To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories.

H.R. 3229/S. 2196 - H.R. 3229/S. 2196 to protect access to complex rehab wheelchairs and essential components required by people with disabilities. H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015 that will create separate recognition for complex rehab technology. United Spinal opposes a proposal in the Presidents FY2017 Budget which expands the competitive bidding program to additional categories, including ostomy and urological supplies. Met with White House to discuss CRT. Support reauthorizing Money Follows the Person under Medicaid. Support protecting rehabilitative and habilitative services for people with disabilities. United Spinal Association joined the Alliance for Healthcare Security in a Preserving the Affordable Care Act (ACA) Advertisement, along with numerous non-profits, in an ad to Congress with the message: Repealing the Affordable Care Act without an immediate plan to replace it is a big risk - like walking off an unfinished bridge. TELL CONGRESS: DONT REPEAL HEALTHCARE WITHOUT A PLAN TO PROTECT OUR CARE.

Client expense: Not reported · Firm income: $75,000

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, Social Security Administration (SSA), Transportation, Dept of (DOT), White House Office

-H.R. 1516/S. 1013, support passage of the Ensuring Access to Quality Complex Rehabilitation Technology Act. -H.R. 3229/S. 2196, support passage to protect access to complex rehabilitative technology accessories.

Client expense: $105,020 · Firm income: Not reported

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

-H.R. 292/S. 849, support passage of the Advancing Research for Neurological Diseases Act. -H.R. 6, 21st Century Cures Act, support inclusion of H.R. 292/S. 849, support increased funding for the National Institutes of Health and support other provisions that speed the development of effective treatments for people with multiple sclerosis. -H.R. 34, 21st Century Cures Act, support inclusion of H.R. 292/S. 849, support increased funding for the National Institutes of Health and support other provisions that speed the development of effective treatments for people with multiple sclerosis. -H.R. 1516/S. 1013, support passage of the Ensuring Access to Quality Complex Rehabilitation Technology Act. -H.R. 3229/S. 2196, support passage to protect access to complex rehabilitative technology accessories. -H.R. 3913, Lifespan Respite Care Reauthorization Act, support reauthorization of the Lifespan Respite Care Program.

Client expense: $105,020 · Firm income: Not reported

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

PL 108-173: Medicare Prescription Drug and Modernization Act of 2003; Community Living Assistance Services and Supports (CLASS) Act; Community Choice Act; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; Health Care and Education Reconciliation Act of 2010; Social Security Protection Act; PL 79-271: Social Security Act of 1935; The Fiscal Responsibility & Retirement Security Act; HR 132: ObamaCare Repeal Act; S 1845: Emergency Unemployment Compensation Extension Act; S 2090/HR 3621: Social Security Earned Benefits Payment Act; HR 1314: Bipartisan Budget Act of 2015, Title VIII - Social Security; HR 1735: National Defense Authorization Act; HR 3229/S 2196: To exempt CR and wheelchair companies from Medicare's Comprehensive Bidding pricing; HR 3913: Lifespan Respite Care Reauthorization Act; and HR 34: 21st Century Cures Act.

Client expense: $41,529 · Firm income: Not reported

Medicare and Medicaid reform; Medicare competitive bidding; PL 108-173: Medicare Prescription Drug and Modernization Act of 2003; Budget Resolutions; Community Choice Act; PL 111-148: Patient Protection and Affordable Care Act; PL 111-152, 124 Stat. 1029: Health Care and Education Reconciliation Act of 2010; HR 132: ObamaCare Repeal Act; S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014; S 539/HR 775: Medicare Access to Rehabilitation Services Act; HR 2339: To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program, and for other purposes; HR 3229: To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories; and HR 5396: Medicare Dental, Vision and Hearing Act of 2015.

Client expense: $41,529 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Defense, Dept of (DOD), Education, Dept of, Equal Employment Opportunity Commission (EEOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

H.R. 3229 S. 2425, the Patient Access and Medicare Protection Act The Ending the Medicare Disability Waiting Period Act Medicaid Block Grants Proposed Reductions in Medicaid Spending Commission on Long Term Care

Client expense: $67,802 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

H.R. 1516 and S. 1013, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015; H.R. 3229 and S. 2196, To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories; H.R. 5210 and S. 2736, Patient Access to Durable Medical Equipment (PADME) Act; H.R. 6, 21st Century Cures Act

