post-Acute Value-Based Purchasing Act of 2015. Chronic Care Management Proposals. Case Mix "Creep" Payment cuts Home Health Access Protection Act (draft legislation). S. 2368, Audit and Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015. Medicare Advantage hospice proposals. S. 2416, VERIFI Act. H.R. 2446, to amend the Social Security Act to require the use of electronic visit verification for Medicaid personal care services. H.R. 3119, Palliative Care and Hospice Education and Training Act. S. 2364, Medicare Home Health Flexibility Act of 2015. VA Home Care Services. Home Health Prior Authorization.

Client expense: $120,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

Issues relating to health disparities, health care reform, childhood cancer, quality of life and palliative care, federal health care programs, genetic information, cancer, nutrition, tanning beds, skin cancer, and wellness, including: H.R.3119, the Palliative Care and Hospice Education and Training Act; H.R.716 & S.370, the Breast Density & Mammography Reporting Act; and regulations relating to tanning beds. In addition, regulatory issues before the F.D.A relating to laboratory developed tests, suncreens, colorectal cancer screening tests, electronic medical devices, H.R.2739/S.1566 - the Cancer Drug Coverage Parity Act, H.R.2846 - Planning Actively for Cancer Treatment Act, S.1014 - Personal Care Products Safety Act, H.R.1608 - Lymphedema Treatment Act, H.R.2191/S.1170 - the Breast Cancer Research Stamp Reauthorization Act, S.705 - Transportation Alternatives Act, S.540 - School Food Modernization Act, H.R.644 - America Gives More Act; and CDC opioid prescription guidelines.

Client expense: $760,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), White House Office

Hospice Medicare Advantage "carve-in"; Medicare Hospice benefit payment reform; S. 1549, Care Planning Act of 2015; H.R. 1202, Medicare Patient Access to Hospice Act of 2015; H.R. 2208, Hospice CARE Act; H.R. 3037, Hospice Care Access Improvement Act of 2015; H.R. 3119, Palliative Care and Hospice Education and Training Act; Access to physicians in rural health clinics (RHCs) and Federally Qualified Health Centers (FQHCs); Notice of election/notice of termination/revocation; Medicare Choices Model

