Flex-IT 2 Act

Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor federal and legislative activity related to Medicare Reimbursement. Monitor federal issues and legislation associated with health care policy. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). H.R. 34, 21st Century Cures Act (P.L. 114-255) H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 3309, Flex-IT 2 Act. H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act. H.R. 4909, National Defense Authorization Act for Fiscal Year 2017. H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. H.R. 5652, Access to Better Care Act of 2016 H.R. 5573, PRICED Act H.R. 5926, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act S. 2943, National Defense Authorization Act for Fiscal Year 2017 S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S. 3094, PRICED Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor federal and legislative activity related to Medicare Reimbursement. Monitor federal issues and legislation associated with health care policy. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). H.R. 34, 21st Century Cures Act (P.L. 114-255) H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 3309, Flex-IT 2 Act. H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act. H.R. 4909, National Defense Authorization Act for Fiscal Year 2017. H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. H.R. 5652, Access to Better Care Act of 2016 H.R. 5573, PRICED Act H.R. 5926, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act S. 2943, National Defense Authorization Act for Fiscal Year 2017 S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S. 3094, PRICED Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor federal and legislative activity related to Medicare Reimbursement. Monitor federal issues and legislation associated with health care policy. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). H.R. 34, 21st Century Cures Act (P.L. 114-255) H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 3309, Flex-IT 2 Act. H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act. H.R. 4909, National Defense Authorization Act for Fiscal Year 2017. H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. H.R. 5652, Access to Better Care Act of 2016 H.R. 5573, PRICED Act H.R. 5926, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act S. 2943, National Defense Authorization Act for Fiscal Year 2017 S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S. 3094, PRICED Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor federal issues and legislation related to healthcare policy. Monitor federal issues and legislation related to Medicare reimbursement. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Extend Section 3111, P.L. 111-148. Monitor the implementation of Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriation Act, 2017, and Zika Response and Preparedness Act (P.L. 114-223). H.R. 6, House 21st Century Cures Act. H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 1725, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. H.R. 1859, Ensuring Children's Access to Specialty Care Act of 2015. H.R. 2256, Veterans Information Modernization Act. H.R. 2464, Demanding Accountability for Veterans Act of 2015. H.R. 3020, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015. H.R. 3309, Flex-IT 2 Act H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act H.R. 4909, National Defense Authorization Act for Fiscal Year 2017 H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. H.R.5721, Local Coverage Determination Clarification Act S. 480, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act S. 2943, National Defense Authorization Act for Fiscal Year 2017 S. 2978, The Protect Continuing Physician Education and Patient Care Act. S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S.3173, EHR Regulatory Relief Act. Senate 21st Century Cures Act counterpart package, including S. 2700, S.185, S.2713, S.2745, S.2742, S.1878, S.1077, S.1101, S.2055, S.1767, S.1597, S.2512, S.2030, S.1622, S.2014, S.800, S.849, S.2503, and S.2511. Funding for NIH, CDC, DOD, related to arthritis and rheumatic disease research and education. Funding for Pediatric Subspecialty Loan Repayment Program. Draft, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017.

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

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

Monitor federal issues and legislation related to healthcare policy. Monitor federal issues and legislation related to Medicare reimbursement. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Extend Section 3111, P.L. 111-148. Monitor the implementation of Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriation Act, 2017, and Zika Response and Preparedness Act (P.L. 114-223). H.R. 6, House 21st Century Cures Act. H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 1725, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. H.R. 1859, Ensuring Children's Access to Specialty Care Act of 2015. H.R. 2256, Veterans Information Modernization Act. H.R. 2464, Demanding Accountability for Veterans Act of 2015. H.R. 3020, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015. H.R. 3309, Flex-IT 2 Act H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act H.R. 4909, National Defense Authorization Act for Fiscal Year 2017 H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. H.R.5721, Local Coverage Determination Clarification Act S. 480, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act S. 2943, National Defense Authorization Act for Fiscal Year 2017 S. 2978, The Protect Continuing Physician Education and Patient Care Act. S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S.3173, EHR Regulatory Relief Act. Senate 21st Century Cures Act counterpart package, including S. 2700, S.185, S.2713, S.2745, S.2742, S.1878, S.1077, S.1101, S.2055, S.1767, S.1597, S.2512, S.2030, S.1622, S.2014, S.800, S.849, S.2503, and S.2511. Funding for NIH, CDC, DOD, related to arthritis and rheumatic disease research and education. Funding for Pediatric Subspecialty Loan Repayment Program. Draft, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017.

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

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

Monitor federal issues and legislation related to healthcare policy. Monitor federal issues and legislation related to Medicare reimbursement. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Extend Section 3111, P.L. 111-148. Monitor the implementation of Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriation Act, 2017, and Zika Response and Preparedness Act (P.L. 114-223). H.R. 6, House 21st Century Cures Act. H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 1725, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. H.R. 1859, Ensuring Children's Access to Specialty Care Act of 2015. H.R. 2256, Veterans Information Modernization Act. H.R. 2464, Demanding Accountability for Veterans Act of 2015. H.R. 3020, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015. H.R. 3309, Flex-IT 2 Act H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act H.R. 4909, National Defense Authorization Act for Fiscal Year 2017 H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. H.R.5721, Local Coverage Determination Clarification Act S. 480, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act S. 2943, National Defense Authorization Act for Fiscal Year 2017 S. 2978, The Protect Continuing Physician Education and Patient Care Act. S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S.3173, EHR Regulatory Relief Act. Senate 21st Century Cures Act counterpart package, including S. 2700, S.185, S.2713, S.2745, S.2742, S.1878, S.1077, S.1101, S.2055, S.1767, S.1597, S.2512, S.2030, S.1622, S.2014, S.800, S.849, S.2503, and S.2511. Funding for NIH, CDC, DOD, related to arthritis and rheumatic disease research and education. Funding for Pediatric Subspecialty Loan Repayment Program. Draft, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017.