Client expense: $100,876 · Firm income: Not reported

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015, all provisions; H.R. 284/S. 148 - Medicare DMEPOS Competitive Bidding Improvement Act of 2015, all provisions; Medicare Audit Improvement and Reform (AIR) Act, all provisions; Medicare DMEPOS Market Pricing Program Act, all provisions; Reimbursement cuts in non-competitive bidding areas, all provisions; H.R. 6/H.R. 34 - 21st Century Cures Act, competitive bidding issues; Complex rehab technology accessories relating to competitive bidding; H.R. 2437 - Creating prior authorization process for DME items, all provisions; Expanding and making permanent the Medicare power mobility device demonstration program, all provisions; Audit and Appeal Fairness, Integrity, and Reforms in the Medicare Act of 2015, all provisions; H.R. 2 - Medicare Access and CHIP Re-authorization Act of 2015, competitive bidding provisions; H.R. 2029 - Omnibus Appropriations Bill, DME provisions; S. 2425 - Patient Access and Medicare Protection Act, all provisions; H.R. 4185/S. 2312 - DME Rural Relief, all provisions; H.R. 3229/S. 2196 - Complex Rehab Accessories Relief, all provisions; S. 2736/H.R. 5210 - Patient Access to Durable Medical Equipment Act of 2016, all provisions.

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

Letter urging passage of S. 2196/H.R. 3229 by years end to protect Complex Rehabilitation Technology Accessories for People with Disabilities

Client expense: Not reported · Firm income: $6,976

Government targets: HOUSE OF REPRESENTATIVES, SENATE

-H.R. 292/S. 849, support passage of the Advancing Research for Neurological Diseases Act. -H.R. 6, 21st Century Cures Act, support inclusion of H.R. 292/S. 849, support increased funding for the National Institutes of Health and support other provisions that speed the development of effective treatments for people with multiple sclerosis. -H.R. 1516/S. 1013, support passage of the Ensuring Access to Quality Complex Rehabilitation Technology Act. -H.R. 3229/S. 2196, support passage to protect access to complex rehabilitative technology accessories. -H.R. 3913, Lifespan Respite Care Reauthorization Act, support reauthorization of the Lifespan Respite Care Program.

Client expense: $90,717 · Firm income: Not reported

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

-H.R. 1516/S. 1013, support passage of the Ensuring Access to Quality Complex Rehabilitation Technology Act. -H.R. 3229/S. 2196, support passage to protect access to complex rehabilitative technology accessories.

Client expense: $90,717 · Firm income: Not reported

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

Health care issues affecting individuals with neuromuscular disease, including transitional health care issues; increased FY 2017 appropriations for the NIH and FDA; newborn screening; and reauthorization of the Prescription Drug User Fee Act (PDUFA). H.R. 6, 21st Century Cures and Innovation for Healthier Americans initiatives; S. 1604, Transition to Independence Act; H.R. 1516/S. 1013, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015; S. 2030, Advancing Targeted Therapies for Rare Diseases Act; H.R. 3229, Enforce the Medicare Improvements for Patients and Providers Act of 2015; S. 2702/H.R. 4795, ABLE to Work Act; S. 2703/H.R. 4794, ABLE Financial Planning Act; S. 2704/H.R. 4813, ABLE Age Adjustment Act; S. 2904/H.R. 5103, ALS Disability Insurance Act

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

Government targets: Executive Office of the President (EOP), Federal Aviation Administration (FAA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), SENATE, Transportation, Dept of (DOT)