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. Provided education to members of Congress and their staff about the importance of adequate funding for the Hospital Preparedness Program. Worked with members of Congress and staff on proposals for combating the Zika virus and encouraged adequate funding of these plans. H.R.2745 - Standard Merger and Acquisition Reviews Through Equal Rules Act of 2015 - Would standardize the merger review process for the Department of Justice (DOJ) and Federal Trade Commission (FTC). Met with congressional staff on how the merger review process impacts hospital mergers and how this legislation would eliminate disparities between the two reviewing agencies. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R. 953 Comprehensive Addiction and Recovery Act - Discussed with congressional staff how hospitals are involved with treating and caring for opioid and other substance abuse patients. Discussed limitations and flexibility within current law and congressional proposals. S.2002 - Mental Health and Safe Communities Act of 2015 - Talked with Senate staff about the importance of adequate funding and coordination of care across multiple disciplines, including hospitals, law enforcement, judicial system, outpatient clinics, community-based treatment and more. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. H.R.1343/S.688 - Would require CMS to take into account patients' sociodemographic status when imposing financial penalties for excessive hospital readmissions for Medicare patients. - Met with congressional staff on how socioeconomic status impacts health and the importance of this legislation, especially to large safety net hospitals. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. H.R. 2646 - Helping Families in Mental Health Crisis Act of 2015 - Would make a variety of sweeping changes to the mental health infrastructure and while also reforming provider outreach, community-based treatment options, and justice system reform. - Discussed with staff how THA support the overall direction this bill would take the mental health system, and encouraged the use of community care in reforming the way we address mental health issues. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Contacts in support of repealing the Patient Protection and Affordable Care Act, Public Law 111-148, because repeal would 1) eliminate the excise tax on high cost employer-sponsored health coverage which would discourage businesses from offering plans less likely to deny life-saving medical treatment, 2) eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation, 3) eliminate the authority of the Department of Health and Human Services to implement those recommendations by imposing quality and efficiency measures on health care providers, limiting the circumstances in which treatments can be given to their patients, 4) eliminate the authority of the Center for Medicare and Medicaid Services effectively to limit the amount of funds senior citizens may voluntarily add on top of the government contribution in order to obtain Medicare Advantage private-fee-for-service health insurance less likely to deny care and more likely to offer health care providers reimbursement rates high enough to induce them to accept Medicare patients, 5) eliminate the requirement that state health insurance exchanges administrators exclude from their exchanges insurance plans offered by any insurers the administrators believe allow their policyholders inside or outside the exchange to spend what the administrators consider an excessive or unjustified amount on their own health care, thereby restricting the medical treatment, and 6) eliminate the provisions related to shared decisionmaking because they are likely to be used, on balance, to dissuade patients from choosing life-saving treatment. Contacts in response to inquiries regarding implementation of certain elements of The Patient Protection and Affordable Care Act, Public Law 111-148, related to the denial of life-saving medical treatments. Contacts regarding S. 1549, the Care Planning Act of 2015 because 1) it fails to contain proper safeguards against dissuading patients to reject life-saving treatment they would otherwise want both to cut costs, and also due to a pervasive quality of life ethic 2) it authorizes health care providers to deny life-preserving treatment against the express will of a patient or surrogate invalidating several state protective laws and 3) advance planning documents that may have been filled out in other states are to be implemented removing state power over informed consent requirements surrounding choosing life-saving measures, food and fluids. Contacts in the U.S. Senate in support of S.2297, the Medicare Choices Empowerment and Protection Act, which would Give Medicare beneficiaries and others online access to a website with state-specific model advance directives that choose life-saving treatment, food and fluids equally with those that reject them. Contacts in the U.S. House in support of H.R. 4059, the Medicare Choices Empowerment and Protection Act, which would give Medicare beneficiaries and others online access to a website with state-specific model advance directives that choose life-saving treatment, food and fluids equally with those that reject them. Contacts regarding advance care planning legislation (not introduced) 1) ensure the legislation provides for adequate oversight regarding the creation of advance planning materials, websites, etc. in order to protect against the materials being crafted in a way that persuades patients to reject treatment they might otherwise choose, 2) ensure that there are not Federally funded unmonitored practitioner consultations could lead to patients forgoing treatment they would otherwise have wanted, 3) ensure that there are not adverse changes to the Assisted Suicide Funding and Restriction Act 4) include oversight for grant approval for physician orders for life-sustaining treatment and 5) protect the right of states to ensure informed consent in choosing and rejecting treatment. Contacts regarding legislation (not introduced) regarding the Patient Protection and Affordable Care Act, Public Law 111-148, provision related to the excise tax on employer-paid health insurance premiums above a governmentally imposed limit that does not allow for medical inflation because the excess benefits tax will have its intended result of effectively imposing a price control on health insurance premiums. Contacts in the U.S. House in support of H.R. 3251 which would prohibit the coverage of advance care planning services under the Medicare Program because unmonitored advance care planning services can in practice be used to nudge patients to agree to forego life-saving treatment and even assisted feeding through the use of unbalanced, distorted, and even inaccurate information. Contacts regarding H.R. 3119, the "Palliative Care and Hospice Education and Training Act" as to whether provisions of the Assisted Suicide Funding Restriction Act would be revoked.

Client expense: $60,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Senate HELP Committee Innovations Package HR 6 21st Century Cures Act HR 1600 Patients Access to Treatment Act of 2015 HR 2739/S 1566 Cancer Drug Coverage Parity Act HR 3381/S 1883 Childhood Cancer STAR Act HR 3119 Palliative Care Hospice Education and Training Act S 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015 H.R. 2846 Planning Actively for Cancer Treatment (PACT) Act of 2015 S. 2511 Improving Health Information Technology Act S.524 Comprehensive Addiction and Recovery Act of 2016

Client expense: $98,340 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE