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Ensuring Access to Quality Medicaid Providers Act
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Momentum (last 30 days)
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0 actions · 0 new cosponsors · 0 votes
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147d open
vs 6,526 other HR bills in the 114th — cohort avg 56d
Ensuring Access to Quality Medicaid Providers Act (Sec. 2) This bill amends titles XIX (Medicaid) and XXI (Children's Health Insurance Program [CHIP]) of the Social Security Act to prohibit federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated. Under current law, a state must exclude from Medicaid participation any provider that has been terminated under any state's Medicaid program or under Medicare. The bill maintains those requirements and further requires a state to exclude from Medicaid participation any provider that has been terminated under CHIP. Furthermore, a state must exclude from CHIP participation any provider that has been terminated under Medicaid or Medicare. The bill also revises a state's reporting requirements with respect to terminating a provider under a state plan. A state shall require each Medicaid or CHIP provider, whether the provider participates on a fee-for-service (FFS) basis or within the network of a managed care organization (MCO), to enroll with the state by providing specified identifying information. When notifying the Department of Health and Human Services (HHS) that a provider has been terminated under a state plan, the state must submit this information as well as information regarding the termination date and reason. HHS shall review such termination notifications and, if appropriate, include them in a database or similar system, as specified by the bill. The bill prohibits federal payment under a state's Medicaid or CHIP program for services provided by an MCO unless: (1) the state has a system for notifying MCOs when a provider is terminated under Medicaid, Medicare, or CHIP; and (2) any contract between the state plan and an MCO provides that such providers be excluded from participation in the MCO provider network. HHS shall report to Congress on this bill's implementation. (Sec. 3) A state must publish and annually update a public directory of FFS providers participating under the state plan.
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Filing registrants (19)
Received in the Senate and Read twice and referred to the Committee on Finance.
Motion to reconsider laid on the table Agreed to without objection.
On passage Passed by the Yeas and Nays: 406 - 0 (Roll no. 105).
HousePassed/agreed to in House: On passage Passed by the Yeas and Nays: 406 - 0 (Roll no. 105).
HouseConsidered as unfinished business. (consideration: CR H1104)
UNFINISHED BUSINESS - The Chair announced that the unfinished business was the question of passage of H.R. 3716 which had been debated earlier and on which further proceedings had been postponed.
POSTPONED PROCEEDINGS - The Chair put the question on passage of H.R. 3716 and by voice vote, announced that the ayes had prevailed. Mr. Bucshon demanded the yeas and nays and the Chair postponed further proceedings on the question of passage of the bill until a time to be announced.
The House adopted the amendment in the nature of a substitute as agreed to by the Committee of the Whole House on the state of the Union.
Bills with similar content found using semantic analysis.
Sources: Congress.gov
2016 · fourth_quarter · Medicare/Medicaid
H.R. 34, 21st Century Cures Act (Upton) - Medicare Advantage and Medicaid issues H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 5659, ESRD Choice Act (Smith) - option for ESRD patients to enroll in MA plans H.R. 5942, Dialysis PATIENTS Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 6265, Medigap Reforms (McDermott) S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD S. 3504, Chronic Care Act (Hatch-Wyden-Isakson-Warner) - chronic care reforms, Medicare Advantage provisions Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.
Client expense: $1,330,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office
2016 · fourth_quarter · Medicare/Medicaid
Medigap; Medicare Advantage; CHIP Reform; Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; site neutral payments; Network Breadth Advisory Council; Rate Notice and Call Letter. HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21,2015 by Keith Rothfus (R-PA) this bill amends title XVII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 ti anebd tutke XVII of the Social Security Act to establish payment parity under the Medicare program for ambulatory care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) to amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-Tx) To amend title XIX of the Social Security Act to provide the same levele of Federal Matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place.
2016 · fourth_quarter · Medicare/Medicaid
Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016
Client expense: Not reported · Firm income: $30,000
2016 · fourth_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 H.R. 5164 - Rural Hospital Regulatory Relief Act H.R. 5122 - To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models H.R. 5210/S. 2736 - Patient Access to Durable Medical Equipment Act H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 H.R. 5613/S. 3129 - Continuing Access to Hospitals Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act S. 2787 - States Achieve Medicaid Expansion (SAME) Act S. 3130 - Independence at Home Act of 2016
2016 · fourth_quarter · Medicare/Medicaid
Medicare/Medicaid Issues; Medicare Advantage; CHIP Reform; Medicare Access & CHIP Reauthorization Act 2015 (MACRA); Chronic Care Reform; Exchanges; Site-neutral Payments; Rate Notice and Call Letter. HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. The Bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider termination, and for other purposes.
The previous question was ordered pursuant to the rule. (consideration: CR H1103)
The House rose from the Committee of the Whole House on the state of the Union to report H.R. 3716.
DEBATE - Pursuant to the provisions of H.Res. 632, the Committee of the Whole proceeded with 10 minutes of debate on the Bucshon amendment No. 1, as modified.
GENERAL DEBATE - The Committee of the Whole proceeded with one hour of general debate on H.R. 3716.
The Speaker designated the Honorable George Holding to act as Chairman of the Committee.
House resolved itself into the Committee of the Whole House on the state of the Union pursuant to H. Res. 632 and Rule XVIII.
Rule provides for consideration of H.R. 3716 with 1 hour of general debate. Previous question shall be considered as ordered without intervening motions except motion to recommit with or without instructions. Measure will be considered read. Specified amendments are in order. It shall be in order to consider as an original bill for the purpose of amendment under the five-minute rule an amendment in the nature of a subsitute consisting of the text of Rules Committee Print 114-45.
Considered under the provisions of rule H. Res. 632. (consideration: CR H1097-1103; text of amendment in the nature of a substitute: CR H1101-1102)
Rule H. Res. 632 passed House.
Rules Committee Resolution H. Res. 632 Reported to House. Rule provides for consideration of H.R. 3716 with 1 hour of general debate. Previous question shall be considered as ordered without intervening motions except motion to recommit with or without instructions. Measure will be considered read. Specified amendments are in order. It shall be in order to consider as an original bill for the purpose of amendment under the five-minute rule an amendment in the nature of a subsitute consisting of the text of Rules Committee Print 114-45.
Placed on the Union Calendar, Calendar No. 326.
Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 114-427.
Congress.gov source codes: 5000, H12200
Ordered to be Reported (Amended) by Voice Vote.
Committee Consideration and Mark-up Session Held.
Committee Consideration and Mark-up Session Held.
Forwarded by Subcommittee to Full Committee (Amended) by Voice Vote .
Subcommittee Consideration and Mark-up Session Held.
Subcommittee Consideration and Mark-up Session Held.
Referred to the Subcommittee on Health.
Referred to the House Committee on Energy and Commerce.
Introduced in House
Congress.gov source codes: 1000, Intro-H
| Referred to |
| October 8, 2015 |
| October 8, 2015 |
| HR 34 | 114th | Related bill |
Client expense: $60,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
Client expense: $20,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · fourth_quarter · Health Issues
H.R. 546/S. 298, the ACE Kids Act of 2015, all provisions. H.R. 3716, Ensuring Access to Quality Medicaid Providers Act, all provisions. H.R. 592/S. 314, the Pharmacy and Medically Underserved Areas Enhancement Act, all provisions. General issues related to infant mortality, public health, and research.
Client expense: $120,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · fourth_quarter · Medicare/Medicaid
Medigap; Medicare Advantage; CHIP Reform; Medicare Access & CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; Site-neutral Payments; Network Breadth Advisory Council; Rate Notice and Call Letter. HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Tiberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.
Client expense: $2,160,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2016 · third_quarter · Medicare/Medicaid
H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 5659, ESRD Choice Act (Smith) - option for ESRD patients to enroll in MA plans H.R. 5942, Dialysis PATIENTS Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 6265, Medigap Reforms (McDermott) S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Client expense: $1,710,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
2016 · third_quarter · Health Issues
H.R. 546/S. 298, the ACE Kids Act of 2015, all provisions. H.R. 3716, Ensuring Access to Quality Medicaid Providers Act, all provisions. General issues related to infant mortality, mental health, and public health.
Client expense: Not reported · Firm income: $50,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · third_quarter · Medicare/Medicaid
Medigap; Medicare Advantage; CHIP Reform; Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; QHP Quality Rating System (QRS)' MHP: FAQ 8 and 9; Form 5500; Schedule j. HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21,2015 by Keith Rothfus (R-PA) this bill amends title XVII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) to amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-Tx) To amend title XIX of the Social Security Act to provide the same levele of Federal Matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place.
Client expense: $50,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · third_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 H.R. 5164 - Rural Hospital Regulatory Relief Act H.R. 5210/S. 2736 - Patient Access to Durable Medical Equipment Act H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 H.R. 5613/S. 3129 - Continuing Access to Hospitals Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act S. 2787 - States Achieve Medicaid Expansion (SAME) Act S. 3130 - Independence at Home Act of 2016
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
2016 · third_quarter · Medicare/Medicaid
Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Electronic Health Record (EHR) Incentive Programs; Payment to Certain Off-Campus Outpatient Departments of a Provider; Hospital Value-Based Purchasing (VBP) Program; Proposed Rule for CY 2017 (CMS-1656-P) Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2017 (CMS-1654-P) California Medicare Geographic Payment Locality Update Implementation (CMS-1654-P) Medicare Access and Childrens Health Insurance Reauthorization Act Implementation (MACRA): Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models; Proposed Rule (CMS-5517-P) Medicare Part B Physician Drug Payment Model Demonstration Project. Medicare Recovery Audit Contractors (H.R. 3081) Ensuring Removal of Terminated Providers from Medicaid & CHIP (H.R. 3716) MACRA Implementation Restoration of the 0.5% Medicare Physician Payment Update pursuant to MACRA California Medicare Geographic Payment Locality Implementation High Cost of Prescription Drugs - Requiring Pharma to Negotiate Drug Prices for Medicare Part D
Client expense: $45,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA), White House Office
2016 · third_quarter · Medicare/Medicaid
Medicare and Medicaid issues, Medigap issues, Medicare Advantage, CHIP reform, chronic care reform HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (weather or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Taberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.
Client expense: $15,183 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2016 · third_quarter · Medicare/Medicaid
Medicare/Medicaid Issues; Medicare Advantage; CHIP Reform; Medicare Access & CHIP Reauthorization Act 2015 (MACRA); Chronic Care Reform; Exchanges; Site-neutral Payments; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; QHP Quality Rating System (QRS); MHP. HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. The Bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider termination, and for other purposes. HR 4588 Introduced February 23, 2016 by Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place.
Client expense: $30,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · third_quarter · Medicare/Medicaid
Medigap; Medicare Advantage; CHIP Reform; Medicare Access & CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; Site-neutral Payments; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; QHP Quality Rating System (QRS); MHP; FAQ 8 and 9; Form 5500; Schedule J HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Tiberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.
Client expense: $2,150,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2016 · third_quarter · Health Issues
H.R. 546/S. 298, the ACE Kids Act of 2015, all provisions. H.R. 3716, Ensuring Access to Quality Medicaid Providers Act, all provisions. H.R. 592/S. 314, the Pharmacy and Medically Underserved Areas Enhancement Act, all provisions. General issues related to infant mortality, public health, and research.
Client expense: $80,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · third_quarter · Medicare/Medicaid
Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 H.R. 5164 - Rural Hospital Regulatory Relief Act H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act S. 2787 - States Achieve Medicaid Expansion (SAME) Act
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
2016 · second_quarter · Health Issues
Comprehensive Addiction and Recovery Act (S 524) Conference Report Zika Virus Response Funding (HR 2577) Mental Health Programs and Policies (HR 2646) Health Savings Accounts (HR 1270) National All Schedules Prescription Electronic Reporting Act (S. 480/HR 1725) Mental Health Reform Act of 2016 (S 2680) Recovery Enhancement for Addiction Treatment Act (S. 1455) The Co-Prescribing Saves Lives Act of 2016 (S. 2256) The Plan of Safe Care Improvement Act (S. 2687) The Partial Fill Amendment within the Managers Amendments to S 2680 Comprehensive Addiction and Recovery Act (S. 524) Comprehensive Opioid Abuse Reduction Act (HR 5046) Interagency Opioid Task Force (HR 4641) The Opioid Use Disorder Treatment Expansion and Modernization Act (HR 4981) Promoting Responsible Opioid Management and Incorporating Scientific Expertise Act - Veterans Administration (HR 4063) Good Samaritan Assessment Act (HR 4058) Opioid Program Evaluation (OPEN) Act (HR 5022) Infant Plan of Safe Care Improvement Act (HR 4843) Nurturing and Supporting Healthy Babies Act (HR 4978) Improving Treatment for Pregnant and Postpartum Women Act (HR 3691) Ensuring Removal of Terminated Providers from Medicaid & CHIP (H.R. 3716) Medication Assisted Treatment for Opioid Use Disorders (SAMHSA, RIN 0930-AA22)
Client expense: $45,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, HOUSE OF REPRESENTATIVES, SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA), White House Office
2016 · second_quarter · Medicare/Medicaid
H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD Draft Bill on Option for ESRD Patients to Enroll in MA Plans (Ways and Means Committee) H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.
Client expense: $1,710,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office
2016 · second_quarter · Health Issues
S. 2832 - Fair Medicare Hospital Payments Act of 2016 H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 H.R. 3299 - Strengthening Public Health Emergency Response Act of 2015 H.R. 4428 - To amend title XVIII of the Social Security Act to ensure fairness in Medicare hospital payments by establishing a floor for the area wage index applied with respect to certain hospitals. H.R. 3716 - Ensuring Terminated Providers are Removed from Medicaid and CHIP Act S.2467 - The Patient Safety Improvement Act H.R. 4725 - The Common Sense Savings Act H.R. 2156 - Medicare Audit Improvement Act H.R. 1342 / S.688 - Establishing Beneficiary Equity in the Hospital Readmission Program Act Critical Access Hospital Reimbursement CMS-5517-P, Medicare Program: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models; Proposed Rule, May 9, 2016 CMS-1645-P, Medicare Program: Skilled Nursing Facility Prospective Payment System for Federal Fiscal Year 2017; Proposed Rule, April 25, 2016 CMS-1647-P, Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2016; Proposed Rule, April 25, 2016 CMS-1655-P, Medicare Program: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; and Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Proposed Rule, April 27, 2016 (CMS-1655-P) CMS-1655-P, Medicare Program: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; and Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Proposed Rule, April 27, 2016 Public Law 114-74 CMS-1670-P, Medicare Program: Part B Drug Payment Model, Proposed Rule (Vol. 81, No. 48, March 11, 2016) CMS 10599; Home health prior authorization
Client expense: $285,512 · 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, Social Security Administration (SSA)
2016 · second_quarter · Health Issues
S.2511 Improving Health Information Technology Act H.R. 6 21st Century Cures Act H.R 5447/S. 3060 Small Business Health Care Relief Act of 2016 S. 2744 Genetic Research Privacy Protection Act H.R. 5273 Helping Hospitals Improve Patient Care Act S. 2713 Advancing Precision Medicine Act S. 1878 The Advancing Hope Act S. 1767 Combination Products Innovation Act S. 1077 Advancing Breakthrough Medical Devices for Patients Act S. 2512 Adding Zika Virus to the FDA Priority Review voucher Program Act S. 1101 Medical Electronic Data Technology Enhancement for Consumers Health Act S. 1597 Patient Focused Impact Assessment Act S. 2055 Medical Countermeasures Innovation Act S. 2873 Expanding Capacity for Health Outcomes (ECHO) Act H.R. 3081/ S. 1778 TELEmedicine for MEDicare (TELE-MED) Act H.R. 4442/S. 2484 CONNECT for Health Act H.R. 1192 National Diabetes Clinical Care Commission Act S. 620, H.R. 1189 Preserving Employee Wellness Programs Act H.R. 4878 Better Care, Lower Cost Act H.R. 5273 Helping Hospitals Improve Patient Care Act H.R. 4774 Training Tomorrows Doctors Today Act S. 2671, H.R.4732 Advancing Medical Resident Training in Community Hospitals Act S. 314, H.R. 592 Pharmacy and Medically and Underserved Areas Enhancement Act H.R.1314 Bipartisan Budget Act H.R. 1190/S. 141 Protecting Seniors' Access to Medicare Act H.R. 160/S. 149 Protect Medical Innovation Act H.R. 4732/ S. 2671 Advancing Medical Resident Training in Community Hospitals Act H.R. 2061, Equitable Access to Care and Health (EACH) Act H.R. 2446 To amend title XIX of the Social Security Act to require the use of electronic visit verification for personal care services furnished under the Medicaid program, and for other purposes. H.R. 2603/S. 1475 Saving Lives, Saving Costs Act H.R. 2646 Helping Families in Mental Health Crisis Act H.R. 2704/H.R. 4212/S.704 Community Based Independence for Seniors Act H.R. 2878/S. 1461 To provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2015. H.R.2911/S. 1697 Small Business Healthcare Relief Act H.R. 3539 Reinvigorating Antibiotic and Diagnostic Innovation (READI) Act H.R. 3660 Preventive Health Savings Act H.R. 3716 Ensuring Terminated Providers are Removed from Medicaid and CHIP Act H.R. 3762 Restoring Americans Healthcare Freedom Reconciliation Act H.R. 3821 Medicaid Directory of Caregivers Act H.R. 5380 Telehealth Parity Act S. 139 Ensuring Access to Clinical Trials Act S. 2023 Prescription Drug Affordability Act S. 2030 Advancing Targeted Therapies for Rare Diseases Act S. 2045 Middle Class Health Benefits Tax Repeal Act S. 2075 American Worker Health Care Tax Relief Act S. 2153 Provider Payment Sunshine Act S. 2187 FDA Regulatory Efficiency Act S. 754 Cyber security Information Sharing Act (CISA) S.2104 Preserving Medicare Advantage for all Medicare Beneficiaries Act
Client expense: $160,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2016 · second_quarter · Medicare/Medicaid
Medigap; CHIP Reform; Medicare Access & CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; ICD-10; Site-Neutral Payments; Medicare Fraud; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; Medical Billing; Transparency Tools; QHP Quality Rating System (QRS) HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend Title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes.
Client expense: $8,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Medicare/Medicaid
Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Medicare/Medicaid
Medigap; Medicare Advantage; CHIP Reform; Medicare Access & CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; ICD-10; Site-neutral Payments; Medicare Fraud; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; Medical Billing; Transparency Tools; QHP Quality Rating System (QRS) HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Taberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.
Client expense: $2,180,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2016 · second_quarter · Medicare/Medicaid
Medicare/Medicaid Issues; Medicare Advantage; Chronic Care Reform; Exchanges; Site-neutral Payments; Quality Improvement Strategy for QHPs; network adequacy standards. HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. The Bill extends the annual period in which an individual enrolled in MA may elect to instead recieve benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified perscription drug coverage. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to estblish payment parity under the Medicare program for ambulatory cancer services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certin information with respect to provider termination, and for other purposes.