HR 3229/S. 2196 To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. Spoke with Rep. Jared Polis district staff member regarding casework for a United Spinal member. H.R. 1516/S. 1013 Amends title XVIII (Medicare) of the Social Security Act to cover, as medical and other health services, complex rehabilitation technology (CRT) items designed or individually configured for a specific qualified individual to meet that individual's unique: (1) medical, physical, or functional needs related to a medical condition; and (2) capacities for basic activities of daily living (ADLs) or instrumental ADLs. A proposal in the Presidents FY2017 Budget expands the competitive bidding program to additional categories, including ostomy and urological supplies. This decision will limit access to prosthetic supplies which need to be clinically prescribed, selected, and/or adjusted and fitted for individuals by specially trained health care professionals based on the unique medical and physical needs of each person in relation to their disease or condition. The incorrect catheters or ostomy supplies can put individuals at risk of severe skin damage, infection, hospitalization and possibly death. Since ostomy and urological medical supplies restore the lost functions of waste storage and elimination, they are defined in the Social Security Act as prosthetics. United Spinal signed onto a letter, led by the Center for Medicare Advocacy, to the Centers for Medicare and Medicaid Services highlighting the problems with access to durable medical equipment (such as wheelchairs and other assistive technology and medical equipment that can be used in the home) when individuals are dual-eligibles - that is, on Medicare and Medicaid. There continues to be a misalignment of payment procedures in Medicare and Medicaid resulting in denials, delays, and higher than appropriate health care costs for essential DME among dually eligible beneficiaries. United Spinal supports the recommended solution which requires state Medicaid agencies, as is the law in Connecticut, to process prior authorization requests for DME for Medicaid beneficiaries whether or not they also are on Medicare. United Spinal signed onto a letter to the House in support of H.R. 5721, the Local Coverage Determination Clarification Act. This important legislation would help ensure basic procedural fairness in Local Coverage Determinations (LCDs), and thereby provide an important Medicare beneficiary protection that is often lacking in local coverage decisions. Competitive Bidding Letter United Spinal signed on to a letter to the Centers for Medicare and Medicaid Services (CMS) supporting competitive bidding reforms including the requirement of DME provider state licensure; the letter states its opposition to the competitive bidding programs limits on choice, access and quality of durable medical equipment. Negative Pressure Wound Therapy United Spinal signed onto this CMS letter which focused on the proposal to implement the newly created statutory benefit to pay home health agencies separately for disposable negative pressure wound therapy. In general, the letter supports the Centers for Medicare and Medicaid Services (CMS) proposal implementing the new statutory benefit to ensure patient access to this important therapy. United Spinal signed onto and helped draft a letter to the Centers for Medicare and Medicaid Services opposing charging people with mobility impairments an extra payment for physician time. PAC VBP United Spinal signed onto this written statement on the Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298) regarding Medicare Spending per Beneficiary (MSPB) measure. MSPB is an economic measure to assess Medicare utilization and is used to ascertain the productivity of a provider within a given setting, or a type of provider compared to another type of provider. The letter states that the PAC-VBP program should not measure MSPB without simultaneously measuring quality, function, and quality of life outcomes so that the Medicare program knows what it is getting for its payments to providers. ICD-10 United Spinal Association, and other stakeholders, requested an in-person meeting to discuss the unintended consequences of ICD-10 conversion on access to inpatient rehabilitation hospitals and units (IRFs) for Medicare beneficiaries with brain injuries and select orthopedic conditions, and to explore possible remedies to this problem. MPFS 2017 and OPPS 2017 United Spinal signed onto a couple of letters to the Centers for Medicare and Medicaid Services on related to various health IT provisions ensuring better protections of chronic care management services and streamlining tools for advanced imaging services.

HR 1516, S 1013, HR 3229. HR 6 - 21st Century Cures Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare and Medicaid reform; Medicare competitive bidding; PL 108-173: Medicare Prescription Drug and Modernization Act of 2003; Budget Resolutions; Community Choice Act; PL 111-148: Patient Protection and Affordable Care Act; PL 111-152, 124 Stat. 1029: Health Care and Education Reconciliation Act of 2010; HR 132: ObamaCare Repeal Act; S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014; S 539/HR 775: Medicare Access to Rehabilitation Services Act; HR 2339: To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program, and for other purposes; HR 3229: To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories; and HR 5396: Medicare Dental, Vision and Hearing Act of 2015.

Client expense: $91,261 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Defense, Dept of (DOD), Education, Dept of, Equal Employment Opportunity Commission (EEOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015, all provisions; H.R. 284/S. 148 - Medicare DMEPOS Competitive Bidding Improvement Act of 2015, all provisions; Medicare Audit Improvement and Reform (AIR) Act, all provisions; Medicare DMEPOS Market Pricing Program Act, all provisions; Reimbursement cuts in non-competitive bidding areas, all provisions; H.R. 6 - 21st Century Cures Act, competitive bidding issues; Complex rehab technology accessories relating to competitive bidding; H.R. 2437 - Creating prior authorization process for DME items, all provisions; Expanding and making permanent the Medicare power mobility device demonstration program, all provisions; Audit and Appeal Fairness, Integrity, and Reforms in the Medicare Act of 2015, all provisions; H.R. 2 - Medicare Access and CHIP Re-authorization Act of 2015, competitive bidding provisions; H.R. 2029 - Omnibus Appropriations Bill, DME provisions; S. 2425 - Patient Access and Medicare Protection Act, all provisions; H.R. 4185/S. 2312 - DME Rural Relief, all provisions; H.R. 3229/S. 2196 - Complex Rehab Accessories Relief, all provisions; S. 2736/H.R. 5210 - Patient Access to Durable Medical Equipment Act of 2016, all provisions.

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

H.R. 3229 S. 2425, the Patient Access and Medicare Protection Act The Ending the Medicare Disability Waiting Period Act Medicaid Block Grants Proposed Reductions in Medicaid Spending Commission on Long Term Care

Client expense: $69,613 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), SENATE

H.R. 1516 and S. 1013, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015; H.R. 3229 and S. 2196, To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories; H.R. 5210 and S. 2736, Patient Access to Durable Medical Equipment (PADME) Act.

