Halt Tax Increases on the Middle Class and Seniors Act

Provisions dealing with Follow on Biologics Implementation of Public Law No: 111-148 (formerly HR3590): Patient Protection and Affordable Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3590, "Patient Protection & Affordable Care Act", the implemenation of various provisions. S. 183, "JobsandPremiumProtectionAct", regarding all provisions. H.R. 3742, "Access to Marketplace Insurance Act", regarding issue of the impact of third party payments on exchange marketplace stability.

Client expense: $490,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Implementation of H.R. 3590, the Patient Protection and Affordable Care Act. S. 289, the American Cures Act. NIH funding. S. 524/H.R. 953, Comprehensive Addiction and Recovery Act (CARA). Labor HHS appropriations bills FY 2017. General opioid funding issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Implementation of H.R. 3590, the Patient Protection and Affordable Care Act. CMMI demonstration projects. S. 971, Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015. H.R. 5273, Helping Hospitals Improve Patient Care Act. Issues related to commercial health plans and health insurance marketplaces.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Implementation of H.R. 3590, the Patient Protection and Affordable Care Act. CMMI demonstration projects. S. 971, Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015. H.R. 5273, Helping Hospitals Improve Patient Care Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Implementation of H.R. 3590, the Patient Protection and Affordable Care Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 506/ S. 245: Automatic IRA Act of 2015. Issue: retirement security H.R. 557/ S. 266: Retirement Security Act of 2014. Issue: retirement security H.R. 3590-The Patient Protection and Affordable Care Act, Issue: Assessments under state-based insurance exchanges. H.R. 2656 - The Receiving Electronic Statements to Improve Retiree Earnings Act. Issue: electronic disclosure of retirement plan notices. HR 2317/ S. 1317 - Lifetime Income Disclosure Act. Issue: lifetime income illustration S. Amendment 2761 to H.R. 1314-Bipartisan Budget Act of 2015. To amend the Internal Revenue Code of 1986 to reduce the payroll tax for self-employed individuals enrolled in a private disability insurance plan, and for employers that provide such plans to their employees. Issue: disability insurance. H.R. ___/S.___ Draft legislation amending Affordable Care Act provisions on health exchange assessments. Issue: Health Exchange Assessments H.R.___/S.___Draft legislation to facilitate disability income insurance options for employees. Issue: Disability income insurance. H.R. 3922 - Retirement Choice Protection Act. Issue: Department of Labors proposed fiduciary rule H.R. 4294 - SAVERS Act. Issue: Department of Labors proposed fiduciary rule H.R. 4293 - Affordable Retirement Advice Protection Act. Issue: Department of Labors proposed fiduciary rule H.R. 4067 - SAVE Act of 2015. Issue: retirement security H.R. ___/S.___ Draft legislation on tax treatment and consumer financing for long-term care insurance. Issue: Social Security Disability Insurance (SSDI) hearing decision backlog S. 3307/HR 6402 - Bill to avoid duplicate annual reporting on Form 5500 H.R. 6396 - Retirement Security for American Workers Act. Issue: multiple employer plans No bill number assigned: Retirement Enhancement and Savings Act of 2016 (passed by Senate Finance Committee on 9/21/16) Retirement Improvements and Savings Enhancement Act Discussion Draft House GOP Blueprint on Tax Reform

Client expense: $500,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to retirement security including: retirement plan standards, savings initiatives, the DOL fiduciary definition reproposal, lifetime income opportunities and public pension reform. S 266 / HR 557 Retirement Security Act of 2015. Issue: retirement security. S 245 / HR 506 Automatic IRA Act of 2015. Issue: retirement security. HR 3590 The Patient Protection and Affordable Care Act. Issue: assessments under state-based insurance exchanges. HR 2656 The Receiving Electronic Statements to Improve Retiree Earnings Act. Issue: electronic disclosure of retirement plan notices. S 1317 / HR 2317 Lifetime Income Disclosure Act. Issue: lifetime income illustration. Draft legislation amending Affordable Care Act provisions on health exchange assessments. Draft legislation to facilitate disability income insurance options for employees. S 2505 / HR 4294 SAVERS Act of 2015. HR 4067 SAVE Act of 2015. No bill number: Retirement Enhancement and Savings Act of 2016. Retirement Improvements and Savings Enhancement Act Discussion Draft. House GOP Blueprint on Tax Reform. Issue: retirement security.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