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

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

Advocate regarding proposed regulations under Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Advocate against CMS proposal regarding collection of data for all 10- and 90- day global surgery services. Advocate for adequate and accurate network coverage for dermatologic care within Medicare Advantage and health insurance exchange networks (S. 2392 / H.R. 4227, the Medicare Advantage Bill of Rights Act of 2015). Support legislation to eliminate the Independent Payment Advisory Board (S.141/ H.R. 1190, Protecting Seniors' Access to Medicare Act of 2015). Lobby Congress on improvements to Health Information Technology implementation. Lobby Congress on issues related to telemedicine and Medicare reimbursement. Support legislation to have telemedicine services reimbursable by Medicare (S. 2484/ H.R. 4442, the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act). Advocate on use and availability of health care data. Lobby in support of legislation to provide more flexibility in the Meaningful Use program (H.R. 3309, the Further Flexibility in HIT Reporting and Advancing Interoperability (Flex IT 2) Act). Advocate for EHR interoperability and enhancements to the federal certification system for health information technology; advocate for provisions to restrict data blocking by Electronic Health Records vendors (S. 2141, Transparent Ratings on Usability & Security to Transform Technology Act of 2015, S.2511, Improving Health Information Technology Act and H.R. 6/H.R. 34, 21st Century Cures Act). Advocate for improving disease management and care coordination for patients with chronic diseases (H.R. 6/H.R. 34, 21st Century Cures Act). Support preservation of the In-Offices Ancillary Services Exemption under Stark Law regarding physician self-referral. Advocate against H.R. 5008, Promoting Integrity in Medicare Act of 2016 Support legislation to provide more flexibility in compliance with the Sunshine Act (S.2978). Support legislation to have telemedicine services reimbursable by Medicare (S. 2484/H.R. 4442, the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act). Support S. 2978, Protecting Continuing Physician Education & Patient Care Act. Advocate for increased graduate medical education funding.

Client expense: $350,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

H.R.3309/S.1137, Protecting American Talent and Entrepreneurship Act of 2015 or the PATENT Act, Monitor generally

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

Government targets: HOUSE OF REPRESENTATIVES, Office of Science & Technology Policy (OSTP), SENATE

S.1013, Patent Abuse Reduction Act, S.1720, Patent Transparency and Improvements Act; S.1612 Patent Litigation Integrity Act; H.R. 845, Saving High-Tech Innovators from Egregious Legal Discputes Act; H.R. 2766, Stopping the Offensive Use of Patents Act; H.R. 3309, Innovation Act; copyright issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1707, Access to Frontline Health Care Act, all sections H.R. 1741, Truth in Health Marketing Act, all sections H.R. 1190, Protecting Seniors Access to Medicare Act, all sections S. 141, Protecting Seniors Access to Medicare Act, all sections P.L. 111-192, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, all sections related to physicians and vision P.L. 111-148 Affordable Care Act, modifications: 1. Reducing regulatory/costly burdens on medical practices - relief from regulatory penalties 2. Preserving patient access to office ancillary testing services 4. Independent Payment Advisory Board H.R. 1312, National Health Service Corps Improvement Act Meaningful Use/EHR program issues P.L. 113-54, Drug Quality & Security Act, all sections Protecting Access to Medicare Act (P.L. 113-93) ASC Quality Reporting Program Medicare Advantage plan network adequacy H.R. 270, FlexIT Act, all sections H.R. 3309, Flex IT 2 Act, all sections S. 2141, Trust IT Act 2016 Physician Schedule Rule, sections pertaining to fee cuts Drug Price Increases Medicare Part B Drug Demonstration Medicare Access and CHIP Reauthorization Act (PL114-10) S.2777, Contact Lens Consumer Health Protection Act H.R. 6, 21st Century Cures Proposed 2017 Physician Fee Schedule. Section pertaining to global surgery data collection proposal H.R. 1178, Ensuring Equal Access to Treatment Act

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

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

HR 270 - Flexibility in Health IT Reporting, Electronic health Records, Patient Safety, Regulation of Health IT, Health Software Regulation, Quality Measurement/ Quality Reporting, Patient Data Matching/ Patient Identification, Interoperability, Cybersecurity, Telehealth, HR 6 - 21st Century Cures Act, HR 3309 - Further Flexibility on Health IT Reporting and Advancing Interoperability Act, S. 2425, S. 2511 - Improving Health Information Technology Act, Prescription Drug Monitoring Programs & Opioid Abuse Prevention, S. 2866 - Jessie's Law, S.3173 - Electronic Health Record (EHR) Regulatory Relief Act

Client expense: $10,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Institute of Standards & Technology (NIST), SENATE

HR 270 - Flexibility in Health IT Reporting, Meaningful Use EHR Incentive Program, Electronic Health Records, Interoperability, Telehealth, HR 6 - 21st Century Cures Act, HR 3309- Further Flexibility in Health IT Reporting and Advancing Interoperability Act, S. 2141 - TRUST-IT, Patient Identification, S. 2425, S. 2511 - Improving Health Information Technology Act, HR 5001/ S.2822 - Flexibility in EHR Reporting Act, S. 3173 - Electronic Health Record (EHR) Regulatory Relief Act

Client expense: $10,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Institute of Standards & Technology (NIST), SENATE

Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical Education Medicaid provider taxes Medicare bad debt payments Medicare and Medicaid payment H.R.2 the Medicare Access and CHIP Reauthorization Act of 2015, all provisions H.R.1343/S.688 Establishing Equity in the Hospital Readmissions Program Act of 2015, all provisions Medicaid Waivers Medicaid Expansion Issues Medicaid disproportionate share hospital payments Medicare disproportionate share hospital payments Medicare hospital readmissions program Funding for the Children's Health Insurance Program Medicaid primary care payment parity Issues related to Medicaid reform including Medicaid block grants and per capita caps Medicare evaluation and management codes and other Medicare outpatient codes/ Medicare site neutral documents Meaningful Use stage 2 and 3 Medicare Shared Savings Program Legislation related to chronic care treatment H.R. 3291 Medicare Crosswalk Hospital Code Development Act Medicaid data and transparency Medicaid Managed Care Policies/ rulemaking Medicaid supplemental payments Medicare Site Neutral payments for hospital outpatient departments H.R.4442/S.2484 Connect for Health Act H.R.3309 Flex-It 2 Act H.R.5542 Medicaid and CHIP Quality Improvement Act S. 2438 Medicaid and CHIP Quality Improvement Act Hospital Star Rating: Methodology H.R.5273 Helping Hospitals Improve Patient Care Act H.R. 3024 Review of certain estimate for determining additional Medicare payments S. 2228 Review of Certain Medicare Payment determinations for DSH Hospitals Legislation related to health care disparities H.R. 31 21st Century Cures, Provisions related to Medicare payments to hospitals CMS OPPS final rule on HOPD grandfather sites relocation

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

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

H.R. 4959: Ensuring Access to General Surgery Act of 2016 H.R. 105: Quality Health Care Coalition Act of 2015 H.R. 3309: Flex-IT 2 Act H.R. 647: Access to Life-Saving Trauma Care for All Americans Act H.R. 648: Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R. 836: Health Care Safety Net Enhancement Act of 2015 H.R. 865: Good Samaritan Health Professionals Act of 2015 S. 3101: Good Samaritan Health Professionals Act of 2016 H.R. 1934: Cancer Care Payment Reform Act of 2015 S. 2943/H.R.1735: National Defense Authorization Act (NDAA) H.R.4909 - National Defense Authorization Act for Fiscal Year 2017 H.R. 2739: Cancer Drug Coverage Parity Act of 2015 S. 624/H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015 S. 3166: Ensuring Access to General Surgery Act of 2016 S. 3522: Graduate Medical Education Equity Act H.R. 1925: To award a Congressional Gold Medal to Dr. Balazs "Ernie" Bodai in recognition of his many outstanding contributions to the Nation, including a tireless commitment to breast cancer research. H.Res. 487: Recognizing the importance of cancer program accreditation in ensuring comprehensive, high quality, patient-centered cancer care Veterans Access, Choice and Accountability Act Concurrent Surgery MACRA Proposed Rule Implementation GME Health Professional Shortage Areas (HPSAs) Health Information Technology (Health IT) Chronic Care Coordination 96-Hour Rule Bleeding Control for the Injured (Stop The Bleed campaign) Opioids Cancer/Appropriations Medicare Part B Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs) Qualified Clinical Data Registry (QCDR) reporting mechanism Physician Quality Reporting System (PQRS) Video Recording Surgery RAC Audits Energy and Commerce Concussion Initiative Data Use Protection Legislation FOIA Energy and Commerce Pediatric Trauma Caucus Responsible Data Transparency Act

Client expense: $18,000 · Firm income: Not reported

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

H.R. 4959: Ensuring Access to General Surgery Act of 2016 H.R. 105: Quality Health Care Coalition Act of 2015 H.R. 3309: Flex-IT 2 Act H.R. 647: Access to Life-Saving Trauma Care for All Americans Act H.R. 648: Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R. 836: Health Care Safety Net Enhancement Act of 2015 H.R. 865: Good Samaritan Health Professionals Act of 2015 S. 3101: Good Samaritan Health Professionals Act of 2016 H.R. 1934: Cancer Care Payment Reform Act of 2015 S. 2943/H.R.1735: National Defense Authorization Act (NDAA) H.R.4909 - National Defense Authorization Act for Fiscal Year 2017 H.R. 2739: Cancer Drug Coverage Parity Act of 2015 S. 624/H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015 S. 3166: Ensuring Access to General Surgery Act of 2016 S. 3522: Graduate Medical Education Equity Act H.R. 1925: To award a Congressional Gold Medal to Dr. Balazs "Ernie" Bodai in recognition of his many outstanding contributions to the Nation, including a tireless commitment to breast cancer research. H.Res. 487: Recognizing the importance of cancer program accreditation in ensuring comprehensive, high quality, patient-centered cancer care Veterans Access, Choice and Accountability Act Concurrent Surgery MACRA Proposed Rule Implementation GME Health Professional Shortage Areas (HPSAs) Health Information Technology (Health IT) Chronic Care Coordination 96-Hour Rule Bleeding Control for the Injured (Stop The Bleed campaign) Opioids Cancer/Appropriations Medicare Part B Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs) Qualified Clinical Data Registry (QCDR) reporting mechanism Physician Quality Reporting System (PQRS) Video Recording Surgery RAC Audits Energy and Commerce Concussion Initiative Data Use Protection Legislation FOIA Energy and Commerce Pediatric Trauma Caucus Responsible Data Transparency Act

Client expense: $18,000 · Firm income: Not reported

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

H.R. 4959: Ensuring Access to General Surgery Act of 2016 H.R. 105: Quality Health Care Coalition Act of 2015 H.R. 3309: Flex-IT 2 Act H.R. 647: Access to Life-Saving Trauma Care for All Americans Act H.R. 648: Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R. 836: Health Care Safety Net Enhancement Act of 2015 H.R. 865: Good Samaritan Health Professionals Act of 2015 S. 3101: Good Samaritan Health Professionals Act of 2016 H.R. 1934: Cancer Care Payment Reform Act of 2015 S. 2943/H.R.1735: National Defense Authorization Act (NDAA) H.R.4909 - National Defense Authorization Act for Fiscal Year 2017 H.R. 2739: Cancer Drug Coverage Parity Act of 2015 S. 624/H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015 S. 3166: Ensuring Access to General Surgery Act of 2016 S. 3522: Graduate Medical Education Equity Act H.R. 1925: To award a Congressional Gold Medal to Dr. Balazs "Ernie" Bodai in recognition of his many outstanding contributions to the Nation, including a tireless commitment to breast cancer research. H.Res. 487: Recognizing the importance of cancer program accreditation in ensuring comprehensive, high quality, patient-centered cancer care Veterans Access, Choice and Accountability Act Concurrent Surgery MACRA Proposed Rule Implementation GME Health Professional Shortage Areas (HPSAs) Health Information Technology (Health IT) Chronic Care Coordination 96-Hour Rule Bleeding Control for the Injured (Stop The Bleed campaign) Opioids Cancer/Appropriations Medicare Part B Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs) Qualified Clinical Data Registry (QCDR) reporting mechanism Physician Quality Reporting System (PQRS) Video Recording Surgery RAC Audits Energy and Commerce Concussion Initiative Data Use Protection Legislation FOIA Energy and Commerce Pediatric Trauma Caucus Responsible Data Transparency Act

Client expense: $168,000 · Firm income: Not reported

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

H.R. 4959: Ensuring Access to General Surgery Act of 2016 H.R. 105: Quality Health Care Coalition Act of 2015 H.R. 3309: Flex-IT 2 Act H.R. 647: Access to Life-Saving Trauma Care for All Americans Act H.R. 648: Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R. 836: Health Care Safety Net Enhancement Act of 2015 H.R. 865: Good Samaritan Health Professionals Act of 2015 S. 3101: Good Samaritan Health Professionals Act of 2016 H.R. 1934: Cancer Care Payment Reform Act of 2015 S. 2943/H.R.1735: National Defense Authorization Act (NDAA) H.R.4909 - National Defense Authorization Act for Fiscal Year 2017 H.R. 2739: Cancer Drug Coverage Parity Act of 2015 S. 624/H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015 S. 3166: Ensuring Access to General Surgery Act of 2016 S. 3522: Graduate Medical Education Equity Act H.R. 1925: To award a Congressional Gold Medal to Dr. Balazs "Ernie" Bodai in recognition of his many outstanding contributions to the Nation, including a tireless commitment to breast cancer research. H.Res. 487: Recognizing the importance of cancer program accreditation in ensuring comprehensive, high quality, patient-centered cancer care Veterans Access, Choice and Accountability Act Concurrent Surgery MACRA Proposed Rule Implementation GME Health Professional Shortage Areas (HPSAs) Health Information Technology (Health IT) Chronic Care Coordination 96-Hour Rule Bleeding Control for the Injured (Stop The Bleed campaign) Opioids Cancer/Appropriations Medicare Part B Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs) Qualified Clinical Data Registry (QCDR) reporting mechanism Physician Quality Reporting System (PQRS) Video Recording Surgery RAC Audits Energy and Commerce Concussion Initiative Data Use Protection Legislation FOIA Energy and Commerce Pediatric Trauma Caucus Responsible Data Transparency Act

Client expense: $168,000 · Firm income: Not reported

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

Monitored consideration of patent legislation; S. 1013, the Patent Abuse Reduction Act of 2013; S. 1612, Patent Litigation Integrity Act of 2013; and H.R. 3309, the Innovation Act.