Client expense: $107,500 · Firm income: Not reported

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

5210 and S 2736--Prevent phase-in of competitive bidding cuts in rural areas HR 3229--Prevent application of competitive bidding payment rates to complex rehab accessories

Client expense: Not reported · Firm income: $7,500

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

Health care issues affecting individuals with neuromuscular disease, including transitional health care issues and increased FY 2017 appropriations for the NIH, FDA, and newborn screening. H.R. 6, 21st Century Cures and Innovation for Healthier Americans initiatives; S. 1604, Transition to Independence Act; H.R. 1516/S. 1013, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015; S. 2030, Advancing Targeted Therapies for Rare Diseases Act; H.R. 3229, Enforce the Medicare Improvements for Patients and Providers Act of 2015; S. 2702/H.R. 4795, ABLE to Work Act; S. 2703/H.R. 4794, ABLE Financial Planning Act; S. 2704/H.R. 4813, ABLE Age Adjustment Act; S. 2904/H.R. 5103, ALS Disability Insurance Act

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

Government targets: Federal Aviation Administration (FAA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), SENATE, Transportation, Dept of (DOT)

-H.R. 292/S. 849, support passage of the Advancing Research for Neurological Diseases Act. -H.R. 6, 21st Century Cures Act, support inclusion of H.R. 292/S. 849, support increased funding for the National Institutes of Health and support other provisions that speed the development of effective treatments for people with multiple sclerosis. -H.R. 1516/S. 1013, support passage of the Ensuring Access to Quality Complex Rehabilitation Technology Act. -H.R. 3229/S. 2196, support passage to protect access to complex rehabilitative technology accessories. -H.R. 3913, Lifespan Respite Care Reauthorization Act, support reauthorization of the Lifespan Respite Care Program.

Client expense: $88,942 · Firm income: Not reported

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

-H.R. 1516/S. 1013, support passage of the Ensuring Access to Quality Complex Rehabilitation Technology Act. -H.R. 3229/S. 2196, support passage to protect access to complex rehabilitative technology accessories.

Client expense: $88,942 · Firm income: Not reported

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

Medicare and Medicaid reform; Medicare competitive bidding; PL 108-173: Medicare Prescription Drug and Modernization Act of 2003; Budget Resolutions; Community Choice Act; PL 111-148: Patient Protection and Affordable Care Act; PL 111-152, 124 Stat. 1029: Health Care and Education Reconciliation Act of 2010; HR 132: ObamaCare Repeal Act; S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014; S 539/HR 775: Medicare Access to Rehabilitation Services Act; HR 2339: To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program, and for other purposes; HR 3229: To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories; and HR 5396: Medicare Dental, Vision and Hearing Act of 2015.

Client expense: $157,721 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Defense, Dept of (DOD), Education, Dept of, Equal Employment Opportunity Commission (EEOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

Supports H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015 - Creates a separate benefit under Medicare for complex rehab technology. Supports H.R. 3229/S. 2196 - This bill amends title XVIII (Medicare) of the Social Security Act to prohibit the application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. (A competitive bidding program has replaced the use of established fee schedule amounts to determine payments under Medicare for certain durable medical equipment such as wheelchairs.) Conducted a Congressional Expo and Briefing on HR 1516/S. 1013 and H.R. 3229 and S. 2196 and educated Congress and the Government Accountability Office on the differences between manual and power CRT. United Spinal, as one of several consumer and disability stakeholders, raised concerns with the Administration for Community Living and the Centers for Medicare and Medicaid Services on access to durable medical equipment as urological and ostomy supplies with the expansion of competitive bidding under Medicare. United Spinal, in collaboration with United Spinals Urology Coalition, opposes expanding Medicares competitive bidding program to urology and ostomy supplies, as laid out in the Presidents Budget. United Spinal also sent a consumer and clinician letter to the committees of jurisdiction opposing the expansion. Part B Demonstration United Spinal signed onto two separate letters led by the Partnership to Improve Patient Care and the MS Coalition, to the Centers for Medicare and Medicaid Services opposing tying payment of drugs to cost-effectiveness. In early 2016, several bipartisan and nonpartisan organizations, including the Bipartisan Policy Center and the Long-Term Care Financing Collaborative, released reports on a path forward for future financing of our nations long-term care needs. The problem is clear: while our nation is aging and people are living longer with disabilities and chronic conditions, we lack a coherent plan on how to provide for their care and supports. Our current financing system relies almost entirely on Medicaid and unpaid family caregivers, both of which thwart family financial planning and hinder the economic opportunities of women, people of color, and people with disabilities. The Consortium for Citizens with Disabilities (CCD) Long-Term Services and Supports Task Force of CCD released a statement, which United Spinal endorsed, to weigh in on the recent reports on long-term care financing, express our support for Medicaid improvements, and support the emerging consensus on the need for a public insurance program. United Spinal signed onto an ITEM Coalition letter in support of HR 5210, the Protecting Patient Access to Durable Medical Equipment Act to Secretary Sylvia Burwell of the Department of Health and Human Services. This letter urged the Centers for Medicare and Medicaid Services (CMS) to extend the current six-month phase-in of modified payment for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for an additional 12 months to avoid disruption in care to beneficiaries. United Spinal is working on increasing coverage for powered exoskeleton devices and on a Congressional advocacy campaign to make Congress aware of research showing benefits to SCI individual in the use of these devices and to help powered exoskeleton devices gain and maintain regulatory approvals and additional insurance carrier recognition.