P.L. 111-148/H.R. 3590, Patient Protection and Affordable Care Act; P.L. 111-152, Health Care and Education Reconciliation Act of 2010; S. 298/H.R. 546, ACE Kids Act; 340B issues, Stark reform issues; LTCH criteria/Site Neutral Payment for Wound Cases (H.R. 1250/S. 1211); 21st Century Cures Act (H.R. 34).

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

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

Ambulatory Surgery Center payment issues; Supporting Colorectal Examination and Education Now (SCREEN) Act; implementation of the Patient Protection & Affordable Care Act (H.R. 3590/Pub. L. 111-148); health IT issues; MACRA (H.R. 2) implementation' CMS survey and certification issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Ambulatory Surgery Center payment issues; Supporting Colorectal Examination and Education Now (SCREEN) Act; implementation of the Patient Protection & Affordable Care Act (H.R. 3590/Pub. L. 111-148); health IT issues: MACRA (H.R. 2) implementation.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; 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 (as first introduced in the 111th Congress). Support 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; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the 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; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, 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; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medicare Physician Fee Schedule: Commented to CMS in Sept/Oct 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 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: 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. Health Information Technology: Commented to HHS Office of the National Coordinator for Health Information Technologys (ONCs) Draft 2017 Interoperability Standards Advisory (ISA), recommending that ONC focus its efforts to identify, repair, and mitigate the negative effects of rapidly spreading bad data; rather than requiring EHRs and other clinical health IT to support multiple separate standards for extracting data for quality, public health, research, payment, and other reporting purposes, ONC should commission development of a single application programming interface (API) for all of the query and data extraction requirements. 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. 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. 21st Century Cures Act: Advocated with Congress on several elements of the 21st Century Cures Act, comprehensive legislation designed to accelerate the discovery, development, and delivery of new cures and treatments. These elements included: support for moving the health information technology (health IT) ecosystem toward an interoperable health information network, combatting business practices that inhibit the flow of information by establishing authority for the HHS Office of Inspector General to investigate claims of information blocking and assign penalties for activities found to be interfering with the lawful sharing of electronic information, ensuring that health care clinicians are not penalized for the failure of developers of health IT in the case of information blocking, the establishment of hardship exemptions from Meaningful Use and the Merit-Based Incentive Payment System (MIPS) payment adjustments due to the decertification of an electronic health record (EHR) and, a commitment to develop a strategy around reducing regulatory and administrative burdens, improving and increasing access to treatment for patients suffering from mental health and substance use disorders and ensure better understanding and enforcement of mental health parity laws, accelerating the integration of behavioral health into the primary care setting.

Client expense: $243,989 · 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; 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 (as first introduced in the 111th Congress). Support 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; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the 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; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, 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; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medicare Physician Fee Schedule: Commented to CMS in Sept/Oct 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 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: 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. Health Information Technology: Commented to HHS Office of the National Coordinator for Health Information Technologys (ONCs) Draft 2017 Interoperability Standards Advisory (ISA), recommending that ONC focus its efforts to identify, repair, and mitigate the negative effects of rapidly spreading bad data; rather than requiring EHRs and other clinical health IT to support multiple separate standards for extracting data for quality, public health, research, payment, and other reporting purposes, ONC should commission development of a single application programming interface (API) for all of the query and data extraction requirements. 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. 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. 21st Century Cures Act: Advocated with Congress on several elements of the 21st Century Cures Act, comprehensive legislation designed to accelerate the discovery, development, and delivery of new cures and treatments. These elements included: support for moving the health information technology (health IT) ecosystem toward an interoperable health information network, combatting business practices that inhibit the flow of information by establishing authority for the HHS Office of Inspector General to investigate claims of information blocking and assign penalties for activities found to be interfering with the lawful sharing of electronic information, ensuring that health care clinicians are not penalized for the failure of developers of health IT in the case of information blocking, the establishment of hardship exemptions from Meaningful Use and the Merit-Based Incentive Payment System (MIPS) payment adjustments due to the decertification of an electronic health record (EHR) and, a commitment to develop a strategy around reducing regulatory and administrative burdens, improving and increasing access to treatment for patients suffering from mental health and substance use disorders and ensure better understanding and enforcement of mental health parity laws, accelerating the integration of behavioral health into the primary care setting.