Client expense: Not reported · Firm income: $9,000

Government targets: SENATE

S. 1137, H.R. 3309 - Protecting American Talent and Entrepreneurship Act of 2015 or the PATENT Act -- entire bill, specifically sections related to university research and patents

Client expense: Not reported · Firm income: $16,000

Government targets: HOUSE OF REPRESENTATIVES, Office of Science & Technology Policy (OSTP), SENATE

Medicare Physician Payment Reform - implementation of Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 Health Care Reform - implementation of the Patient Protection and Affordable Care Act of 2009 Repeal of the Independent Payment Advisory Board, H.R. 1190/S. 141 Meaningful Use of EHRs - Further Flexibility in HIT Reporting and Advancing Interoperability Act, H.R. 3309 Protect Continuing Education and Patient Care Act, H.R. 293 Comments submitted to CMS on 2017 Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System Final Rules 21st Century Cures Act, H.R. 34

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

oppose cuts to medical imaging; support appropriateness model for diagnostic imaging;support IPAB repeal(HR1189);support SGR reform (HR2);oppose site neutral cuts; support HR 3309 FLEX IT2 to delay stage 3 meaningful use;support S.2425 for hardship exemptions for health IT

Client expense: Not reported · Firm income: $45,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

oppose cuts to medical imaging; support appropriateness model for diagnostic imaging;support IPAB repeal(HR1189);support SGR reform (HR2);oppose site neutral cuts; monitor implementation of meaningful use standards; support HR 3309 FLEX IT2 to delay stage 3 meaningful use;support S.2425 for hardship exemptions for health IT

Client expense: Not reported · Firm income: $45,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Further Flexibility in HIT Reporting and Advancing Interoperability Act (FLEX-IT 2 Act) (H.R. 3309) Implementation of the Medicare Appropriate Use Criteria Program

Client expense: Not reported · Firm income: $10,000

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

HR 1220 / S. 624 - Removing Barriers to Colorectal Cancer Screening Act S. 1347 / HR 887 -- The Electronic Health Fairness Act; A bill exempting patient encounters that occur in Ambulatory Surgery Centers when calculating attainment of the Medicare Electronic Health Record Meaningful Use requirements. Further Flexibility in HIT Reporting and Advancing Interoperability Act (FLEX-IT 2 Act) (H.R. 3309)

Client expense: Not reported · Firm income: $28,500

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor federal issues and legislation related to healthcare policy. Monitor federal issues and legislation related to Medicare reimbursement. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Extend Section 3111, P.L. 111-148. Monitor the implementation of Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriation Act, 2017, and Zika Response and Preparedness Act (P.L. 114-223). H.R. 6, House 21st Century Cures Act. H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 1725, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. H.R. 1859, Ensuring Children's Access to Specialty Care Act of 2015. H.R. 2256, Veterans Information Modernization Act. H.R. 2464, Demanding Accountability for Veterans Act of 2015. H.R. 3020, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015. H.R. 3309, Flex-IT 2 Act H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act H.R. 4909, National Defense Authorization Act for Fiscal Year 2017 H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. H.R.5721, Local Coverage Determination Clarification Act S. 480, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act S. 2943, National Defense Authorization Act for Fiscal Year 2017 S. 2978, The Protect Continuing Physician Education and Patient Care Act. S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S.3173, EHR Regulatory Relief Act. Senate 21st Century Cures Act counterpart package, including S. 2700, S.185, S.2713, S.2745, S.2742, S.1878, S.1077, S.1101, S.2055, S.1767, S.1597, S.2512, S.2030, S.1622, S.2014, S.800, S.849, S.2503, and S.2511. Funding for NIH, CDC, DOD, related to arthritis and rheumatic disease research and education. Funding for Pediatric Subspecialty Loan Repayment Program. Draft, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017.

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

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

Monitor federal issues and legislation related to healthcare policy. Monitor federal issues and legislation related to Medicare reimbursement. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Extend Section 3111, P.L. 111-148. Monitor the implementation of Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriation Act, 2017, and Zika Response and Preparedness Act (P.L. 114-223). H.R. 6, House 21st Century Cures Act. H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 1725, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. H.R. 1859, Ensuring Children's Access to Specialty Care Act of 2015. H.R. 2256, Veterans Information Modernization Act. H.R. 2464, Demanding Accountability for Veterans Act of 2015. H.R. 3020, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015. H.R. 3309, Flex-IT 2 Act H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act H.R. 4909, National Defense Authorization Act for Fiscal Year 2017 H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. H.R.5721, Local Coverage Determination Clarification Act S. 480, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act S. 2943, National Defense Authorization Act for Fiscal Year 2017 S. 2978, The Protect Continuing Physician Education and Patient Care Act. S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S.3173, EHR Regulatory Relief Act. Senate 21st Century Cures Act counterpart package, including S. 2700, S.185, S.2713, S.2745, S.2742, S.1878, S.1077, S.1101, S.2055, S.1767, S.1597, S.2512, S.2030, S.1622, S.2014, S.800, S.849, S.2503, and S.2511. Funding for NIH, CDC, DOD, related to arthritis and rheumatic disease research and education. Funding for Pediatric Subspecialty Loan Repayment Program. Draft, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017.

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

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

Monitor federal issues and legislation related to healthcare policy. Monitor federal issues and legislation related to Medicare reimbursement. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Extend Section 3111, P.L. 111-148. Monitor the implementation of Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriation Act, 2017, and Zika Response and Preparedness Act (P.L. 114-223). H.R. 6, House 21st Century Cures Act. H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 1725, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. H.R. 1859, Ensuring Children's Access to Specialty Care Act of 2015. H.R. 2256, Veterans Information Modernization Act. H.R. 2464, Demanding Accountability for Veterans Act of 2015. H.R. 3020, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015. H.R. 3309, Flex-IT 2 Act H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act H.R. 4909, National Defense Authorization Act for Fiscal Year 2017 H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. H.R.5721, Local Coverage Determination Clarification Act S. 480, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act S. 2943, National Defense Authorization Act for Fiscal Year 2017 S. 2978, The Protect Continuing Physician Education and Patient Care Act. S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. S.3173, EHR Regulatory Relief Act. Senate 21st Century Cures Act counterpart package, including S. 2700, S.185, S.2713, S.2745, S.2742, S.1878, S.1077, S.1101, S.2055, S.1767, S.1597, S.2512, S.2030, S.1622, S.2014, S.800, S.849, S.2503, and S.2511. Funding for NIH, CDC, DOD, related to arthritis and rheumatic disease research and education. Funding for Pediatric Subspecialty Loan Repayment Program. Draft, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017.

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

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

Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor federal and legislative activity related to Medicare Reimbursement. Monitor federal issues and legislation associated with health care policy. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor the implementation of Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriation Act, 2017, and Zika Response and Preparedness Act (P.L. 114-223). H.R. 6, House 21st Century Cures Act. H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 3309, Flex-IT 2 Act. H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act. H.R. 4909, National Defense Authorization Act for Fiscal Year 2017. H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act. S. 2943, National Defense Authorization Act for Fiscal Year 2017. S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. Senate 21st Century Cures Act counterpart package, including S. 2700, S.185, S.2713, S.2745, S.2742, S.1878, S.1077, S.1101, S.2055, S.1767, S.1597, S.2512, S.2030, S.1622, S.2014, S.800, S.849, S.2503, and S.2511. Draft, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor federal and legislative activity related to Medicare Reimbursement. Monitor federal issues and legislation associated with health care policy. Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor the implementation of Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriation Act, 2017, and Zika Response and Preparedness Act (P.L. 114-223). H.R. 6, House 21st Century Cures Act. H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015. H.R.775, Medicare Access to Rehabilitation Services Act of 2015. H.R. 1600, Patients' Access to Treatments Act of 2015. H.R. 3309, Flex-IT 2 Act. H.R. 4227, Medicare Advantage Bill of Rights. H.R. 4848, HIP Act. H.R. 4909, National Defense Authorization Act for Fiscal Year 2017. H.R. 5001, Flexibility in Electronic Health Record Reporting Act. H.R. 5122, To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models. H.R. 5293, Department of Defense Appropriations, FY 2017. S.539, Medicare Access to Rehabilitation Services Act of 2015. S. 2392, Medicare Advantage Bill of Rights. S. 2511, Improving Health Information Technology Act. S. 2822, Flexibility in Electronic Health Record Reporting Act. S. 2943, National Defense Authorization Act for Fiscal Year 2017. S. 3000, Department of Defense Appropriations, FY 2017. S. 3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017. Senate 21st Century Cures Act counterpart package, including S. 2700, S.185, S.2713, S.2745, S.2742, S.1878, S.1077, S.1101, S.2055, S.1767, S.1597, S.2512, S.2030, S.1622, S.2014, S.800, S.849, S.2503, and S.2511. Draft, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY 2017.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3309, the 'Innovation Act.'

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocate regarding proposed regulations under Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Advocate for adequate and accurate network coverage for dermatologic care within Medicare Advantage and health insurance exchange networks (S. 2392 / H.R. 4227, the Medicare Advantage Bill of Rights Act of 2015). Support legislation to eliminate the Independent Payment Advisory Board (S.141/ H.R. 1190, Protecting Seniors' Access to Medicare Act of 2015). Lobby Congress on improvements to Health Information Technology implementation. Lobby Congress on issues related to telemedicine and Medicare reimbursement. Support legislation to have telemedicine services reimbursable by Medicare (S. 2484/ H.R. 4442, the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act). Advocate on use and availability of health care data. Lobby in support of legislation to provide more flexibility in the Meaningful Use program (, H.R. 3309, the Further Flexibility in HIT Reporting and Advancing Interoperability (Flex IT 2) Act), H.R. 3940, HR 5001/S.2822 Flexibility in Electronic Health Record Reporting Act. Advocate for EHR interoperability and enhancements to the federal certification system for health information technology (S. 2141, Transparent Ratings on Usability & Security to Transform Technology Act of 2015 and S.2511, Improving Health Information Technology Act). Lobby in support of legislation to require the Secretary of Health and Human Services to issue guidance on the application of the Common Rule to clinical data registries (H.R. 965, Facilitating Participation in Clinical Data Registries Act of 2015). Support legislation to reduce Medicare fraud and improve access to Death Master File, S. 1073, the Stopping Improper Payments to Deceased People Act. Advocate for improving disease management and care coordination for patients with chronic diseases Support preservation of the In Offices Ancillary Services Exemption under Stark Law regarding physician self-referral. Advocate against H.R. 5008, Promoting Integrity in Medicare Act of 2016 Support legislation to provide more flexibility in compliance with the Sunshine Act (S.2978). Advocate against data blocking by Electronic Health Records vendors. Support legislation to have telemedicine services reimbursable by Medicare (S. 2484/H.R. 4442, the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act). Support S. 2978, Protecting Continuing Physician Education & Patient Care Act. Advocate for increased graduate medical education funding. Lobby members of House to write to CMS in opposition of a policy in the 2017 Medicare Physician Fee Schedule Proposed Rule that would require all physicians to collect and report data on all services included in 10- and 90-day global surgery codes.

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

HR 270 - Flexibility in Health IT Reporting, Electronic health Records, Patient Safety, Regulation of Health IT, Health Software Regulation, Quality Measurement/ Quality Reporting, Patient Data Matching/ Patient Identification, Interoperability, Cybersecurity, Telehealth, HR 6 - 21st Century Cures Act, HR 3309 - Further Flexibility on Health IT Reporting and Advancing Interoperability Act, S. 2425, S. 2511 - Improving Health Information Technology Act, Prescription Drug Monitoring Programs & Opioid Abuse Prevention, S. 2866 - Jessie's Law, S.3173 - Electronic Health Record (EHR) Regulatory Relief Act

Client expense: $10,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Institute of Standards & Technology (NIST), SENATE

HR 270 - Flexibility in Health IT Reporting, Meaningful Use EHR Incentive Program, Electronic Health Records, Interoperability, Telehealth, HR 6 - 21st Century Cures Act, HR 3309- Further Flexibility in Health IT Reporting and Advancing Interoperability Act, S. 2141 - TRUST-IT, Patient Identification, S. 2425, S. 2511 - Improving Health Information Technology Act, HR 5001/ S.2822 - Flexibility in EHR Reporting Act, S. 3173 - Electronic Health Record (EHR) Regulatory Relief Act

Client expense: $10,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Institute of Standards & Technology (NIST), SENATE

H.R. 4959: Ensuring Access to General Surgery Act of 2016 H.R. 105: Quality Health Care Coalition Act of 2015 H.R. 3309: Flex-IT 2 Act H.R. 647: Access to Life-Saving Trauma Care for All Americans Act H.R. 648: Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R. 836: Health Care Safety Net Enhancement Act of 2015 H.R. 865: Good Samaritan Health Professionals Act of 2015 S. 3101: Good Samaritan Health Professionals Act of 2016 H.R. 1934: Cancer Care Payment Reform Act of 2015 S. 2943/H.R.1735: National Defense Authorization Act (NDAA) H.R.4909 - National Defense Authorization Act for Fiscal Year 2017 H.R. 2739: Cancer Drug Coverage Parity Act of 2015 S. 624/H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015 S. 3166: Ensuring Access to General Surgery Act of 2016 H.R. 1925: To award a Congressional Gold Medal to Dr. Balazs "Ernie" Bodai in recognition of his many outstanding contributions to the Nation, including a tireless commitment to breast cancer research. H.Res. 487: Recognizing the importance of cancer program accreditation in ensuring comprehensive, high quality, patient-centered cancer care Veterans Access, Choice and Accountability Act Concurrent Surgery MACRA Proposed Rule Implementation GME Health Professional Shortage Areas (HPSAs) Health Information Technology (Health IT) Chronic Care Coordination 96-Hour Rule Bleeding Control for the Injured (Stop The Bleed campaign) Opioids Cancer/Appropriations Medicare Part B Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs) Qualified Clinical Data Registry (QCDR) reporting mechanism Physician Quality Reporting System (PQRS) Video Recording Surgery RAC Audits Energy and Commerce Concussion Initiative Data Use Protection Legislation FOIA Energy and Commerce Pediatric Trauma Caucus Responsible Data Transparency Act

Client expense: $30,154 · Firm income: Not reported

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

H.R. 4959: Ensuring Access to General Surgery Act of 2016 H.R. 105: Quality Health Care Coalition Act of 2015 H.R. 3309: Flex-IT 2 Act H.R. 647: Access to Life-Saving Trauma Care for All Americans Act H.R. 648: Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R. 836: Health Care Safety Net Enhancement Act of 2015 H.R. 865: Good Samaritan Health Professionals Act of 2015 S. 3101: Good Samaritan Health Professionals Act of 2016 H.R. 1934: Cancer Care Payment Reform Act of 2015 S. 2943/H.R.1735: National Defense Authorization Act (NDAA) H.R.4909 - National Defense Authorization Act for Fiscal Year 2017 H.R. 2739: Cancer Drug Coverage Parity Act of 2015 S. 624/H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015 S. 3166: Ensuring Access to General Surgery Act of 2016 H.R. 1925: To award a Congressional Gold Medal to Dr. Balazs "Ernie" Bodai in recognition of his many outstanding contributions to the Nation, including a tireless commitment to breast cancer research. H.Res. 487: Recognizing the importance of cancer program accreditation in ensuring comprehensive, high quality, patient-centered cancer care Veterans Access, Choice and Accountability Act Concurrent Surgery MACRA Proposed Rule Implementation GME Health Professional Shortage Areas (HPSAs) Health Information Technology (Health IT) Chronic Care Coordination 96-Hour Rule Bleeding Control for the Injured (Stop The Bleed campaign) Opioids Cancer/Appropriations Medicare Part B Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs) Qualified Clinical Data Registry (QCDR) reporting mechanism Physician Quality Reporting System (PQRS) Video Recording Surgery RAC Audits Energy and Commerce Concussion Initiative Data Use Protection Legislation FOIA Energy and Commerce Pediatric Trauma Caucus Responsible Data Transparency Act

Client expense: $30,154 · Firm income: Not reported

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

H.R. 4959: Ensuring Access to General Surgery Act of 2016 H.R. 105: Quality Health Care Coalition Act of 2015 H.R. 3309: Flex-IT 2 Act H.R. 647: Access to Life-Saving Trauma Care for All Americans Act H.R. 648: Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R. 836: Health Care Safety Net Enhancement Act of 2015 H.R. 865: Good Samaritan Health Professionals Act of 2015 S. 3101: Good Samaritan Health Professionals Act of 2016 H.R. 1934: Cancer Care Payment Reform Act of 2015 S. 2943/H.R.1735: National Defense Authorization Act (NDAA) H.R.4909 - National Defense Authorization Act for Fiscal Year 2017 H.R. 2739: Cancer Drug Coverage Parity Act of 2015 S. 624/H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015 S. 3166: Ensuring Access to General Surgery Act of 2016 H.R. 1925: To award a Congressional Gold Medal to Dr. Balazs "Ernie" Bodai in recognition of his many outstanding contributions to the Nation, including a tireless commitment to breast cancer research. H.Res. 487: Recognizing the importance of cancer program accreditation in ensuring comprehensive, high quality, patient-centered cancer care Veterans Access, Choice and Accountability Act Concurrent Surgery MACRA Proposed Rule Implementation GME Health Professional Shortage Areas (HPSAs) Health Information Technology (Health IT) Chronic Care Coordination 96-Hour Rule Bleeding Control for the Injured (Stop The Bleed campaign) Opioids Cancer/Appropriations Medicare Part B Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs) Qualified Clinical Data Registry (QCDR) reporting mechanism Physician Quality Reporting System (PQRS) Video Recording Surgery RAC Audits Energy and Commerce Concussion Initiative Data Use Protection Legislation FOIA Energy and Commerce Pediatric Trauma Caucus Responsible Data Transparency Act

Client expense: $184,615 · Firm income: Not reported

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

H.R. 4959: Ensuring Access to General Surgery Act of 2016 H.R. 105: Quality Health Care Coalition Act of 2015 H.R. 3309: Flex-IT 2 Act H.R. 647: Access to Life-Saving Trauma Care for All Americans Act H.R. 648: Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R. 836: Health Care Safety Net Enhancement Act of 2015 H.R. 865: Good Samaritan Health Professionals Act of 2015 S. 3101: Good Samaritan Health Professionals Act of 2016 H.R. 1934: Cancer Care Payment Reform Act of 2015 S. 2943/H.R.1735: National Defense Authorization Act (NDAA) H.R.4909 - National Defense Authorization Act for Fiscal Year 2017 H.R. 2739: Cancer Drug Coverage Parity Act of 2015 S. 624/H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015 S. 3166: Ensuring Access to General Surgery Act of 2016 H.R. 1925: To award a Congressional Gold Medal to Dr. Balazs "Ernie" Bodai in recognition of his many outstanding contributions to the Nation, including a tireless commitment to breast cancer research. H.Res. 487: Recognizing the importance of cancer program accreditation in ensuring comprehensive, high quality, patient-centered cancer care Veterans Access, Choice and Accountability Act Concurrent Surgery MACRA Proposed Rule Implementation GME Health Professional Shortage Areas (HPSAs) Health Information Technology (Health IT) Chronic Care Coordination 96-Hour Rule Bleeding Control for the Injured (Stop The Bleed campaign) Opioids Cancer/Appropriations Medicare Part B Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs) Qualified Clinical Data Registry (QCDR) reporting mechanism Physician Quality Reporting System (PQRS) Video Recording Surgery RAC Audits Energy and Commerce Concussion Initiative Data Use Protection Legislation FOIA Energy and Commerce Pediatric Trauma Caucus Responsible Data Transparency Act