HR 1516, S 1013, HR 3229. HR 6 - 21st Century Cures Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015, all provisions; H.R. 284/S. 148 - Medicare DMEPOS Competitive Bidding Improvement Act of 2015, all provisions; Medicare Audit Improvement and Reform (AIR) Act, all provisions; Medicare DMEPOS Market Pricing Program Act, all provisions; Reimbursement cuts in non-competitive bidding areas, all provisions; H.R. 6 - 21st Century Cures Act, competitive bidding issues; Complex rehab technology accessories relating to competitive bidding; H.R. 2437 - Creating prior authorization process for DME items, all provisions; Expanding and making permanent the Medicare power mobility device demonstration program, all provisions; Audit and Appeal Fairness, Integrity, and Reforms in the Medicare Act of 2015, all provisions; H.R. 2 - Medicare Access and CHIP Re-authorization Act of 2015, competitive bidding provisions; H.R. 2029 - Omnibus Appropriations Bill, DME provisions; S. 2425 - Patient Access and Medicare Protection Act, all provisions; H.R. 4185/S. 2312 - DME Rural Relief, all provisions; H.R. 3229/S. 2196 - Complex Rehab Accessories Relief, all provisions; S. 2736/H.R. 5210 - Patient Access to Durable Medical Equipment Act of 2016, all provisions.

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

H.R. 1516 and S. 1013, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015; H.R. 3229 and S. 2196, To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories; H.R. 5210 and S. 2736, Patient Access to Durable Medical Equipment (PADME) Act.

Client expense: $102,665 · Firm income: Not reported

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

Health care issues affecting individuals with neuromuscular disease, including transitional health care issues and increased FY 2017 appropriations for the NIH and for FDA. H.R. 6, 21st Century Cures and Innovation for Healthier Americans initiatives; S. 1604, Transition to Independence Act; H.R. 1516/S. 1013, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015; S. 1597, Patient-Focused Impact Assessment Act of 2015; S. 2030, Advancing Targeted Therapies for Rare Diseases Act; HR 3229, Enforce the Medicare Improvements for Patients and Providers Act of 2015

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

Government targets: Federal Aviation Administration (FAA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), SENATE, Transportation, Dept of (DOT)

-H.R. 1516/S. 1013, support passage of the Ensuring Access to Quality Complex Rehabilitation Technology Act. -H.R. 3229/S. 2196, support passage to protect access to complex rehabilitative technology accessories.

Client expense: $122,684 · Firm income: Not reported

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

-H.R. 292/S. 849, support passage of the Advancing Research for Neurological Diseases Act. -H.R. 6, 21st Century Cures Act, support inclusion of H.R. 292/S. 849, support increased funding for the National Institutes of Health and support other provisions that speed the development of effective treatments for people with multiple sclerosis. -H.R. 1516/S. 1013, support passage of the Ensuring Access to Quality Complex Rehabilitation Technology Act. -H.R. 3229/S. 2196, support passage to protect access to complex rehabilitative technology accessories. -H.R. 3913, Lifespan Respite Care Reauthorization Act, support reauthorization of the Lifespan Respite Care Program.