Client expense: $30,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Medicare/Medicaid
Medigap; Medicare Advantage; CHIP Reform; Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; ICD-10; Site-Neutral Payments; Medicare Fraud; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; Medical Billing; Transparency Tools; QHP Quality Rating System (QRS) HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21,2015 by Keith Rothfus (R-PA) this bill amends title XVII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer treatment Act of 2015 to amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) to amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-Tx) To amend title XIX of the Social Security Act to provide the same levele of Federal Matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 1, 2016 by Patrick Taberi (R-OH) to amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data and for other purposes.
Client expense: $30,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Health Issues
H.R. 546/S. 298, the ACE Kids Act of 2015, all provisions. H.R. 3716, Ensuring Access to Quality Medicaid Providers Act, all provisions. General issues related to infant mortality and public health.
Client expense: Not reported · Firm income: $50,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Medicare/Medicaid
Medicare and Medicaid issues, Medigap issues, Medicare Advantage, CHIP reform, chronic care reform HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (weather or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Taberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.
Client expense: $52,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Medicare/Medicaid
Medicare and Medicaid issues, Medigap issues, Medicare Advantage, CHIP reform, chronic care reform HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (weather or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Taberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.
Client expense: $290,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2016 · second_quarter · Health Issues
H.R. 546/S. 298, the ACE Kids Act of 2015, all provisions. H.R. 3716, Ensuring Access to Quality Medicaid Providers Act, all provisions. General issues related to infant mortality and public health.
Client expense: $80,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Health Issues
S.3040, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY2017, provisions relating to NIH and drug abuse and treatment H.R.6, 21st Century Cures Act, Medical research issues. Drug abuse research and treatment related issues: S. 2030, The Advancing Targeted Therapies for Rare Diseases Act of 2015 S. 1622, The FDA Device Accountability Act of 2015 S. 2014, Next Generation Researchers Act S. 800, The Enhancing the Stature and Visibility of Medical Rehabilitation Research at NIH Act S. 849, Advancing Research for Neurological Diseases Act of 2015 S. 2503, Preventing Superbugs and Protecting Patients Act S. 2511, Improving Health Information Technology S. 1878, The Advancing Hope Act of 2015 S. 1077, The Advancing Breakthrough Medical Devices for Patients Act of 2015 S. 1101, The Medical Electronic Data Technology Enhancement for Consumers Health Act S. 2055, The Medical Countermeasures Innovation Act of 2015 S. 1767, The Combination Products Innovation Act of 2015 S. 1597, Patient Focused Impact Assessment Act of 2015 S. 2512, Adding Zika Virus to the FDA Priority Review Voucher Program Act S. 2700, FDA and NIH Workforce Authorities Modernization Act S. 185, Promise for Antibiotics and Therapeutics for Health Act S. 2713, Advancing Precision Medicine Act of 2016 S. 2745, Advancing NIH Strategic Planning and Representation in Medical Research Act S. 2742, Promoting Biomedical Research and Public Health for Patients Act Opioid abuse legislation. H.R.2872, Opioid Addiction Treatment Modernization Act H.R.3537, Synthetic Drug Control Act of 2015 H.R.2536/S.1455, Recovery Enhancement for Addiction Treatment Act TREAT Act H.R.2805, Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015 H.R.3014, Medical Controlled Substances Transportation Act of 2015 H.R.3716, Ensuring Terminated Providers are Removed from Medicaid and CHIP Act H.R.3821, Medicaid DOC Act H.R.2646, Helping Families in Mental Health Crisis Act of 2015 S.524, Comprehensive Addiction and Recovery Act of 2016 H.R.4396, Heroin and Prescription Drug Abuse Prevention and Reduction Act S.2256, Co-Prescribing Saves Lives Act of 2015 S.480, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 S.2680, Mental Health Reform Act of 2016 S.2687, Plan of Safe Care Improvement Act S.2423/H.R.4447, Opioid and Heroin Epidemic Emergency Supplemental Appropriations Act S.1455/H.R.2536, Recovery Enhancement for Addiction Treatment Act (TREAT Act) H.R.5046, Comprehensive Opioid Abuse Reduction Act of 2016 H.R.3680, Co-Prescribing to Reduce Overdoses Act of 2016 H.R.4981, Opioid Use Disorder Treatment Expansion and Modernization Act H.R.3691, Improving Treatment for Pregnant and Postpartum Women Act of 2016 H.R.4586, Lali's Law H.R.4976, Opioid Review Modernization Act of 2016 H.R.4599, Reducing Unused Medications Act of 2016 H.R.4969, John Thomas Decker Act of 2016 H.R.4641, To provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes. H.R.4978, NAS Healthy Babies Act H.R.3691, Improving Treatment for Pregnant and Postpartum Women Act of 2016 H.R.4229/S.36, Protecting Our Youth from Dangerous Synthetic Drugs Act of 2015
Client expense: Not reported · Firm income: $20,000
Government targets: HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), SENATE
2016 · second_quarter · Medicare/Medicaid
Actuarial soundness; Appropriate payment, including risk adjustment, for D-SNPs and MMPs; Appropriate quality measurement for D-SNPs and MMPs; Changes to Medicare/Medicaid programs as part of entitlement reform and deficit reduction efforts; Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles; Fraud, waste, and abuse issues for Medicare and Medicaid; H.R. 2646, Helping Families in Mental Health Crisis Act of 2015; H.R. 546 and S. 298, The Advancing Care for Exceptional (ACE) Kids Act of 2015; H.R. 700, Stabilize Medicaid and CHIP Coverage Act; High cost specialty medications; Impact of significant budget cuts in Medicaid; Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs; Medicaid and Medicare reform discussions with MACPAC and MedPAC; Medicaid eligibility and enrollment issues; Medicaid health plans serving as qualified health plans in the Exchange; Medicaid managed care regulations; Medicaid quality measurement and improvement; Mental Health Issues and Legislation; Mental Health Parity; Network adequacy; Risk adjustment; S. 2438, Medicaid and CHIP Quality Improvement Act; S. 428, Stabilize Medicaid and CHIP Coverage Act; SNP reauthorization; SNP sustainability and improvements to MMPs; H.R. 4588, Incentivizing Medicaid Expansion Act of 2016; Amendment to S. Con. Res. 11 Regarding Continuous Eligibility in Medicaid; Capped Medicaid Funding Proposals; H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated; H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016
Client expense: $30,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)
2016 · first_quarter · Medicare/Medicaid
Medigap; CHIP Reform; Chronic Care Reform; Exchanges; ICD-10; Nondiscrimination Delivery System Reform; Enrollee Experience Survey-Technical Expert Panel; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; Transparency Tools; All Payer Claims Databases HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend Title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes.
Client expense: Not reported · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2016 · first_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
2016 · first_quarter · Health Issues
H.R. 3762 Restoring Americans Healthcare Freedom Reconciliation Act, H.R. 4262 Transparency and Accountability of Failed Exchanges Act, H.R. 4725 Common Sense Savings Act, H.R. 4723 Protecting Taxpayers by Recovering Improper Obamacare Subsidy Overpayments Act, H.R. 3716 Ensuring Removal of Terminated Providers from Medicaid and CHIP Act
Client expense: $80,000 · Firm income: Not reported
Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of
2016 · first_quarter · Medicare/Medicaid
H.R. 4725 Common Sense Savings Act, H.R. 3716 Ensuring Removal of Terminated Providers from Medicaid and CHIP Act
Client expense: $80,000 · Firm income: Not reported
Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of
2016 · first_quarter · Medicare/Medicaid
California Medicare Geographic Payment Locality Update Implementation (PL 113-93) Medicare Access and Childrens Health Insurance Reauthorization Act Implementation (MACRA) Medicare Part B Physician In-Office Drug Costs Palliative Care Medical Home Medicare Pilot Project Medicare Recovery Audit Contractors (H.R. 3081) Ensuring Removal of Terminated Providers from Medicaid & CHIP (H.R. 3716) California Medicare Geographic Payment Locality Implementation MACRA Implementation HIT Meaningful Use Program Palliative Care Medical Home Medicare Pilot Program High Cost of Prescription Drugs - Requiring Pharma to Negotiate Drug Prices for Medicare Part D
Client expense: $80,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, HOUSE OF REPRESENTATIVES, SENATE, White House Office
2016 · first_quarter · Medicare/Medicaid
H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, , enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Client expense: $2,210,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
2016 · first_quarter · Health Issues
H.R. 4428 - To amend title XVIII of the Social Security Act to ensure fairness in Medicare hospital payments by establishing a floor for the area wage index applied with respect to certain hospitals. H.R. 3716 - Ensuring Terminated Providers are Removed from Medicaid and CHIP Act S.2467 - The Patient Safety Improvement Act H.R. 4725 - The Common Sense Savings Act H.R. 2156 - Medicare Audit Improvement Act H.R. 1342 / S.688 - Establishing Beneficiary Equity in the Hospital Readmission Program Act
Client expense: $313,500 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2016 · first_quarter · Health Issues
H.R. 546/S. 298, the ACE Kids Act of 2015, all provisions. H.R. 3716, Ensuring Access to Quality Medicaid Providers Act, all provisions. General issues related to infant mortality and public health.
Client expense: Not reported · Firm income: $50,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · first_quarter · Medicare/Medicaid
Medigap; Medicare Advantage; CHIP Reform; Medicare Access & CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; ICD-10; Site-neutral Payments; Medicare Fraud; Nondiscrimination Delivery System Reform; Provider Lookup Tool; Enrollee Experience Survey-Technical Expert Panel; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; Medical Billing; Transparency Tools; All Payer Claims Databases HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. S. 2425 Patient Access and Medicare Protection Act Introduced December 18, 2015 by Robert Portman (R-OH) A bill to amend titles XVIII and XIX of the Social Security Act to improve payments for complex rehabilitation technology and certain radiation therapy services, to ensure flexibility in applying the hardship exception for meaningful use for the 2015 EHR reporting period for 2017 payment adjustments, and for other purposes
Client expense: $1,940,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2016 · first_quarter · Insurance
Legislation and regulations affecting health plans. S.1549, Care Planning Act of 2015; issues related to palliative care. H.R.3716, Ensuring Access to Quality Medicaid Providers Act.
Client expense: Not reported · Firm income: $50,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · first_quarter · Health Issues
Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY2017, provisions relating to NIH and drug abuse and treatment H.R.6, 21st Century Cures Act, Medical research issues. Drug abuse research and treatment related issues: S. 2030, The Advancing Targeted Therapies for Rare Diseases Act of 2015 S. 1622, The FDA Device Accountability Act of 2015 S. 2014, Next Generation Researchers Act S. 800, The Enhancing the Stature and Visibility of Medical Rehabilitation Research at NIH Act S. 849, Advancing Research for Neurological Diseases Act of 2015 S. 2503, Preventing Superbugs and Protecting Patients Act S. 2511, Improving Health Information Technology S. 1878, The Advancing Hope Act of 2015 S. 1077, The Advancing Breakthrough Medical Devices for Patients Act of 2015 S. 1101, The Medical Electronic Data Technology Enhancement for Consumers Health Act S. 2055, The Medical Countermeasures Innovation Act of 2015 S. 1767, The Combination Products Innovation Act of 2015 S. 1597, Patient Focused Impact Assessment Act of 2015 S. 2512, Adding Zika Virus to the FDA Priority Review Voucher Program Act S. 2700, FDA and NIH Workforce Authorities Modernization Act S. 185, Promise for Antibiotics and Therapeutics for Health Act S. 2713, Advancing Precision Medicine Act of 2016 S. 2745, Advancing NIH Strategic Planning and Representation in Medical Research Act S. 2742, Promoting Biomedical Research and Public Health for Patients Act Opioid abuse legislation. H.R.2872, Opioid Addiction Treatment Modernization Act H.R.3537, Synthetic Drug Control Act of 2015 H.R.2536/S.1455, Recovery Enhancement for Addiction Treatment Act TREAT Act H.R.2805, Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015 H.R.3014, Medical Controlled Substances Transportation Act of 2015 H.R.3716, Ensuring Terminated Providers are Removed from Medicaid and CHIP Act H.R.3821, Medicaid DOC Act H.R.2646, Helping Families in Mental Health Crisis Act of 2015 S.524, Comprehensive Addiction and Recovery Act of 2016 H.R.4396, Heroin and Prescription Drug Abuse Prevention and Reduction Act S.2256, Co-Prescribing Saves Lives Act of 2015 S.480, National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 S.2680, Mental Health Reform Act of 2016 S.2687, Plan of Safe Care Improvement Act S.2423/H.R.4447, Opioid and Heroin Epidemic Emergency Supplemental Appropriations Act
Client expense: Not reported · Firm income: $10,000
Government targets: HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), SENATE
2016 · first_quarter · Health Issues
H.R. 546/S. 298, the ACE Kids Act of 2015, all provisions. H.R. 3716, Ensuring Access to Quality Medicaid Providers Act, all provisions. General issues related to infant mortality and public health.
Client expense: $110,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · first_quarter · Health Issues
.R. 1020 STEM Education Act H.R. 1190/S. 141 Protecting Seniors' Access to Medicare Act H.R. 1314 Bipartisan Budget Act H.R. 160/S. 149 Protect Medical Innovation Act H.R. 1624/S. 1099, Protecting Affordable Coverage for Employees Act (PACE Act) H.R. 2061, Equitable Access to Care and Health (EACH) Act H.R. 2446 To amend title XIX of the Social Security Act to require the use of electronic visit verification for personal care services furnished under the Medicaid program, and for other purposes. H.R. 2603/S. 1475 Saving Lives, Saving Costs Act H.R. 2646 Helping Families in Mental Health Crisis Act H.R. 4212/S.704 Community Based Independence for Seniors Act H.R. 2745/S. 2102 Standard Mergers & Acquisitions Review Through Equal Rules (SMARTER) Act H.R. 2878/S. 1461 To provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2015. H.R. 2911/S. 1697 Small Business Healthcare Relief Act H.R. 292/S. 2260 Long-Term Studies of Comprehensive Outcomes and Returns for the Economy Act (Long-Term SCORE Act) H.R. 3081/S. 1778 TELEmedicine for MEDicare (TELE-MED) Act H.R. 3539 Reinvigorating Antibiotic and Diagnostic Innovation (READI) Act H.R. 3660 Preventive Health Savings Act H.R. 3716 Ensuring Terminated Providers are Removed from Medicaid and CHIP Act H.R. 3762 Restoring Americans Healthcare Freedom Reconciliation Act H.R. 4469/S.2499 Health Savings Act of 2016 H.R. 4723 Protecting Taxpayers by Recovering Improper Obamacare Subsidy Overpayments Act H.R. 4725 Common Sense Savings Act H.R. 4732/S.2671 Advancing Medical Resident Training in Community Hospitals Act H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 4774 Training Tomorrows Doctors Today Act H.R. 4801 Medical Loss Ratio Accountability Act of 2016 H.R. 4832 Health Savings Protection Act H.R. 4848 Healthy Inpatient Procedures (HIP) Act H.R. 4878 Better Care, Lower Cost Act H.R. 5380 Telehealth Parity Act H.R. 6 21st Century Cures Act H.R.4442/S.2484 CONNECT for Health Act S. 1077 Advancing Breakthrough Medical Devices for Patients Act S. 1101 Medical Electronic Data Technology Enhancement for Consumers Health (MEDTECH) Act S. 139 Ensuring Access to Clinical Trials Act S. 1622 FDA Device Accountability Act S. 1945 Mental Health Reform Act of 2016 S. 2023 Prescription Drug Affordability Act S. 2030 Advancing Targeted Therapies for Rare Diseases Act S. 2045 Middle Class Health Benefits Tax Repeal Act S. 2075 American Worker Health Care Tax Relief Act S. 2153 Provider Payment Sunshine Act S. 2187 FDA Regulatory Efficiency Act S. 2343 Telehealth Innovation and Improvement Act S. 2511 Improving Health Information Technology Act S. 2680 Mental Health Reform Act of 2016 S. 2698 Preserving Consumer Health Accounts Act of 2016 S. 2713 Advancing Precision Medicine Act S. 754 Cybersecurity Information Sharing Act (CISA) S. 1101, the Medical Electronic Data Technology Enhancement for Consumers Health (MEDTECH) Act S. 1077, the Advancing Breakthrough Medical Devices for Patients Act. S. 1622, the FDA Device Accountability Act S. 2511, the Improving Health Information Technology Act S. 2680, the Mental Health Reform Act of 2016 S. 2713, the Advancing Precision Medicine Act
Client expense: $160,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2016 · first_quarter · Medicare/Medicaid
H.R. 1190Protecting Seniors' Access to Medicare Act S. 141 Protecting Seniors' Access to Medicare Act H.R. 2446 To amend title XIX of the Social Security Act to require the use of electronic visit verification for personal care services furnished under the Medicaid program, and for other purposes. H.R. 3716 Ensuring Terminated Providers are Removed from Medicaid and CHIP Act H.R. 4212 Community Based Independence for Seniors Act S.704 Community Based Independence for Seniors Act H.R. 3081 TELEmedicine for MEDicare (TELE-MED) Act S. 1778 TELEmedicine for MEDicare (TELE-MED) Act H.R. 4878 Better Care, Lower Cost Act H.R.4442CONNECT for Health Act S.2484 CONNECT for Health Act
Client expense: $160,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2016 · first_quarter · Insurance
Vote YES on H.R. 4262 Vote NO on H.R. 244 Oppose Adding H.R. 244 to H.R. 3716
Client expense: $40,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2015 · fourth_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 2151 - Improving Oversight and Accountability in Medicaid Non-DSH Supplemental Payments Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821 - Medicaid Directory of Caregivers (Medicaid DOC) Act S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
2015 · fourth_quarter · Health Issues
H.R.3020/S.1695, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations, FY2016, provisions relating to NIH and drug abuse and treatment H.R.6, 21st Century Cures Act, Medical research issues. Opioid abuse legislation. H.R.2872, Opioid Addiction Treatment Modernization Act, generally H.R.3537, Synthetic Drug Control Act of 2015, generally H.R.2536, Recovery Enhancement for Addiction Treatment Act TREAT Act, generally H.R.2805, Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015, generally H.R.3014, Medical Controlled Substances Transportation Act of 2015, generally H.R.3716, Ensuring Terminated Providers are Removed from Medicaid and CHIP Act, generally H.R.3821, Medicaid DOC Act, generally H.R.2646, Helping Families in Mental Health Crisis Act of 2015, generally
Client expense: Not reported · Firm income: $20,000
Government targets: HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), SENATE