Client expense: $88,904 · 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)

Implementation of Patient Protection and Affordable Care Act (H.R. 3590/Pub. L. 111-148); telemedicine and connected care; remote patient monitoring; Health Care and Education Reconciliation Act (H.R. 4872/Pub. L. 111-152); Protect Medical Innovation Act of 2015 (H.R. 160/S. 149); The Medicare Access and CHIP Reauthorization Act (H.R. 2); Medicare Telehealth Parity Act (H.R. 2948); CONNECT for Health Act (S 2484/HR 4442); Diabetic Eye Disease Prevention Act (H.R. 4642); safe patient handling, FDA reform.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Technology research; telemedicine and connected care; remote patient monitoring; implementation of Patient Protection and Affordable Care Act (H.R. 3590/P.L. 111-148); Health Care and Education Reconciliation Act (H.R. 4872/P.L. 111-152); the Protect Medical Innovation Act (H.R. 160/S. 149); 21st Century Cures Act (H.R. 6/HR 34); The Medicare Access and CHIP Reauthorization Act (H.R. 2); Medicare Telehealth Parity Act (H.R. 2948); CONNECT for Health Act (S 2484/HR 4442); Diabetic Eye Disease Prevention Act (H.R. 4642); safe patient handling, FDA reform.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

"Patient Protection and Affordable Care Act," H.R.3590, Public Law No: 111-148

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. Tax reform proposals to address depreciation rates and like-kind exchanges. 2. Expiration of Medical Expense Deduction for Seniors. 3. H.R. 3590 The Halt Tax Increases In the Middle Class and Seniors Act. All provisions. 4. S.3111 Seniors tax hike prevention act of 2016. All provisions

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

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

General health care coverage and reimbursement; implementation issues regarding H.R. 3590, the Patient Protection and Affordable Care Act; legislative and regulatory issues related to vaccine development; and the Food and Drug Administration legislative and regulatory issues.

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

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

General health care coverage and reimbursement; implementation issues regarding H.R. 3590, the Patient Protection and Affordable Care Act; and the Food and Drug Administration legislative and regulatory issues.

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

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

General health care coverage and reimbursement; implementation issues regarding H.R. 3590, the Patient Protection and Affordable Care Act; and the Food and Drugs Administration legislative and regulatory issues.

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

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

General health care coverage and reimbursement; implementation issues regarding H.R. 3590, the Patient Protection and Affordable Care Act; legislative and regulatory issues related to pandemic influenza and biodefense vaccine development and procurement; and the Food and Drugs Administration legislative and regulatory issues.

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

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

General health care coverage and reimbursement; implementation issues regarding H.R. 3590, the Patient Protection and Affordable Care Act; the Food and Drugs Administration legislative and regulatory issues.

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

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

General health care coverage and reimbursement; implementation issues regarding H.R. 3590, the Patient Protection and Affordable Care Act; and the Food and Drugs Administration legislative and regulatory issues.