Client expense: $122,684 · Firm income: Not reported

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

HR 3016 Advocated against this bill because it caps funding for certain aviation degree programs and discriminates against veterans who want to train as rotary wing pilots. HR 385 HAVEN Act. Working with Congressman Al Greens office to make recommendations to Department of Housing and Urban Development for the implementation of a grant program that helps low income disabled veterans rehabilitate dilapidated buildings for use as residences. HR 2264/S 2596. Signed onto a letter of support to go in base National Defense Authorization Act for 100% disabled veterans (who had not retired from military service) to receive space available (Space A) on military flights. Liaised with numerous Congressional offices to inform them of the need to support HR 3229 Complex Rehabilitation Technology legislation. HR 3471 Veterans Mobility Safety Act- this bill is to amend title 38, United States Code, to make certain improvements in the provision of automobiles and adaptive equipment by the Department of Veterans Affairs-Wrote letter in support of this legislation to Congresswoman Walorski. Lobbied Congressional offices of the need to revamp VAs Vocational Rehabilitation and Employment Program (VR&E). The expectation is that by raising the disability rating qualification, the understaffed VR&E workforce can focus on those veterans most in need of services. Signed onto a letter to Department of Labors Veterans Employment and Training Service to support its efforts to increase employment for veterans with disabilities. HR 4683 Wrote a letter in support of HR 4683 Fairness for Veterans Act that provides for the reevaluation of discharges for veterans released under other than honorable conditions due to the effects of traumatic brain injury or post-traumatic stress.

Client expense: Not reported · Firm income: $75,000

Supports H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015 - Creates a separate benefit under Medicare for complex rehab technology. Supports H.R. 3229/S. 2196 - This bill amends title XVIII (Medicare) of the Social Security Act to prohibit the application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. (A competitive bidding program has replaced the use of established fee schedule amounts to determine payments under Medicare for certain durable medical equipment such as wheelchairs.) Supports S. 2425 - Patient Access and Medicare Protection Act - A bill 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. Discussed with CMS, ACL and GAO concerns as it relates to access to durable medical equipment and complex rehab technology and accessories under Medicare's competitive acquisition program. Discussed with CMS consumer access problems with Medicare's competitive bidding program. United Spinal submitted comments to the Centers for Medicare and Medicaid Services regarding Medicaid access to covered services. United Spinal signed onto a comment letter to entities in the Federally-Facilitated Marketplaces, seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Marketplaces (FFMs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs) with operational and technical guidance for the disability population. United Spinal opposes the provision in the FY2017 Presidential Budget to provide authority to expand competitive bidding for certain durable medical equipment specifically: ostomy and urological supplies. United Spinal commented to CMS on the issue of discharge planning for hospitals, critical access hospitals, and home health agencies. This proposed rule would revise the discharge planning requirements in order to participate in the Medicare and Medicaid programs. United Spinal signed onto a letter to CMS opposing the same reimbursement to Medicare from skilled nursing facilities as well as in-patient rehab facilities and units (IRFs). United Spinal also edited and endorsed a letter from Congressman G. T. Thompson (R-PA) to the Centers for Medicare and Medicaid Services to urge Medicare Advantage plants to follow Medicare criteria Medicare IRF coverage criteria when determining coverage for IRF care. United Spinal signed onto a comment letter to the Centers for Medicare and Medicaid Services (CMS) regarding the Summary of Benefits and Coverage, the Uniform Glossary of Medical Terms. United Spinal signed onto a letter to MedPAC on Medicare Part D cost sharing for LIS and dual eligible beneficiaries. Generic Utilization is already high in both LIS and non-LIS populations and higher cost sharing for branded products could reduce adherence, increase spending on other health care services in Medicare/Medicaid.

Medicare and Medicaid reform; Medicare competitive bidding; PL 108-173: Medicare Prescription Drug and Modernization Act of 2003; Budget Resolutions; Community Choice Act; PL 111-148: Patient Protection and Affordable Care Act; PL 111-152, 124 Stat. 1029: Health Care and Education Reconciliation Act of 2010; HR 132: ObamaCare Repeal Act; S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014; S 539/HR 775: Medicare Access to Rehabilitation Services Act; HR 2339: To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program, and for other purposes; and HR 3229: To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories.

Client expense: $71,499 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Defense, Dept of (DOD), Education, Dept of, Equal Employment Opportunity Commission (EEOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015, all provisions; H.R. 284/S. 148 - Medicare DMEPOS Competitive Bidding Improvement Act of 2015, all provisions; Medicare Audit Improvement and Reform (AIR) Act, all provisions; Medicare DMEPOS Market Pricing Program Act, all provisions; Reimbursement cuts in non-competitive bidding areas, all provisions; H.R. 6 - 21st Century Cures Act, competitive bidding issues; Complex rehab technology accessories relating to competitive bidding; H.R. 2437 - Creating prior authorization process for DME items, all provisions; Expanding and making permanent the Medicare power mobility device demonstration program, all provisions; Audit and Appeal Fairness, Integrity, and Reforms in the Medicare Act of 2015, all provisions; H.R. 2 - Medicare Access and CHIP Re-authorization Act of 2015, competitive bidding provisions. H.R. 2029 - Omnibus Appropriations Bill, DME provisions; S. 2425 - Patient Access and Medicare Protection Act, all provisions; H.R. 4185/S. 2312 - DME Rural Relief, all provisions; H.R. 3229/S. 2196 - Complex Rehab Accessories Relief, all provisions; S. 2736 - Patient Access to Durable Medical Equipment Act of 2016, all provisions.