Client expense: $184,615 · Firm income: Not reported

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

Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical Education Medicaid provider taxes Medicare bad debt payments Medicare and Medicaid payment H.R.2 the Medicare Access and CHIP Reauthorization Act of 2015, all provisions H.R.1343/S.688 Establishing Equity in the Hospital Readmissions Program Act of 2015, all provisions Medicaid Waivers Medicaid Expansion Issues Medicaid disproportionate share hospital payments Medicare disproportionate share hospital payments Medicare hospital readmissions program Funding for the Children's Health Insurance Program Medicaid primary care payment parity Issues related to Medicaid reform including Medicaid block grants and per capita caps Medicare evaluation and management codes and other Medicare outpatient codes/ Medicare site neutral documents Meaningful Use stage 2 and 3 Medicare Shared Savings Program Legislation related to chronic care treatment H.R. 3291 Medicare Crosswalk Hospital Code Development Act Medicaid data and transparency Medicaid Managed Care Policies/ rulemaking Medicaid supplemental payments Medicare Site Neutral payments for hospital outpatient departments H.R.4442/S.2484 Connect for Health Act H.R.3309 Flex-It 2 Act H.R.5542 Medicaid and CHIP Quality Improvement Act S. 2438 Medicaid and CHIP Quality Improvement Act Hospital Star Rating: Methodology H.R.5273 Helping Hospitals Improve Patient Care Act

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

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

S.1013, Patent Abuse Reduction Act, S.1720, Patent Transparency and Improvements Act; S.1612 Patent Litigation Integrity Act; H.R. 845, Saving High-Tech Innovators from Egregious Legal Discputes Act; H.R. 2766, Stopping the Offensive Use of Patents Act; H.R. 3309, Innovation Act; copyright issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1137, H.R. 3309 - Protecting American Talent and Entrepreneurship Act of 2015 or the PATENT Act -- entire bill, specifically sections related to university research and patents

Client expense: Not reported · Firm income: $15,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3309/S.1137, Protecting American Talent and Entrepreneurship Act of 2015 or the PATENT Act, generally

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Praised members of Congress for the bipartisan effort in finally ending the SGR and for passing H.R. 2; Advocated with CMS on numerous aspects of the MACRA proposed rule, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions. Medicare Physician Fee Schedule: Commented to CMS in Sept. 2016 on the proposed rule that included numerous recommendations, including but not limited to: supports the proposed code additions to the list of Medicare approved telehealth services; supports CMS proposal to review the 83 indicated codes and will be involved to the extent possible through the Relative Value Scale Update Committee (RUC) process; recommends CMS seek specific direction on how to revise and improve on the policies related to End-Stage Renal Disease home dialysis; recommends the use of CPT code 99024 (postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management (E/M) service was performed during a postoperative period for a reason(s) related to the original procedure) to identify the number of postoperative visits associated with a surgical procedure; urges CMS to hold clinicians providing global surgical services to the same documentation standards and guidelines as clinicians performing E/M services when providing a visit. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations. FY2017 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Health Information Technology: Urged support for H.R. 3309, the Further Flexibility in Health Information Technology (HIT) Reporting and Advancing Interoperability Act (Flex-IT 2 Act); Advocated that CMS pause the implementation of Stage 3 meaningful use requirements until the new Merit-Based Incentive Payment System (MIPS) is ready to be implemented, and shorten the reporting period for the EHR Incentive Payment Programs from twelve months each year to three months. H.R. 3309 would also provide the Secretary of HHS greater flexibility to change, suspend, or revoke meaningful use criteria if the requirements are not consistent with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law last year. Urged lawmakers to require the Office of the National Coordinator (ONC) to develop and implement national EHR interoperability standards with direct input from practicing clinicians on the necessary data elements for care delivery, quality improvement and reporting, including the need for a narrative that provides the context of the care needed; Exempt clinicians in small/medium-sized practices from unfunded mandates that require them to purchase health IT software, services or infrastructure to support data exchanges with little or no clinical value, as determined by the Secretary with input from practicing physicians. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. Medicare Part B Payment Model: ACP provided comments on CMS proposed Part B payment model, including urging CMS to reassess implementing the proposal to change the current ASP+6% payment structure to the proposed ASP+2.5%+$16.80 rate because of the severe negative impact it may have on some physicians and their practices and appropriate patient access to needed medications. Zika: ACP urged lawmakers to pass legislation that would provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the Zika virus that is commensurate with the public health emergency that the virus represents. Prescription Drugs: ACP advocated support for lawmakers efforts in preventing some brand-name drug-companies from using statutorily required Food and Drug Administration (FDA) risk and safety programs to stifle other companies development of generic and biosimilar versions of brand-name drugs, specifically through introduction of the CREATES Act of 2016. Urged lawmakers to increase transparency in drug pricing by requiring pharmaceutical manufacturers to publically disclose production costs including research and development investments for specific high�cost drugs that the Secretary identifies through regulation; Authorize and appropriate $2.74 billion in discretionary spending for the FDA to expedite, through fast-track approval, new drugs that address unmet medical need in the treatment of a serious or life threatening condition, as well as to address the back-log of pending generic drug applications; Grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for prescription drugs covered under Part D of the Medicare program. Firearms: ACP urged lawmakers to expand background checks on all gun purchases making it more difficult for known or suspected terrorists to purchase firearms; Urged lawmakers to reject a proposal that would allow people who have been involuntarily committed due to severe mental illness to buy a gun immediately after leaving a psychiatric hospital and enable veterans who suffer from severe mental illness, and who are at risk of suicide, to legally buy guns. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses. Telemedicine: Urged lawmakers to broadly lift geographic restrictions on telemedicine, facilitate the use of such telehealth services in stroke treatment, and incorporate the use of these services into ACOs, cosponsor bipartisan legislation, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) For Health Act (the CONNECT For Health Act), H.R. 4442/S. 2484, which would expand the use of telemedicine and remote patient monitoring (RPM) services by physicians to improve care of patients enrolled in Medicare. Mental Health: Urged lawmakers to establish grants, including Innovation and Demonstration grants, to State and local governments, educational institutions, and nonprofit organizations for integrating or coordinating physical health, mental health and substance abuse services; Provide a defined portion of grant funding to the effective integration of services to address mental illness and substance abuse within the primary care setting and to expand a workforce trained to integrate behavioral health within the primary care setting. Veterans Affairs: Commented on the VAs proposed rule regarding Advanced Practice Registered Nurses, specifically: Urged the VA to eliminate the proposal to amend the medical regulations within the VA to permit full practice authority for all VA APRNs (which include Certified Nurse Practitioners, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, and Certified Nurse-Midwives) when they are acting within the scope of their VA employment, thereby broadly preempting applicable state laws that do not grant such authority; Urged the VA to implement alternative approaches that support dynamic clinical care teams rather than by granting full independent practice authority to APRNs.