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

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

RET - Fourth Quarter Report - 2016 H.R. 506/ S. 245: Automatic IRA Act of 2015. Issue: retirement security H.R. 557/ S. 266: Retirement Security Act of 2015. Issue: retirement security H.R. 2028 - Further Continuing and Security Assistance Appropriations Act. Section 172, regarding funding to address the Social Security Disability Insurance (SSDI) hearing backlog. Issue: disability insurance H.R. 2317/ S. 1317 - Lifetime Income Disclosure Act. Issue: lifetime income illustration H.R. 2656 - The Receiving Electronic Statements to Improve Retiree Earnings Act. Issue: electronic disclosure of retirement plan notices. H.R. 3590-The Patient Protection and Affordable Care Act, Issue: Assessments under state-based insurance exchanges. H.R. 4067 - SAVE Act of 2015. Issue: retirement security H.R. 6396 - the Retirement Security for American Workers Act. Issue: expanding retirement savings plans. H.R. ___/S.___ Draft legislation amending Affordable Care Act provisions on health exchange assessments. Issue: Health Exchange Assessments H.R.___/S.___ Draft legislation to facilitate disability income insurance options for employees. Issue: Disability income insurance. H.R. ___/S.___ Draft legislation on tax treatment and consumer financing for long-term care insurance. Issue: Social Security Disability Insurance (SSDI) hearing decision backlog S. Amendment 2761 to H.R. 1314-Bipartisan Budget Act of 2015. To amend the Internal Revenue Code of 1986 to reduce the payroll tax for self-employed individuals enrolled in a private disability insurance plan, and for employers that provide such plans to their employees. Issue: disability insurance. S. 3471 Retirement Enhancement and Savings Act of 2016. Issue: expanding retirement savings plans. Retirement Improvements and Savings Enhancement Act Discussion Draft House GOP Blueprint on Tax Reform

Client expense: $800,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Public access to national parks, marine sanctuaries, fishing in the EEZ and other Federally managed areas. HR 3320, HR 2406, S 405, S 659, S. 556, HR 3590 S. 3099, HR 2406 (SHARE Act)

Client expense: $34,855 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Council on Environmental Quality (CEQ), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), Internal Revenue Service (IRS), Natl Oceanic & Atmospheric Administration (NOAA), Natl Park Service (NPS), SENATE, U.S. Fish & Wildlife Service (USFWS), U.S. Forest Service

Proposals relating to seniors housing, seniors housing residences, and long-term care insurance. Changes in the tax treatment of real estate, including carried interest, like-kind exchanges, and depreciation. Proposals to retain the 7 1/2% medical expense deduction for individuals age 65 and older. H.R. 3590, Halt Increases in The Middle Class and Seniors Act, S. 3111, The Seniors Tax Hike Prevention Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Special Needs plans (Medicare advantage insurance reforms) HR3590, HR 4872. Socio-economic factors in Medicare.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health Care Reform, HR 3590, Patient Protection & Affordable Care Act. HR 4872 Recon Act 2010. USPSTF Approvals. Legislation on cancer screening test process.

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Office of Personnel Management (OPM), SENATE

Health Care Reform, HR 3590 Patient Protection and Affordable Care Act. Long term care reimbursement. Impact act; VA Contract with long term care facilities, Brady/Kind Long Term Care HR 3298 Post Accute Care Purchasing Act. All Healthcare related financing and coverage issues.

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3590, Halt Tax Increases on the Middle Class and Seniors Act. S.3111, Seniors Tax Hike Prevention Act of 2016. Tax credit for expenses related to caregivers.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Patient Protection and Affordable Care Act, H.R.3590, Public Law No: 111-148

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 506/ S. 245: Automatic IRA Act of 2015. Issue: retirement security H.R. 557/ S. 266: Retirement Security Act of 2015. Issue: retirement security H.R. 3590-The Patient Protection and Affordable Care Act, Issue: Assessments under state-based insurance exchanges. H.R. 2656 - The Receiving Electronic Statements to Improve Retiree Earnings Act. Issue: electronic disclosure of retirement plan notices. HR 2317/ S. 1317 - Lifetime Income Disclosure Act. Issue: lifetime income illustration S. Amendment 2761 to H.R. 1314-Bipartisan Budget Act of 2015. To amend the Internal Revenue Code of 1986 to reduce the payroll tax for self-employed individuals enrolled in a private disability insurance plan, and for employers that provide such plans to their employees. Issue: disability insurance. H.R. ___/S.___ Draft legislation amending Affordable Care Act provisions on health exchange assessments. Issue: Health Exchange Assessments H.R.___/S.___ Draft legislation to facilitate disability income insurance options for employees. Issue: Disability income insurance. H.R. 2028 - Further Continuing and Security Assistance Appropriations Act. Section 172, regarding funding to address the Social Security Disability Insurance (SSDI) hearing backlog. Issue: disability insurance HR 4067 - SAVE Act of 2015. Issue: retirement security H.R. ___/S.___ Draft legislation on tax treatment and consumer financing for long-term care insurance. Issue: Social Security Disability Insurance (SSDI) hearing decision backlog Retirement Improvements and Savings Enhancement Act Discussion Draft House GOP Blueprint on Tax Reform S. 3471 Retirement Enhancement and Savings Act of 2016. Issue: expanding retirement savings plans. H.R. 6396 - the Retirement Security for American Workers Act. Issue: expanding retirement savings plans.