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

HR 1516, S 1013, HR 3229. 21st Century Cures Act.

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

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

H.R. 1516 and S. 1013, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015; H.R. 3229 and S. 2196, To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories; S. 2425, Patient Access and Medicare Protection Act; S. 2312, The DME Access and Stabilization Act; H.R. 4185, Protecting Access Through Competitive-Pricing Transition (PACT) Act of 2015 and S. 2736, The DME Stabilization Act of 2016;

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

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

HR 3229/S 2196--Exclude competitive bidding fee reductions for wheelchair accessories when furnished with complex rehabilitation wheelchairs S 2425--Delay for one year competitive bidding fee reductions for wheelchair accessories when furnished with complex rehabilitation wheelchairs

Client expense: Not reported · Firm income: $7,500

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

Submitted testimony in support of HR 353-Veterans Access to Hearing Health Act. This bill is designed to amend title 38, United States Code, to include licensed hearing aid specialists as eligible for appointment in the Veterans Health Administration of the Department of Veterans Affairs, and for other purposes. Wrote a letter of support for HR 3970, Housing our Heroes Act that would provide funding for a test program designed to renovate abandoned property to provide housing for veterans Liaised with numerous Congressional offices to inform them of the need to support H.R. 3229/S.2196 - To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. Support HR 3471 Veterans Mobility Safety Act- this bill is to amend title 38, United States Code, to make certain improvements in the provision of automobiles and adaptive equipment by the Department of Veterans Affairs. Support S.1203 This is a bill to amend title 38, United States Code, to improve the furnishing of health care to veterans by the Department of Veterans Affairs, to improve the processing by the Department of claims for disability compensation, and for other purposes. Support S. 1021 Wounded Warrior Workforce Enhancement Act- A bill to require the Secretary of Veterans Affairs to award grants to establish, or expand upon, master's degree programs in orthotics and prosthetics, and for other purposes. S. 1022 Wounded Warrior Research Enhancement Act- This bill directs the Secretary of Defense to award research grants for: actions that can be taken to prevent amputation of limbs, the most effective point for orthotic and prosthetic intervention during patient treatment, orthotic interventions that are most effective in treating the physical effects of traumatic brain injury, patients that benefit most from particular orthotic and prosthetic technologies, orthotic and prosthetic services that best facilitate the return to active duty of members of the Armed Forces, and the effect of aging on the use of prosthetics.

Submitted comments to CMS requiring better clarification of resident rights and person-centered planning needs. United Spinal signed onto a letter of support for the nomination of Henry Claypool to serve as a Commissioner on the Medicaid and CHIP Payment and Access Commission (MACPAC). United Spinal signed onto a letter of support to CMS regarding Section 1557 and nondiscrimination towards people with disabilities in health programs and activities including the ACA regarding the enrollment of people with disabilities and the availability of plans and services for the disability community. Transition to Independence Act (S. 1604) United Spinal Association supports the Transition to Independence Act (S. 1604), introduced by Senator Charles Grassley (R-IA) and signed onto a Consortium for Citizens with Disabilities letter. This bill directs the Secretary of Health and Human Services to establish a demonstration program over five fiscal years, beginning with FY2017, under which a Medicaid Buy-In-State program meeting certain criteria may receive bonus payments for: meeting specific measurable benchmarks in expanding individual integrated employment and reducing subminimum wage work, congregate setting work, or facility-based day habilitation placements for working-age individuals with a disability receiving Medicaid-funded home or community-based services; and taking other actions conducive to expanding employment opportunities for individuals with disabilities within the state. United Spinal signed onto a letter to CMS in support of protecting and improving access to electronic health records - Medicare and Medicaid Programs: Electronic Health Record Incentive Program. Support H.R. 3229/S. 2196 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015 Amends title XVIII (Medicare) of the Social Security Act to cover, as medical and other health services, complex rehabilitation technology (CRT) items designed or individually configured for a specific qualified individual to meet that individual's unique: (1) medical, physical, or functional needs related to a medical condition; and (2) capacities for basic activities of daily living (ADLs) or instrumental ADLs. Support H.R. 1516/S. 1013 - This bill amends title XVIII (Medicare) of the Social Security Act to prohibit the application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories. (A competitive bidding program has replaced the use of established fee schedule amounts to determine payments under Medicare for certain durable medical equipment such as wheelchairs.) Support S. 2425 - Patient Acsess and Medicare Protection Act - A bill 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. Discussed with CMS, ACL and GAO concerns as it relates to access to durable medical equipment and accessories under Medicare's competitive acquisition program.