Client expense: $261,848 · Firm income: Not reported

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

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Praised members of Congress for the bipartisan effort in finally ending the SGR and for passing H.R. 2; Advocated with CMS on numerous aspects of the MACRA proposed rule, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions. Medicare Physician Fee Schedule: Commented to CMS in Sept. 2016 on the proposed rule that included numerous recommendations, including but not limited to: supports the proposed code additions to the list of Medicare approved telehealth services; supports CMS proposal to review the 83 indicated codes and will be involved to the extent possible through the Relative Value Scale Update Committee (RUC) process; recommends CMS seek specific direction on how to revise and improve on the policies related to End-Stage Renal Disease home dialysis; recommends the use of CPT code 99024 (postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management (E/M) service was performed during a postoperative period for a reason(s) related to the original procedure) to identify the number of postoperative visits associated with a surgical procedure; urges CMS to hold clinicians providing global surgical services to the same documentation standards and guidelines as clinicians performing E/M services when providing a visit. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations FY2017 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Fully fund the commission at levels authorized in the Affordable Care Act; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine: Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Health Information Technology: Urged support for H.R. 3309, the Further Flexibility in Health Information Technology (HIT) Reorting and Advancing Interoperability Act (Flex-IT 2 Act); Advocated that CMS pause the implementation of Stage 3 meaningful userequirements until the new Merit-Based Incentive Payment System (MIPS) is ready to be implemented, and shorten the reporting period for the EHR Incentive Payment Programs from twelve months each year to three months. H.R. 3309 would also provide the Secretary of HHS greater flexibility to change, suspend, or revoke meaningful use criteria if the requirements are not consistent with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law last year. Urged lawmakers to require the Office of the National Coordinator (ONC) to develop and implement national EHR interoperability standards with direct input from practicing clinicians on the necessary data elements for care delivery, quality improvement and reporting, including the need for a narrative that provides the context of the care needed; Exempt clinicians in small/medium-sized practices from unfunded mandates that require them to purchase health IT software, services or infrastructure to support data exchanges with little or no clinical value, as determined by the Secretary with input from practicing physicians. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. Medicare Part B Payment Model: ACP provided comments on CMS proposed Part B payment model, including urging CMS to reassess implementing the proposal to change the current ASP+6% payment structure to the proposed ASP+2.5%+$16.80 rate because of the severe negative impact it may have on some physicians and their practices and appropriate patient access to needed medications. Zika: ACP urged lawmakers to pass legislation that would provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the Zika virus that is commensurate with the public health emergency that the virus represents. Prescription Drugs: ACP advocated support for lawmakers efforts in preventing some brand-name drug-companies from using statutorily required Food and Drug Administration (FDA) risk and safety programs to stifle other companies development of generic and biosimilar versions of brand-name drugs, specifically through introduction of the CREATES Act of 2016. Urged lawmakers to increase transparency in drug pricing by requiring pharmaceutical manufacturers to publically disclose production costs including research and development investments for specific high�cost drugs that the Secretary identifies through regulation; Authorize and appropriate $2.74 billion in discretionary spending for the FDA to expedite, through fast-track approval, new drugs that address unmet medical need in the treatment of a serious or life threatening condition, as well as to address the back-log of pending generic drug applications; Grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for prescription drugs covered under Part D of the Medicare program. Firearms: ACP urged lawmakers to expand background checks on all gun purchases making it more difficult for known or suspected terrorists to purchase firearms; Urged lawmakers to reject a proposal that would allow people who have been involuntarily committed due to severe mental illness to buy a gun immediately after leaving a psychiatric hospital and enable veterans who suffer from severe mental illness, and who are at risk of suicide, to legally buy guns. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses. Telemedicine: Urged lawmakers to broadly lift geographic restrictions on telemedicine, facilitate the use of such telehealth services in stroke treatment, and incorporate the use of these services into ACOs, cosponsor bipartisan legislation, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) For Health Act (the CONNECT For Health Act), H.R. 4442/S. 2484, which would expand the use of telemedicine and remote patient monitoring (RPM) services by physicians to improve care of patients enrolled in Medicare. Mental Health: Urged lawmakers to establish grants, including Innovation and Demonstration grants, to State and local governments, educational institutions, and nonprofit organizations for integrating or coordinating physical health, mental health and substance abuse services; Provide a defined portion of grant funding to the effective integration of services to address mental illness and substance abuse within the primary care setting and to expand a workforce trained to integrate behavioral health within the primary care setting. Veterans Affairs: Commented on the VAs proposed rule regarding Advanced Practice Registered Nurses, specifically: Urged the VA to eliminate the proposal to amend the medical regulations within the VA to permit full practice authority for all VA APRNs (which include Certified Nurse Practitioners, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, and Certified Nurse-Midwives) when they are acting within the scope of their VA employment, thereby broadly preempting applicable state laws that do not grant such authority; Urged the VA to implement alternative approaches that support dynamic clinical care teams rather than by granting full independent practice authority to APRNs.

Client expense: $87,998 · Firm income: Not reported

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

H.R. 1707, Access to Frontline Health Care Act, all sections H.R. 1741, Truth in Health Marketing Act, all sections H.R. 1190, Protecting Seniors Access to Medicare Act, all sections S. 141, Protecting Seniors Access to Medicare Act, all sections P.L. 111-192, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, all sections related to physicians and vision P.L. 111-148 Affordable Care Act, modifications: 1. Reducing regulatory/costly burdens on medical practices - relief from regulatory penalties 2. Preserving patient access to office ancillary testing services 4. Independent Payment Advisory Board H.R. 1312, National Health Service Corps Improvement Act Meaningful Use/EHR program issues P.L. 113-54, Drug Quality & Security Act, all sections Protecting Access to Medicare Act (P.L. 113-93) ASC Quality Reporting Program Medicare Advantage plan network adequacy H.R. 270, FlexIT Act, all sections H.R. 3309, Flex IT 2 Act, all sections S. 2141, Trust IT Act 2016 Physician Schedule Rule, sections pertaining to fee cuts Drug Price Increases Medicare Part B Drug Demonstration Medicare Access and CHIP Reauthorization Act (PL114-10) S.2777, Contact Lens Consumer Health Protection Act H.R. 6, 21st Century Cures Proposed 2017 Physician Fee Schedule. Section pertaining to global surgery data collection proposal

Client expense: $170,000 · Firm income: Not reported

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