Client expense: $1,134,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2028, Further Continuing and Security Assistance Appropriations Act (teen pregnancy prevention) (House and Senate). H.R. 3590, The Affordable Care Act (advancing health insurance coverage quality and accessibility for sexual and reproductive health services). no bill number, adolescent sexual and reproductive health education and services (strategy for new administration). no bill number, advancing comprehensive health coverage without cost-sharing of preventive sexual and reproductive health care, particularly the Affordable Care Act's contraceptive coverage benefit (strategy for new administration). no bill number, removing legal and policy barriers to immigrants' eligibility for health insurance coverage (strategy for new administration). no bill number, clinic and provider safety (House). no bill number, upcoming legislation to repeal the Affordable Care Act (Senate). no bill number, provided input to Senate committee staff regarding sexual and reproductive health issues for the confirmation hearing of Representative Tom Price as DHHS Secretary (Senate).

Client expense: $5,000 · Firm income: Not reported

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act. Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010. Regulations implementing Administrative Simplification reforms included in H.R. 3590. Issues involving Qualified Health Plans and Health Insurance Marketplaces. HIPAA privacy, security and Administrative simplification. Network adequacy in Qualified Health Plans. Provider Contracting in Qualified Health Plans. ICD-10 implementation.

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

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act. Regulations implementing the Medicare Access and CHIP Reauthorization Act of 2015 Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010. Regulations establishing meaningful use criteria for electronic health records. Issues involving provider enrollment in Medicare and the ability to order or refer patients. ICD-10 Code implementation. Issues affecting electronic claims transactions H.R 2 Medicare changes in Place of Service and Date of Service policy. Issues involving Medicare Enrollment and re-validation. Medicare policies on overpayment of claims. Issues involving sequestration and its impact on Medicare provider payments. Medicare Changes to Place of Service and Date of Service Policy. Proposed Changes to Medicare False Claims Act and fraud and abuse criteria. Medicare/administrative simplification. Policies implementing Medicare coverage of low-dose CT for lung cancer screening

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

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act. Regulations implementing the Medicare Access and CHIP Reauthorization Act of 2015 Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010. Regulations and legislation dealing with physician ownership of hospitals. Regulations dealing with changes in how hospitals and physicians are paid. Issues involving drug shortages and federal legislation aimed at alleviating drug shortages. Issues involving drug compounding and disposal of unused controlled substances. Issues related to network adequacy for Qualified Health Plans. Definition of Essential Community Providers under the ACA. Legislation affecting Federally Certified Rural Health Clinics. Legislation promoting/mandating site-neutral payments for off-campus hospital outpatient departments

Client expense: Not reported · Firm income: $25,000

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

Medicare regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act. Regulations implementing the Medicare Access and CHIP Reauthorization Act of 2015 Medicare regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010. Regulations dealing with physician ownership of hospitals. Medicare Regulations affecting Rural Health Clinics. Legislation affecting Medicare payments for physician owned hospitals. The Rural Health Clinic Patient Access Improvement Act. Sequester related reductions in physician and hospital payments. Payment equalization between physicians offices and hospital outpatient departments. Rural Health Clinics Fairness Act. Medicaid Reform initiatives. Provider Payments reforms under Medicare. Legislation and regulations mandating/promoting/implementing site-neutral payment policy for Medicare for off-campus hospital outpatient departments