Health care issues affecting individuals with neuromuscular disease, including transitional health care issues and increased funding for the NIH. H.R. 209/S. 139, Expanding Access to Clinical Trials Act of 2015 (PL 114-63); H.R. 6, 21st Century Cures and Innovation for Healthier Americans initiatives; S. 1604, Transition to Independence Act; H.R. 1516/S. 1013, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015; S. 1597, Patient-Focused Impact Assessment Act of 2015; S. 2030, Advancing Targeted Therapies for Rare Diseases Act; HR 3229, Enforce the Medicare Improvements for Patients and Providers Act of 2015; S 2425 Patient Access and Medicare Protection Act (PL 114-115)

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), SENATE

-H.R. 1516/S. 1013, support passage of the Ensuring Access to Quality Complex Rehabilitation Technology Act. -H.R. 3229/S. 2196, support passage to protect access to complex rehabilitative technology accessories. -S. 2425, Patient Access and Medicare Protection Act, support one-year delay of rule that would restrict access to complex rehabilitation technology accessories

Client expense: $70,307 · Firm income: Not reported

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

-H.R. 292/S. 849, support passage of the Advancing Research for Neurological Diseases Act. -H.R. 6, 21st Century Cures Act, support inclusion of H.R. 292/S. 849, support increased funding for the National Institutes of Health and support other provisions that speed the development of effective treatments for people with multiple sclerosis. -H.R. 1516/S. 1013, support passage of the Ensuring Access to Quality Complex Rehabilitation Technology Act. -H.R. 3229/S. 2196, support passage to protect access to complex rehabilitative technology accessories. -S. 2425, Patient Access and Medicare Protection Act, support one-year delay of rule that would restrict access to complex rehabilitation technology accessories -H.R. 3913, Lifespan Respite Care Reauthorization Act, support reauthorization of the Lifespan Respite Care Program. -H.R. 1969, Military and Veteran Caregiver Services Improvement Act, support passage

Client expense: $70,307 · Firm income: Not reported

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

Medicare and Medicaid reform; Medicare competitive bidding; PL 108-173: Medicare Prescription Drug and Modernization Act of 2003; Budget Resolutions; Community Choice Act; PL 111-148: Patient Protection and Affordable Care Act; PL 111-152, 124 Stat. 1029: Health Care and Education Reconciliation Act of 2010; HR 132: ObamaCare Repeal Act; S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014; S 539/HR 775: Medicare Access to Rehabilitation Services Act; HR 2339: To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program, and for other purposes; and HR 3229: To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories.

Client expense: $73,347 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Defense, Dept of (DOD), Education, Dept of, Equal Employment Opportunity Commission (EEOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

HR 1516, S 1013, HR 3229. 21st Century Cures Act.

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

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

H.R. 1516 and S. 1013, Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015; H.R. 6, 21st Century Cures Act and H.R. 3229, To amend title XVIII of the Social Security Act to provide for the non-application of Medicare competitive acquisition rates to complex rehabilitative wheelchairs and accessories; S. 2425, Patient Access and Medicare Protection Act; S. 2312, The DME Access and Stabilization Act; H.R. 4185, Protecting Access Through Competitive-Pricing Transition (PACT) Act of 2015.

Client expense: $116,880 · Firm income: Not reported

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

Issues pertaining to durable medical equipment including: bidding, power wheelchairs, oxygen, diabetic supplies, negative pressure wound therapy, Medicare audits, sequestration, and fraud abuse; H.R. 1516/S. 1013 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2015, all provisions; H.R. 284/S. 148 - Medicare DMEPOS Competitive Bidding Improvement Act of 2015, all provisions; Medicare Audit Improvement and Reform (AIR) Act, all provisions; Medicare DMEPOS Market Pricing Program Act, all provisions; Reimbursement cuts in non-competitive bidding areas, all provisions; H.R. 6 - 21st Century Cures Act, competitive bidding issues; Complex rehab technology accessories relating to competitive bidding; H.R. 2437 - Creating prior authorization process for DME items, all provisions; Expanding and making permanent the Medicare power mobility device demonstration program, all provisions; Audit and Appeal Fairness, Integrity, and Reforms in the Medicare Act of 2015, all provisions; H.R. 2 - Medicare Access and CHIP Re-authorization Act of 2015, competitive bidding provisions. H.R. 2029 - Omnibus Appropriations Bill, DME provisions; S. 2425 - Patient Access and Medicare Protection Act, all provisions; H.R. 4185/S. 2312 - DME Rural Relief, all provisions; H.R. 3229/S. 2196 - Complex Rehab Accessories Relief, all provisions.

Client expense: $130,000 · Firm income: Not reported