Client expense: Not reported · Firm income: $25,000

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act. Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010. Proposed Regulations affecting Rural Health Clinics. S. 1355 and H.R. 3986, the Rural Health Clinic Patient Access Improvement Act of 2009. Regulations establishing standards for the meaningful use of electronic health records. Provider enrollment (PECOS) in Medicare and the ability to order or refer patients. Possible cuts in Medicare bad debt payments for RHCs. Rural Health Clinics Fairness Act. Electronic Health Records Improvement Act. Seniors Mental Health Access Improvement Act of 2013. Proposed Changes in RHC regulations dealing with employment of PAs and NPs. Changes to the RHC manual by CMS. Medicaid waiver applications submitted by Arkansas and Iowa. Legislation repeal/replacing SGR (H.R. 2). Network Adequacy. Chronic Care Management and payment for RHCs. Coding on RHC claims. Development of the RHC Qualifying Visit list and clarification of billing requirements. PQRS application to RHCs. Support for S. 2786, the Rural Access to Hospice Act Regulations implementing the Medicare Access and CHIP Reauthorization Act of 2015

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

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

Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Care Act. Regulations stemming from enactment of H.R. 4872, The Reconciliation Act of 2010. Adoption of negotiated rulemaking committee recommendations on new methodology for designating areas as underserved. Standards for meaningful use of electronic health records. Consumer ability to change plans when qualified health plan changes network. QHP network adequacy standards. Essential Community Provider designation for RHCs under ACA. Development of Alternative Payment models. Regulations implementing the Medicare Access and CHIP Reauthorization Act of 2015

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

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

H.R. 3590 Patient Protection and Affordable Care Act (implementation)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3590 (P.L. No: 111-148): The Patient Protection and Affordable Care Act: concerns regarding readmissions, value based purchasing, medicare and medicaid disproportionate share cuts under ACA regulations, Common Rule HR 1343/ S688: Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015 HR6: 21st Century Cures Act 340b Mega Guidance Rule from HRSA Common Rule on Human Subjects

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Tax Reform 1031 Like Kind Exchange Cash Accounting HR 3590 Halt Tax Increases on the Middle Class and Seniors Act

Client expense: $243,152 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, SENATE

S. 2759, H.R. 4708, Credit for Caring Act - Urged co-sponsorship of the bill, discussed bill supporters, and responded to inquiries. H.R.3590, Halt Tax Increases for Seniors Act - Discussed bill. S. 3111, Senior Tax Prevention Hike Act - Discussed bill. S. 3067, H.R. 5485, H.R. 5325, Financial Services & General Government Appropriations bill, FY 2017 - Lobbied to protect and enhance funding levels for IRS VITA & TCE taxpayer assistance programs.

Client expense: $2,290,000 · Firm income: Not reported

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

S. 709, H.R. 1270, Restoring Access to Medication Act - Supported bill. H.R. 3590, Halt Tax Increases on the Middle Class and Seniors Act - Meetings, calls and emails urging support. Discussed the Fair Medical Billing Act. Discussed Medicare Advantage, Medicare Supplemental and employer health insurance. Discussed Affordable Care Act Medicaid expansion issues, including AARP comments on state 1115 waiver proposals to expand Medicaid. Discussed Medicare-Medicaid integration efforts and financial alignment demonstrations, other CMS demonstration initiatives. Discussed Older Americans Act home and community-based services program funding for FY2017. S. 2956, H.R. 5054 - Discussed nutrition programs including the Supplemental Nutrition Assistance Program (SNAP)and related changes under the 2014 farm bill. S. 3040, H.R. 5926, H.R. 5325, Labor, Health and Human Services Appropriations, FY2017 - Lobbied for funding support for various health and health care related programs serving seniors. S.3111, Seniors Tax Hike Prevention Act - Discussed medical expense deduction for the 65 plus population. Advocated on the issue of limited age rating for private health insurance. S. 3335, H.R. 6043, FAIR Drug Pricing Act - Supported bill.

Client expense: $2,290,000 · Firm income: Not reported

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

Tax reform proposals. H.R. 3590, Halt Tax Increases on the Middle Class and Seniors Act. S. 3111, Seniors Tax Hike Prevention Act of 2016.

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE