Medicare Advantage Quality Payment Relief Act of 2015

Medicare Advantage Policy and Reimbursement Part D Policy and Reimbursement Medicaid and Dual Eligible Issues Pharmacy Reimbursement Issues Medicare Access and CHIP Reauthorization Act (MACRA) Implementation Chronic Care Working Group Issues H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act H.R. 2507, Increasing Regulatory Fairness Act H.R. 2582, Seniors' Health Care Plan Protection Act H.R. 3831, Securing Fairness in Regulatory Timing Act H.R. 4275, Medicare Advantage Quality Payment Relief Act S. 1913, Stopping Medication Abuse and Protecting Seniors Act S. 524/H.R. 953, Comprehensive Addiction and Recovery Act Opioid and Drug Abuse Issues H.R. 5659, ESRD Choice Act

Client expense: $670,000 · Firm income: Not reported

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

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

Affordable Care Act Issues - ACA Regulations, Postal Reform; Department of Labor Conflict of Interest Rule; HCR Implementation; Health Savings Accounts (HSA's); Re-insurance; Co-ops; Notice of Benefit and Payment Parameters (NBPP); Health Care Bill; Market Stability; Year end priorities; Cost Sharing Reduction (CSR); "Better Way"; Repeal/Replace Modeling: ACA reform; Risk Corridors; Chronic Care; Comprehensive Care; Comprehensive Care and Recovery Act (CARA); Mental Health Reform; Premium Education; Third Party Payment of Premiums; Association Health Plans; SEPs; Grace Periods; Age Bands. HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) this bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. 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 3463 Aligning Children's Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) to amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes as introduced. HR 3742 Access to Marketplace Insurance Act Introduced October 9, 2015 by Kevin Cramer (R-ND) to amend the Patient Protection and Affordable Care Act to allow for certain third party payments. HR 4275 Medicare Advantage Quality Payment Relief Act of 2015 Introduced December 16, 2015 by Mike Kelly (R-PA) to amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. HR 5410 Health Coverage State Flexibility Act of 2016 Introduced June 8, 2016 by Bill Flores (R-TX) to amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State Law. HR 5447 Small Business Health Care Relief Act of 2016 introduced June 21, 2016 by Charles Boustany, Jr. (R-LA) to provide an exception from certain group health plan requirements for qualified small employer health reimbursement arrangements. HR 5506 Introduced June 15, 2016 by Todd Young (R-IN) to amend title XVIII of the Social Security Act to establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and for other purposes. HR 5547 Health Care Price Transparency Promotion Act of 2016 Introduced by Michael Burgess (R-IN) to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. HR 5589 Plan Verification and Fairness Act of 2016 Introduced June 28, 2016 by Marsha Blackburn (R-TN) to amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. HR 5904 Tax Payers Before Insurers Act Introduced July 14, 2016 by Mark Walker (R-NC) to require the Secretary of Health and Human Services to deposit certain funds into the general fund of the Treasury in accordance with provisions of Federal law with regard to the Patient Protection and Affordable Care Act's Transitional Reinsurance Program. HR 5921 State Age Rating Flexibility Act Introduced July 21, 2016 by Larry Bucshon (R-IN) to amend title XXVII of the Public Health Service act to change the permissible age variation in health insurance rates. S. 524 Comprehensive Addiction and Recovery Act of 2016 Introduced February 12, 2015 by Sheldon Whitehouse (D-RI) overdoses from heroin prescription drugs and opioid pain relievers last year surpassed car accidents as the leading cause of injury-related death in America, according to the Center for Disease Control. Deaths have reached their highest levels of the 21st Century in 2014, the most recent year for which data is available, according to the National Institute on Drug Abuse. Heroin overdoses have more than tripled in the last five years, an issue receiving outsize attention nationally but especially during the presidential campaign season as New Hampshire has been one of the hardest-hit states. S. 1697 Small Business Healthcare Relief Act Introduced June 25, 2015 by Charles Grassley (R-IA) a bill to provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market and for other purposes. S. 1945 Introduced August 5, 2015 by Bill Cassidy (R-LA) A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Affordable Care Act (ACA) Issues; ACA Regulations; HCR Implementation; Re-insurance; Co-ops; Market Stability; Cost-sharing Reduction (CSR); Better Way; ACA Reform; Risk Corridors; Chronic Care; Mental Health Reform; Premium Education; Third Party Payment of Premiums; SEPs; Grace Periods; Age Bands, Individual Mandate. HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) This bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. 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 3463 Aligning Childrens Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) To amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes as introduced. HR 3742 Access to Marketplace Insurance Act Introduced October 9, 2015 by Kevin Cramer (R-ND) To amend the Patient Protection and Affordable Care Act to allow for certain third party payments. HR 4275 Medicare Advantage Quality Payment Relief Act of 2015 Introduced December 16, 2015 by Mike Kelly (R-PA) To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. HR 5410 Health Coverage State Flexibility Act of 2016 Introduced June 8, 2016 by Bill Flores (R-TX) to amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. HR 5447 Small Business Health Care Relief Act of 2016 Introduced June 21, 2016 by Charles Boustany, Jr. (R-LA) To provide an exception from certain group health plan requirements for qualified small employer health reimbursement arrangements. HR 5589 Plan Verification and Fairness Act of 2016 Introduced June 28, 2016 by Marsha Blackburn (R-TN) To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. HR 5904 Tax Payers Before Insurers Act Introduced July 14, 2016 by Mark Walker (R-NC) To require the Secretary of Health and Human Services to deposit certain funds into the general fund of the Treasury in accordance with provisions of Federal law with regard to the Patient Protection and Affordable Care Act's Transitional Reinsurance Program

Client expense: $270,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Department of Health & Human Services: Medicare Advantage: operational issues, annual payment updates and policy changes. HR 2505 - Medicare Advantage Coverage Transparency Act of 2015: To amend title XVIII of the Social Security Act to require the annual reporting of data on enrollment in Medicare Advantage plans. Kelly (R-PA) HR 2507 - Increasing Regulatory Fairness Act of 2015: To amend title XVIII of the Social Security Act to establish an annual rulemaking schedule for payment rates under Medicare Advantage. Brady (R-TX) HR 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015: To amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the co-payments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures, and for other purposes. Black (R-TN) HR 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015: To amend title XVIII of the Social Security Act to establish a 3-year demonstration program to test the use of value-based insurance design methodologies under eligible Medicare Advantage plans, to preserve Medicare beneficiary choice under Medicare Advantage, to revise the treatment under the Medicare program of infusion drugs furnished through durable medical equipment, and for other purposes. Brady (R-TX) HR 2582 - Seniors' Health Care Plan Protection Act of 2015: To amend title XVIII of the Social Security Act to delay the authority to terminate Medicare Advantage contracts for MA plans failing to achieve minimum quality ratings, to make improvements to the Medicare Adjustment risk adjustment system, and for other purposes. Buchanan (R-FL) HR 4275 - Medicare Advantage Quality Payment Relief Act of 2015: To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. Kelly (R-PA) HR 5659 - ESRD Choice Act of 2016: To amend title XVIII of the Social Security Act with respect to expanding Medicare Advantage coverage for individuals with end-stage renal disease (ESRD). Smith (R-MO) S 2425 - Patient Access and Medicare Protection Act: 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. Portman (R-OH) S 2484 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act: To amend titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program through the use of Telehealth and remote patient monitoring services, and for other purposes. Schatz (D-HI)

Client expense: $1,450,000 · Firm income: Not reported

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

HR 4275: Discussions regarding the Medicare Advantage Benchmark Cap.

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

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

Medicare Advantage Policy and Reimbursement. Part D Policy and Reimbursement. Medicaid and Dual Eligible issues. Pharmacy Reimbursement Issues. MACRA Implementation. H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act. H.R. 2507, Increasing Regulatory Fairness Act. H.R. 2582, Seniors' Health Care Plan Protection Act. H.R. 3831, Securing Fairness and Regulatory Timing. H.R. 4275, Medicare Advantage Quality Payment Relief Act. S. 1913, Stopping Medication Abuse and Protecting Seniors ACt. S. 524 and H.R. 953, Comprehensive Addiction and Recovery Act. Opioid and Drug Abuse Issues. H.R. 5659, ESRD Choice Act. H.R. 6, 21st Century Cures Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Removal of quality incentive payments from the Medicare Advantage Benchmark Cap. H.R. 4275, the Medicare Advantage Quality Payment Relief Act of 2015 Drug costs Provisions related to the repeal and replacement of the Affordable Care Act

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

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

Regulatory and legislative matters related to the implementation of the Affordable Care Act and Medicare Advantage (MA). Removal of quality incentive payments from the MA benchmark cap. H.R. 4275, the Medicare Advantage Quality Payment Relief Act of 2015

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

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

Advocacy with House and Senate offices on behalf of and related to proposals to improve chronic care in Medicare and elsewhere in the health care system, including the efforts of the Senate Finance Committee's Chronic Care Working Group. Advocacy with House and Senate offices on behalf of the Community based Independence for Seniors Act (S. 4212/HR 2704). Advocacy with House and Senate offices on behalf of HR 4275, the Medicare Advantage Quality Payment Relief Act. Advocacy regarding possible improvements to HR 3298, the Medicare Post-Acute Care Value-Based Purchasing Act. Advocacy on behalf of S 843/HR 1571 the Improving Access to Medicare Act of 2015. Advocacy with House and Senate offices regarding the importance of moving forward with reauthorization of the Children's Health Insurance Program. Discussion with House and Senate Committee staff regarding potential opportunities for bipartisan legislation in Medicare and Medicaid for the remainder of this Congress and during the next Congress.

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

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

Many aspects of the Affordable Care Act promote changes that are consistent with the mission of the Marshfield Clinic: Extends health insurance to the uninsured Calls for Value Based Purchasing for all providers Calls for the establishment of Accountable Care Organizations The following are key elements of the health policy agenda of the Marshfield Clinic Health System: Medicare Access and CHIP Reauthorization Act With passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress has put to rest the constant threat of massive cuts to Medicare physician fees. Going forward Medicare physician payments will transition to an incentive-based system based on value and accountability. Starting in 2019, Medicare physician payment will be based on the Merit-Based Incentive Payment System (MIPS). Physicians who perform well on quality, value and IT metrics will be rewarded with higher pay rates and those who perform poorly will face penalties. Participants in Alternative Payment Systems (APMs) such as accountable care organizations that assume financial risk will receive 5% bonuses between 2019 and 2024. Because the language of the statute is not specific, the Centers for Medicare and Medicaid Services (CMS) is developing metrics that will be used to determine the bonus payments and penalties that will start in 2019 in a public rulemaking currently underway. The proposed metrics simplify and consolidate the existing measurements employed under the Meaningful Use Incentive Program, the Physician Reporting System (PQRS), and the Value-Based Modifier (VBM) to streamline the reporting burden for physician practices. MIPS will then pay physicians based on four weighted performance categories: Quality (50% of total score in year 1), Advancing Care Information (25% of total score in year 1); Clinical Practice Improvement Activities (15% of total score in year 1): Resource Use (10% of total score in year 1, but growing to 30% in subsequent years). Having a source of credible data as the foundation of CMS metrics is critical both to fair payment and maintaining access to medical services in rural areas. CMS will be refining the metrics perpetually throughout the lifespan of this program. Challenges to fair reimbursement persist under the current Medicare fee schedule, which remains the foundation of the reimbursement system, particularly in regard to the valuation of primary care and the geographic adjustment of physician wages. These challenges must be addressed. Adequate funding for CMS to implement and maintain this new system is critical to patient care, provider education and acceptance of the new program and its long term success. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs and full implementation of the Affordable Care Act and MACRA. MCHS also supported MACRA provisions that extended funding for the Childrens Health Insurance Program and provided $7.2 billion to community health centers over the next 2 years, postponed cuts in payments to hospitals that treat large numbers of low-income patients; and extended provisions that funded geographic adjustment of the physician work, therapy services and payments for rural hospitals. Accountable Care Organizations Marshfield Clinic has benefitted substantially from its 9 + years of experience with CMS in the development and implementation of the Physician Group Practice Demonstration, and the Medicare Shared Savings Program. The mission of the Clinic and the objectives of the PGP and MSSP programs are closely paralleled in that it is our mission and objective to make compassionate care more affordable, improve outcomes and enrich the care experience of our patients. It is in our organizational self-interest that these programs succeed, so we have committed substantial resources and energy to the understanding and improvement of the programs. By both objective and subjective criteria Marshfield Clinic has performed successfully. In a recent letter to CMS we focused on the CMS program objective of encouraging ACOs to transition into full risk arrangements. In the proposed regulations codifying the terms and definitions of the Medicare and CHIP Reauthorization Act of 2015, (MACRA) we find that we must become a risk-bearing MSSP ACO before 2017 to become a qualified Alternative Payment Model (APM). This is a primary strategic objective for MCHS. As Dr. Patrick Conway testified before the Energy and Commerce Health subcommittee on March 17th We (CMS) want to help (organizations) make the transition to become APMs. We believe that it is in our own and our patients best interests that we take whatever steps are necessary to move into risk-bearing arrangements, and we have requested support from CMS to make this necessary transition. Graduate Medical Education - MCHS is concerned about having a sufficient supply of primary care physicians to meet the demands of an expanding and aging population. This is doubly true for patients and health systems in rural settings. Currently only about 10% of physicians practice in rural areas while 25% of the population resides there. While 36% allopathic residents and 50% osteopathic residents who are trained in a rural residency end up practicing in a rural area, only 4% of the residency training actually occurs in rural areas. Currently there are more US medical students graduating from medical school than there are GME slots. An increase in GME primary care training positions is essential to maintaining high-quality, accessible, and cost efficient care. Teaching hospitals in rural locations provide an environment for residents to learn and faculty to serve as educators, providers and researchers. These roles advance the broad mission of preparing each generation of physicians, provide critical patient care and specialized services, often to the disadvantaged, facilitate the discovery of new therapies and treatments, and enable residents to acclimate to the rural setting. As new payment and delivery models emphasize primary care to improve patient outcomes and reduce costs, and as more care shifts to outpatient settings, teaching faculty and residency programs must increase access to ambulatory residency rotations to serve Americans who live in areas with an under-supply of primary care physicians including Psychiatry. The purpose and value of residency training in clinical settings and the financial support needed to sustain physician education will only increase as the U.S. population lives longer with more complex health conditions. To ensure GME can meet the future needs of the newly insured and aging population, Congress must commit to the consistent GME funding and lift Medicares limit on funded residency positions. We support the Teaching Health Center funding in MACRA for Community Health Centers but request you extend funding beyond 2017. The Medicare Advantage Benchmark Cap - ACA SEC. 3201. (b) (4) The Medicare Advantage program provides a full risk, capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. The Medicare Advantage Benchmark Cap - ACA SEC. 3201. (b) (4) By authorizing Quality Incentive Payments for MA plans with star ratings of 4 stars and above, Congress made a significant policy change towards value-based purchasing in the MA program. If a plan is eligible for a Quality Incentive Payment, it receives it in the form of a 5 percent increase to its benchmark. However, Congress also authorized a new methodology for calculating benchmarks, and mandated that benchmarks under the new methodology cannot be greater than what they would have been under the old benchmark methodology. This is the benchmark cap. The benchmark cap reduces or even eliminates Quality Incentive Payments. The policy issue is that the cap weakens the incentive for plans to attain higher star ratings and undermines the shift towards paying for performance in the MA program. We do not think that Congress intended to take away with one provision (the cap) the significant policy change towards paying for value that it enacted in the ACA. This change will have a significant negative impact on Medicare Advantage beneficiaries. Medicare Advantage benchmark cap legislation was introduced in December. MCHS supports H.R. 4275, the Medicare Advantage Quality Payment Relief Act of 2015, introduced by Reps. Mike Kelly (R-PA), Ron Kind (D-WI), Brett Guthrie (R-KY) and Mike Doyle (D-PA) that would remove the quality incentive payments from the calculation of the benchmark cap. Geographic Adjustment of Physician Payments - Recent findings by the Institute of Medicine and the Medicare Payment Advisory Commission have demonstrated significant shortcomings in the data utilized to geographically adjust physician payments. The IOM and MedPAC studies have confirmed that the data sources currently relied upon for geographic adjustment bear no correlation to physician earnings. CMS officials have admitted that the proxies utilized for the purpose of geographic adjustment have never been validated, and there never has been a new data source utilized in the twenty years since the fee schedule was implemented. MedPAC data show that the geographic adjustment reference occupations predict earnings of rural physicians to be 25-30% less than physicians in metropolitan areas. MedPAC data show that earnings of primary care physicians in rural areas are, in fact, 13% higher than physicians in metropolitan areas. Since there is no statistical basis of support for disparities in payment we strongly recommend that Congress require CMS to correct this inequity immediately. Having a source of credible data and a sustainable payment mechanism is critical to maintaining access to primary care services in rural areas for patients who reside in those areas. Telemedicine in Medicare Changes to Medicare law and regulation are needed to improve equity in access for Medicare beneficiaries to services delivered via TeleHealth. Medicare beneficiaries should be allowed to receive services in telemedicine sites located in urban areas. The necessary changes would remove restrictions on originating sites by removing the rural requirement and the list of originating sites and allowing any certified Medicare facility to provide the services; current requirements that physician must bill for services from the originating site should be removed; restrictions on eligible practitioners should be removed to allow all Medicare approved practitioners to provide telemedicine services; and there should be no restrictions on which Medicare services may be provided through telemedicine. We recommend that the Medicare requirement for non-MSA geographic location of the patient be expanded to allow all Medicare certified organizations as originating sites regardless of rural or metropolitan statistical area designation. In addition, MCHS supports the CONNECT for Health Act (S. 2484) and (H.R. 4442) that contains a provision which would permit Medicare Advantage plans to use telehealth or remote patient monitoring technologies to provide basic Medicare benefits, without the restrictions that limit originating sites, geographic locations, store-and-forward technologies, and types of health care provider. We believe that telehealth is a different way of delivering an already covered service, and that Medicare should treat remote access technologies as an alternative modality or complementary means of providing clinical services, and not a service itself. In other words, telehealth should not be seen as simply a supplement or complement to face-to-face encounters. Patients increasingly expect their health plans to provide the access to services and convenience that remote technologies facilitate. These technologies can increase communication between providers and patients, enhance care coordination, and help physicians and patients work together to treat illness and maintaining health. Oral Health Coverage for the Medically Compromised and at Risk Populations There is sufficient data that demonstrates oral health impacts the systemic health of the patient and in doing can reduce the cost of care. Linkages that encourage patient compliance, patient education, provider education, and bi-directional referral and surveillance should be incented and compensated. Shared savings demonstrations should be developed for health systems and co-pay incentives developed for patients engaging in and complying with such inter-disciplinary care. Part B Drug Payment Model CMS proposed a new Medicare Part B Drug Payment Model in the Federal Register on March 11, 2016. This model proposes to test alternative payment methodologies for separately payable Part B drugs to determine whether alternative drug payment designs will lead to a reduction in Medicare expenditures while preserving or enhancing quality of care. MCHS supports CMS efforts to address the rising cost of Medicare Part B drugs, but has concerns about the proposed demonstration of a new Average Sales Price (ASP) payment methodology. Specifically we believe that CMS should utilize its rule making authority to de-link physician payment entirely from the drugs they prescribe for patients. MCHS believes that the major responsibility for unsustainable drug spending remains with pharmaceutical manufacturers. The rising costs of drugs and biologics is a system-wide concern. A major contributing factor to those costs is the price set by manufacturers. The fact that there are no regulations on pricing of new anticancer drugs is disturbing. Pharmaceutical companies have the freedom to price their drug liberally at whatever price they deem appropriate, on the basis of what they presume the market will bear. The fact that the largest purchaser of drugs, the US Government, via Medicare and VA, is obligated to purchase the drug at that price and is barred by law from negotiating price, is illogical, disturbing, and unfortunate for public beneficiaries throughout the country. We believe manufacturers should be transparent about their research and development, marketing, advertising and other costs in getting a drug to market and setting prices that reasonably reflect the true costs. MCHS encourages CMS to work further with stakeholders to address the pricing side of the ledger with the expectation that this will enable it to move beyond shortsighted modifications in the Average Sales Price (ASP)-based payment methodology. To be very explicit we are not recommending that this proposal be withdrawn, but we do believe it is a long way from perfect policy. We believe that some necessary preconditions should be met before this program is implemented. The first of which must be to de-link physician payment entirely from the drugs they prescribe for patients. In addition, we believe manufacturers should be transparent about their research and development, marketing, advertising and other costs in getting a drug to market and setting prices that reasonably reflect the true costs. Advance Care Planning MCHS supports S. 1549 Care Planning Act of 2015, introduced by Senators Mark Warner, Johnny Isakson and Tammy Baldwin which Amends titles XVIII of Medicare) of the Social Security Act (SSAct) to cover advanced illness planning and coordination services furnished to an eligible individual with progressive illness, including Alzheimer's disease, by a hospice or other provider through an interdisciplinary team.

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

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

The Medicare Advantage Benchmark Cap - ACA SEC. 3201. (b) (4) The Medicare Advantage program provides a full risk, capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. The Medicare Advantage Benchmark Cap - ACA SEC. 3201. (b) (4) By authorizing Quality Incentive Payments for MA plans with star ratings of 4 stars and above, Congress made a significant policy change towards value-based purchasing in the MA program. If a plan is eligible for a Quality Incentive Payment, it receives it in the form of a 5 percent increase to its benchmark. However, Congress also authorized a new methodology for calculating benchmarks, and mandated that benchmarks under the new methodology cannot be greater than what they would have been under the old benchmark methodology. This is the benchmark cap. The benchmark cap reduces or even eliminates Quality Incentive Payments. The policy issue is that the cap weakens the incentive for plans to attain higher star ratings and undermines the shift towards paying for performance in the MA program. We do not think that Congress intended to take away with one provision (the cap) the significant policy change towards paying for value that it enacted in the ACA. This change will have a significant negative impact on Medicare Advantage beneficiaries. Medicare Advantage benchmark cap legislation was introduced in December. MCHS supports H.R. 4275, the Medicare Advantage Quality Payment Relief Act of 2015, introduced by Reps. Mike Kelly (R-PA), Ron Kind (D-WI), Brett Guthrie (R-KY) and Mike Doyle (D-PA) that would remove the quality incentive payments from the calculation of the benchmark cap. Geographic Adjustment of Physician Payments - Recent findings by the Institute of Medicine and the Medicare Payment Advisory Commission have demonstrated significant shortcomings in the data utilized to geographically adjust physician payments. The IOM and MedPAC studies have confirmed that the data sources currently relied upon for geographic adjustment bear no correlation to physician earnings. CMS officials have admitted that the proxies utilized for the purpose of geographic adjustment have never been validated, and there never has been a new data source utilized in the twenty years since the fee schedule was implemented. MedPAC data show that the geographic adjustment reference occupations predict earnings of rural physicians to be 25-30% less than physicians in metropolitan areas. MedPAC data show that earnings of primary care physicians in rural areas are, in fact, 13% higher than physicians in metropolitan areas. Since there is no statistical basis of support for disparities in payment we strongly recommend that Congress require CMS to correct this inequity immediately. Having a source of credible data and a sustainable payment mechanism is critical to maintaining access to primary care services in rural areas for patients who reside in those areas.

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

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

Affordable Care Act (ACA) Issues; ACA Regulations; Postal Reform; Department of Labor Conflict of Interest Rule; HCR Implementation; Health Savings Accounts (HSAs); Re-insurance; Co-ops; Notice of Benefit and Payment Parameters (NBPP); Health Care Bill; Market Stability; Year-end Priorities; Cost-sharing Reduction (CSR); Better Way; Repeal/Replace Modeling; ACA Reform; Risk Corridors; Chronic Care; Comprehensive Care and Recovery Act (CARA); Mental Health Reform; Premium Education; Third Party Payment of Premiums; Association Health Plans; SEPs; Grace Periods; Age Bands. HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) This bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1934 Cancer Care Payment Reform Act of 2015 Introduced April 22, 2015 by Cathy McMorris Rodgers To amend title XVIII of the Social Security Act to establish a national Oncology Medical Home Demonstration Project under the Medicare program for the purpose of changing the Medicare payment for cancer care in order to enhance the quality of care and to improve cost efficiency, and for other purposes. 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 2646 Helping Families in Mental Health Crisis Act of 2015 Introduced May 4, 2015 by Tim Murphy (R-PA) To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes. HR 3244 Providing Innovative Care for Complex Cases Demonstration Act of 2015 Introduced July 28, 2015 by Cathy McMorris Rodgers (R-WA) To amend title XVIII of the Social Security Act to establish a pilot program to improve care for the most costly Medicare fee-for-service beneficiaries through the use of comprehensive and effective care management while reducing costs to the Federal Government for these beneficiaries, and for other purposes. HR 3463 Aligning Childrens Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) To amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes as introduced. HR 3742 Access to Marketplace Insurance Act Introduced October 9, 2015 by Kevin Cramer (R-ND) To amend the Patient Protection and Affordable Care Act to allow for certain third party payments. HR 4275 Medicare Advantage Quality Payment Relief Act of 2015 Introduced December 16, 2015 by Mike Kelly (R-PA) To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. 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. HR 5410 Health Coverage State Flexibility Act of 2016 Introduced June 8, 2016 by Bill Flores (R-TX) to amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. HR 5447 Small Business Health Care Relief Act of 2016 Introduced June 21, 2016 by Charles Boustany, Jr. (R-LA) To provide an exception from certain group health plan requirements for qualified small employer health reimbursement arrangements. HR 5506 Introduced June 15, 2016 by Todd Young (R-IN) To amend title XVIII of the Social Security Act to establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and for other purposes. HR 5547 Health Care Price Transparency Promotion Act of 2016 Introduced by Michael Burgess (R-IN) To amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. HR 5589 Plan Verification and Fairness Act of 2016 Introduced June 28, 2016 by Marsha Blackburn (R-TN) To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. HR 5904 Tax Payers Before Insurers Act Introduced July 14, 2016 by Mark Walker (R-NC) To require the Secretary of Health and Human Services to deposit certain funds into the general fund of the Treasury in accordance with provisions of Federal law with regard to the Patient Protection and Affordable Care Act's Transitional Reinsurance Program. HR 5921 State Age Rating Flexibility Act Introduced July 21, 2016 by Larry Bucshon (R-IN) To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. S. 524 Comprehensive Addiction and Recovery Act of 2016 Introduced February 12, 2015 by Sheldon Whitehouse (D-RI) Overdoses from heroin, prescription drugs, and opioid pain relievers last year surpassed car accidents as the leading cause of injury-related death in America, according to the Centers for Disease Control. Deaths have reached their highest levels of the 21st century in 2014, the most recent year for which data is available, according to the National Institute on Drug Abuse. Heroin overdoses have more than tripled in the last five years, an issue receiving outsize attention nationally but especially during the presidential campaign season as New Hampshire has been one of the hardest-hit states. S. 1697 Small Business Healthcare Relief Act Introduced June 25, 2015 by Charles Grassley (R-IA) A bill to provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market, and for other purposes. S. 1945 Mental Health Reform Act of 2015 Introduced August 5, 2015 by Bill Cassidy (R-LA) A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes. S. 2713 Introduced March 17, 2016 by Lamar Alexander (R-TN) Advancing Precision Medicine Act of 2016 A bill to provide for the implementation of a Precision Medicine Initiative

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

Health care affordability and coverage, health care delivery reform, chronic care, MACRA, Medicare Advantage reform and Medicaid. Specifically HR 4212, The Community Based Care for Seniors Act of 2016 and HR 4275, the Medicare Advantage Quality Payment Relief Act.

Client expense: Not reported · Firm income: $12,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care affordability and coverage, health care delivery reform, chronic care, MACRA, Medicare Advantage reform and Medicaid. Specifically HR 4212, The Community Based Care for Seniors Act of 2016 and HR 4275, the Medicare Advantage Quality Payment Relief Act.

Client expense: Not reported · Firm income: $12,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage Policy and Reimbursement Part D Policy and Reimbursement Medicaid and Dual Eligible Issues Pharmacy Reimbursement Issues Medicare Access and CHIP Reauthorization Act (MACRA) Implementation Chronic Care Working Group Issues H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act H.R. 2507, Increasing Regulatory Fairness Act H.R. 2582, Seniors' Health Care Plan Protection Act H.R. 3831, Securing Fairness in Regulatory Timing Act H.R. 4275, Medicare Advantage Quality Payment Relief Act S. 1913, Stopping Medication Abuse and Protecting Seniors Act S. 524/H.R. 953, Comprehensive Addiction and Recovery Act Opioid and Drug Abuse Issues H.R. 5659, ESRD Choice Act

Client expense: $480,000 · Firm income: Not reported

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

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

(1) Issues related to Public Law 111-148 - The Patient Protection and Affordable Care Act (provisions related to Medicaid and Medicare) (2) Issues related to Public Law 111-152 - Health Care and Education Reconciliation Act of 2010 (provisions related to Medicaid and Medicare) (3) Issues pertaining to entitlement reform, Medicare Advantage, Part D, Medicaid Dual Eligibles, and Medicare reimbursement and enrollment (4) Issues related to S.2498 - Medicare Program Linking Uncoordinated Services (PLUS) Act (5) Issues related to H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act (6) Issues related to H.R. 1190 - Protecting Seniors Access to Medicare Act of 2015 (7) Issues related to H.R. 2505 - Medicare Advantage Coverage Transparency Act of 2015 (8) Issues related to H.R. 2506 - Seniors Health Care Plan Protection Act of 2015 (9 Issues related to H.R. 2507 - Increasing Regulatory Fairness Act of 2015 (10)Issues related to H.R. 2579 - Securing Care for Seniors Act of 2015 (11) Issues related to H.R.3244 - Providing Innovative Care for Complex Cases Demonstration Act of 2015 (12) Issues related to H.R.3288 - Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 (13) Issues related to H.R. 4275 - Medicare Advantage Quality Payment Relief Act of 2015 (14) Issues related to H.R.3831 - Securing Fairness in Regulatory Timing Act of 2015 (15) Issues related to H.R.2582 - Seniors' Health Care Plan Protection Act of 2015 (16) Issues related to CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter (17) Issues related to H.R.5659, ESRD Choice Act of 2016

Client expense: $740,000 · 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), Labor, Dept of (DOL), SENATE, Treasury, Dept of

Affordable Care Act Issues - Chronic Care Innovations; Payment reform 2017 Notice of Benefit and Payment Parameters (NBPP); ACA Regulations, Co-ops, Implementation; Market Stability Department of Labor Conflict of Interest Rule; Grace Periods, Special Enrollment Periods; Reinsurance; Risk Corridors; Risk Mitigation, Risk Programs; Premiums; Health Reimbursment Arrangements (HRA;s) Legislation; Individual Market Reform; Third Party Payments; Exchanges; Age Bands. Other Health Care Issues - Mental Health Parity; Opioid Education, End Stage Renal Disease (ESRD); Zika Virus; Postal Reform, End Stage Renal Disease. HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) this bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1934 Cancer Care Payment Reform Act of 2015 Introduced April 22, 2015 by Cathy McMorris Rodgers to amend title XVIII of the Social Security Act to establish a national Oncology Medical Home demonstration Project under the Medicare program for the purpose of changing the Medicare payment for cancer care in order to enhance the quality of care and to improve cost efficiency and for other purposes. 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 3244 Providing Innovative Care for Complex Cases Demonstration Act of 2015 Introduced July 28, 2015 by Cathy McMorris Rodgers (R-WA) to amend title XVIII of the Social Security Act to establish a pilot program to improve care for the most costly Medicare fee-for-service beneficiaries through the use of comprehensive and effective care management while reducing costs to the Federal Government for these beneficiaries, and for other purposes. HR 3463 Aligning Children's Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) to amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes as introduced. HR 3742 Access to Marketplace Insurance Act Introduced October 9, 2015 by Kevin Cramer (R-ND) to amend the Patient Protection and Affordable Care Act to allow for certain third party payments. HR 4275 Medicare Advantage Quality Payment Relief Act of 2015 Introduced December 16, 2015 by Mike Kelly (R-PA) to amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. 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. HR 5410 Health Coverage State Flexibility Act of 2016 Introduced June 8, 2016 by Bill Flores (R-TX) to amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State Law. HR 5506 Introduced June 15, 2016 by Todd Young (R-IN) to amend title XVIII of the Social Security Act to establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and for other purposes. HR 5547 Health Care Price Transparency Promotion Act of 2016 Introduced by Michael Burgess (R-IN) to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. HR 5589 Plan Verification and Fairness Act of 2016 Introduced June 28, 2016 by Marsha Blackburn (R-TN) to amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. HR 5921 State Age Rating Flexibility Act Introduced July 21, 2016 by Larry Bucshon (R-IN) to amend title XXVII of the Public Health Service act to change the permissible age variation in health insurance rates. S. 524 Comprehensive Addiction and Recovery Act of 2016 Introduced February 12, 2015 by Sheldon Whitehouse (D-RI) overdoses from heroin prescription drugs and opioid pain relievers last year surpassed car accidents as the leading cause of injury-related death in America, according to the Center for Disease Control. Deaths have reached their highest levels of the 21st Century in 2014, the most recent year for which data is available, according to the National Institute on Drug Abuse. Heroin overdoses have more than tripled in the last five years, an issue receiving outsize attention nationally but especially during the presidential campaign season as New Hampshire has been one of the hardest-hit states. S. 1697 Small Business Healthcare Relief Act Introduced June 25, 2015 by Charles Grassley (R-IA) a bill to provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market and for other purposes. S. 1945 Introduced August 5, 2015 by Bill Cassidy (R-LA) A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocacy with House and Senate offices on behalf of and related to proposals to improve chronic care in Medicare and elsewhere in the health care system, including the efforts of the Senate Finance Committee's Chronic Care Working Group. Advocacy with House and Senate offices on behalf of the Community based Independence for Seniors Act (S. 4212/HR 2704). Advocacy with House and Senate offices on behalf of HR 4275, the Medicare Advantage Quality Payment Relief Act. Advocacy regarding possible improvements to HR 3298, the Medicare Post-Acute Care Value-Based Purchasing Act. Advocacy with House and Senate offices regarding the importance of moving forward with reauthorization of the Children's Health Insurance Program. Discussion with House and Senate Committee staff regarding potential opportunities for bipartisan legislation in Medicare and Medicaid for the remainder of this Congress and during the next Congress.

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

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

Department of Health & Human Services: Medicare Advantage: operational issues, annual payment updates and policy changes. HR 2505 - Medicare Advantage Coverage Transparency Act of 2015: To amend title XVIII of the Social Security Act to require the annual reporting of data on enrollment in Medicare Advantage plans. Kelly (R-PA) HR 2507 - Increasing Regulatory Fairness Act of 2015: To amend title XVIII of the Social Security Act to establish an annual rulemaking schedule for payment rates under Medicare Advantage. Brady (R-TX) HR 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015: To amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the co-payments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures, and for other purposes. Black (R-TN) HR 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015: To amend title XVIII of the Social Security Act to establish a 3-year demonstration program to test the use of value-based insurance design methodologies under eligible Medicare Advantage plans, to preserve Medicare beneficiary choice under Medicare Advantage, to revise the treatment under the Medicare program of infusion drugs furnished through durable medical equipment, and for other purposes. Brady (R-TX) HR 2582 - Seniors' Health Care Plan Protection Act of 2015: To amend title XVIII of the Social Security Act to delay the authority to terminate Medicare Advantage contracts for MA plans failing to achieve minimum quality ratings, to make improvements to the Medicare Adjustment risk adjustment system, and for other purposes. Buchanan (R-FL) HR 4275 - Medicare Advantage Quality Payment Relief Act of 2015: To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. Kelly (R-PA) HR 5659 - ESRD Choice Act of 2016: To amend title XVIII of the Social Security Act with respect to expanding Medicare Advantage coverage for individuals with end-stage renal disease (ESRD). Smith (R-MO) S 2425 - Patient Access and Medicare Protection Act: 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. Portman (R-OH) S 2484 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act: To amend titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program through the use of Telehealth and remote patient monitoring services, and for other purposes. Schatz (D-HI)

Client expense: $145,000 · Firm income: Not reported

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

Medicare Advantage; Medicaid; Medicare Access & CHIP Reauthorization Act of 2015 (MACRA); Site-neutral Payments; Rate Notice and Call Letter; QHP Quality Rating System (QRS); ESRD HR 5506 Introduced June 15, 2016 by Todd Young (R-IN) To amend title XVIII of the Social Security Act to establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and for other purposes. HR 4275 Medicare Advantage Quality Payment Relief Act of 2015 Introduced December 16, 2015 by Mike Kelly (R-PA) To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. 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.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Affordable Care Act Issues - Chronic Care Innovations; Payment reform; 2017 Notice of Benefit and Payment Parameters (NBPP); ACA Regulations; Co-ops; Implementation; Market Stability; Department of Labor Conflict of Interest Rule; Grace Periods; Special Enrollment Periods (SEPs); Reinsurance; Risk Corridors; Risk Mitigation; Risk Programs; Premiums; Health Reimbursement Arrangements (HRAs) Legislation; Individual Market Reform; Third-party Payments; Exchanges; Age Bands Other Health Care Issues - Mental Health Reform; End Stage Renal Disease (ESRD); Zika Virus; Postal Reform; Health Savings Accounts HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) This bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1934 Cancer Care Payment Reform Act of 2015 Introduced April 22, 2015 by Cathy McMorris Rodgers To amend title XVIII of the Social Security Act to establish a national Oncology Medical Home Demonstration Project under the Medicare program for the purpose of changing the Medicare payment for cancer care in order to enhance the quality of care and to improve cost efficiency, and for other purposes. 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 2646 Helping Families in Mental Health Crisis Act of 2015 Introduced May 4, 2015 by Tim Murphy (R-PA) To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes HR 3244 Providing Innovative Care for Complex Cases Demonstration Act of 2015 Introduced July 28, 2015 by Cathy McMorris Rodgers (R-WA) To amend title XVIII of the Social Security Act to establish a pilot program to improve care for the most costly Medicare fee-for-service beneficiaries through the use of comprehensive and effective care management while reducing costs to the Federal Government for these beneficiaries, and for other purposes. HR 3463 Aligning Childrens Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) To amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes as introduced. HR 3742 Access to Marketplace Insurance Act Introduced October 9, 2015 by Kevin Cramer (R-ND) To amend the Patient Protection and Affordable Care Act to allow for certain third party payments. HR 4275 Medicare Advantage Quality Payment Relief Act of 2015 Introduced December 16, 2015 by Mike Kelly (R-PA) To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. 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. HR 5410 Health Coverage State Flexibility Act of 2016 Introduced June 8, 2016 by Bill Flores (R-TX) to amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. HR 5447 Small Business Health Care Relief Act of 2016 Introduced June 21, 2016 by Charles Boustany, Jr. (R-LA) To provide an exception from certain group health plan requirements for qualified small employer health reimbursement arrangements. HR 5506 Introduced June 15, 2016 by Todd Young (R-IN) To amend title XVIII of the Social Security Act to establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and for other purposes. HR 5547 Health Care Price Transparency Promotion Act of 2016 Introduced by Michael Burgess (R-IN) To amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. HR 5589 Plan Verification and Fairness Act of 2016 Introduced June 28, 2016 by Marsha Blackburn (R-TN) To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. HR 5904 Tax Payers Before Insurers Act Introduced July 14, 2016 by Mark Walker (R-NC) To require the Secretary of Health and Human Services to deposit certain funds into the general fund of the Treasury in accordance with provisions of Federal law with regard to the Patient Protection and Affordable Care Act's Transitional Reinsurance Program. HR 5921 State Age Rating Flexibility Act Introduced July 21, 2016 by Larry Bucshon (R-IN) To amend title XXVII of the Public Health Service Act to change the permissible age variation in health insurance premium rates. S. 524 Comprehensive Addiction and Recovery Act of 2016 Introduced February 12, 2015 by Sheldon Whitehouse (D-RI) Overdoses from heroin, prescription drugs, and opioid pain relievers last year surpassed car accidents as the leading cause of injury-related death in America, according to the Centers for Disease Control. Deaths have reached their highest levels of the 21st century in 2014, the most recent year for which data is available, according to the National Institute on Drug Abuse. Heroin overdoses have more than tripled in the last five years, an issue receiving outsize attention nationally but especially during the presidential campaign season as New Hampshire has been one of the hardest-hit states. S. 1697 Small Business Healthcare Relief Act Introduced June 25, 2015 by Charles Grassley (R-IA) A bill to provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market, and for other purposes. S. 1945 Mental Health Reform Act of 2015 Introduced August 5, 2015 by Bill Cassidy (R-LA) A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes. S. 2713 Introduced March 17, 2016 by Lamar Alexander (R-TN) Advancing Precision Medicine Act of 2016 A bill to provide for the implementation of a Precision Medicine Initiative.

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 3292 Medicare IME Pool Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter; S. 2484 CONNECT for Health Act; MACRA payment models & reimbursement policies; Hospital Inpatient Payment Systems; Acute Care Hospitals and the Long Term Care Hospital PPS; policy changes to FY 2017 Rates-CMS-1655-P proposed rule; Home infusion payment issues

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

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter. Advancing Care for Exceptional Kids Act of 2015 (H.R. 546. S. 298).

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

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

Medicare Advantage Policy and Reimbursement. Part D Policy and Reimbursement. Medicaid and Dual Eligible issues. Pharmacy Reimbursement Issues. MACRA Implementation. H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act. H.R. 2507, Increasing Regulatory Fairness Act. H.R. 2582, Seniors' Health Care Plan Protection Act. H.R. 3831, Securing Fairness and Regulatory Timing. H.R. 4275, Medicare Advantage Quality Payment Relief Act. S. 1913, Stopping Medication Abuse and Protecting Seniors ACt. S. 524 and H.R. 953, Comprehensive Addiction and Recovery Act. Opioid and Drug Abuse Issues. H.R. 5659, ESRD Choice Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Supported Medicare Advantage Program (MA) and advocated against implementation of CMS benchmark cap on the MA Program. Requested PA congressional delegation support for HR 4275 which would effectively deal with benchmark cap issue and for Senate sponsorship of companion bill to HR 4275. Requested PA delegation co-sponsor subject legislation and sign "Dear Colleague" letters to have bills considered and passed. Sent letter of support on issue to HHS Regional Director and requested Senate contacts with HHS Secretary to administratively "fix" issue.

Client expense: $90,857 · Firm income: Not reported

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

Removal of quality incentive payments from the Medicare Advantage Benchmark Cap. H.R. 4275, the Medicare Advantage Quality Payment Relief Act of 2015 Drug costs

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

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

Regulatory and legislative matters related to the implementation of the Affordable Care Act and Medicare Advantage (MA). Removal of quality incentive payments from the MA benchmark cap. H.R. 4275, the Medicare Advantage Quality Payment Relief Act of 2015

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

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

Medicare Access and CHIP Reauthorization Act With passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress has put to rest the constant threat of massive cuts to Medicare physician fees. Going forward Medicare physician payments will transition to an incentive-based system based on value and accountability. Starting in 2019, Medicare physician payment will be based on the Merit-Based Incentive Payment System (MIPS). Physicians who perform well on quality, value and IT metrics will be rewarded with higher pay rates and those who perform poorly will face penalties. Participants in Alternative Payment Systems (APMs) such as accountable care organizations that assume financial risk will receive 5% bonuses between 2019 and 2024. Because the language of the statute is not specific, the Centers for Medicare and Medicaid Services (CMS) is developing metrics that will be used to determine the bonus payments and penalties that will start in 2019 in a public rulemaking currently underway. The proposed metrics simplify and consolidate the existing measurements employed under the Meaningful Use Incentive Program, the Physician Reporting System (PQRS), and the Value-Based Modifier (VBM) to streamline the reporting burden for physician practices. MIPS will then pay physicians based on four weighted performance categories: Quality (50% of total score in year 1), Advancing Care Information (25% of total score in year 1); Clinical Practice Improvement Activities (15% of total score in year 1): Resource Use (10% of total score in year 1, but growing to 30% in subsequent years). Having a source of credible data as the foundation of CMS metrics is critical both to fair payment and maintaining access to medical services in rural areas. CMS will be refining the metrics perpetually throughout the lifespan of this program. Challenges to fair reimbursement persist under the current Medicare fee schedule, which remains the foundation of the reimbursement system, particularly in regard to the valuation of primary care and the geographic adjustment of physician wages. These challenges must be addressed. Adequate funding for CMS to implement and maintain this new system is critical to patient care, provider education and acceptance of the new program and its long term success. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs and full implementation of the Affordable Care Act and MACRA. Accountable Care Organizations Marshfield Clinic has benefitted substantially from its 9 + years of experience with CMS in the development and implementation of the Physician Group Practice Demonstration, and the Medicare Shared Savings Program. The mission of the Clinic and the objectives of the PGP and MSSP programs are closely paralleled in that it is our mission and objective to make compassionate care more affordable, improve outcomes and enrich the care experience of our patients. It is in our organizational self-interest that these programs succeed, so we have committed substantial resources and energy to the understanding and improvement of the programs. By both objective and subjective criteria Marshfield Clinic has performed successfully. In a recent letter to CMS we focused on the CMS program objective of encouraging ACOs to transition into full risk arrangements. In the proposed regulations codifying the terms and definitions of the Medicare and CHIP Reauthorization Act of 2015, (MACRA) we find that we must become a risk-bearing MSSP ACO before 2017 to become a qualified Alternative Payment Model (APM). This is a primary strategic objective for MCHS. Unfortunately, CMS has not allowed for a pathway for Track 1 ACOs in their second three year term to transition to a full risk Track until 2019, which forecloses our opportunities to become an APM. We believe that it is in our own and our patients best interests that we take whatever steps are necessary to move into risk-bearing arrangements, and we have requested support from CMS to make this necessary transition. Medicare Advantage The Medicare Advantage program provides a full risk, capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. The Medicare Advantage Benchmark Cap - ACA SEC. 3201. (b) (4) By authorizing Quality Incentive Payments for MA plans with star ratings of 4 stars and above, Congress made a significant policy change towards value-based purchasing in the MA program. If a plan is eligible for a Quality Incentive Payment, it receives it in the form of a 5 percent increase to its benchmark. However, Congress also authorized a new methodology for calculating benchmarks, and mandated that benchmarks under the new methodology cannot be greater than what they would have been under the old benchmark methodology. This is the benchmark cap. The benchmark cap reduces or even eliminates Quality Incentive Payments. The policy issue is that the cap weakens the incentive for plans to attain higher star ratings and undermines the shift towards paying for performance in the MA program. We do not think that Congress intended to take away with one provision (the cap) the significant policy change towards paying for value that it enacted in the ACA. This change will have a significant negative impact on Medicare Advantage beneficiaries. CMS has indicated that it wants to remove the cap administratively, and we believe that Secretary Burwell and CMS have the authority under law to make the necessary changes. If HHS and CMS do not make the change, then a statutory change will be necessary. Medicare Advantage benchmark cap legislation was introduced in December. We urge you to cosponsor H.R. 4275, the Medicare Advantage Quality Payment Relief Act of 2015, introduced by Reps. Mike Kelly (R-PA), Ron Kind (D-WI), Brett Guthrie (R-KY) and Mike Doyle (D-PA) that would remove the quality incentive payments from the calculation of the benchmark cap. Graduate Medical Education MCHS is concerned about having a sufficient supply of primary care physicians to meet the demands of an expanding and aging population. This is doubly true for patients and health systems in rural settings. Currently only about 10% of physicians practice in rural areas while 25% of the population resides there. While 36% allopathic residents and 50% osteopathic residents who are trained in a rural residency end up practicing in a rural area, only 4% of the residency training actually occurs in rural areas. Currently there are more US medical students graduating from medical school than there are GME slots. An increase in GME primary care training positions is essential to maintaining high-quality, accessible, and cost efficient care. Teaching hospitals in rural locations provide an environment for residents to learn and faculty to serve as educators, providers and researchers. These roles advance the broad mission of preparing each generation of physicians, provide critical patient care and specialized services, often to the disadvantaged, facilitate the discovery of new therapies and treatments, and enable residents to acclimate to the rural setting. As new payment and delivery models emphasize primary care to improve patient outcomes and reduce costs, and as more care shifts to outpatient settings, teaching faculty and residency programs must increase access to ambulatory residency rotations to serve Americans who live in areas with an under-supply of primary care physicians including Psychiatry. The purpose and value of residency training in clinical settings and the financial support needed to sustain physician education will only increase as the U.S. population lives longer with more complex health conditions. To ensure GME can meet the future needs of the newly insured and aging population, Congress must commit to the consistent GME funding and lift Medicares limit on funded residency positions. We support the Teaching Health Center funding in MACRA for Community Health Centers but request you extend funding beyond 2017. Geographic Adjustment of Physician Payments Recent findings by the Institute of Medicine and the Medicare Payment Advisory Commission have demonstrated significant shortcomings in the data utilized to geographically adjust physician payments. The IOM and MedPAC studies have confirmed that the data sources currently relied upon for geographic adjustment bear no correlation to physician earnings. CMS officials have admitted that the proxies utilized for the purpose of geographic adjustment have never been validated, and there never has been a new data source utilized in the twenty years since the fee schedule was implemented. MedPAC data show that the geographic adjustment reference occupations predict earnings of rural physicians to be 25-30% less than physicians in metropolitan areas. MedPAC data show that earnings of primary care physicians in rural areas are, in fact, 13% higher than physicians in metropolitan areas. Since there is no statistical basis of support for disparities in payment we strongly recommend that Congress require CMS to correct this inequity immediately. These corrections are necessary to assure the credibility of the changes enacted in MACRA. Telemedicine in Medicare Changes to Medicare law and regulation are needed to improve equity in access for Medicare beneficiaries to services delivered via TeleHealth. Medicare beneficiaries should be allowed to receive services in telemedicine sites located in urban areas. The necessary changes would remove restrictions on originating sites by removing the rural requirement and the list of originating sites and allowing any certified Medicare facility to provide the services; current requirements that physician must bill for services from the originating site should be removed; restrictions on eligible practitioners should be removed to allow all Medicare approved practitioners to provide telemedicine services; and there should be no restrictions on which Medicare services may be provided through telemedicine. We recommend that the Medicare requirement for non-MSA geographic location of the patient be expanded to allow all Medicare certified organizations as originating sites regardless of rural or metropolitan statistical area designation. Part B Drug Payment Model CMS proposed a new Medicare Part B Drug Payment Model in the Federal Register on March 11, 2016. This model proposes to test alternative payment methodologies for separately payable Part B drugs to determine whether alternative drug payment designs will lead to a reduction in Medicare expenditures while preserving or enhancing quality of care. MCHS supports CMS efforts to address the rising cost of Medicare Part B drugs, but has concerns about the proposed demonstration of a new Average Sales Price (ASP) payment methodology. Specifically we believe that CMS should utilize its rule making authority to de-link physician payment entirely from the drugs they prescribe for patients. MCHS believes that the major responsibility for unsustainable drug spending remains with pharmaceutical manufacturers. The rising costs of drugs and biologics is a system-wide concern. A major contributing factor to those costs is the price set by manufacturers. The fact that there are no regulations on pricing of new anticancer drugs is disturbing. Pharmaceutical companies have the freedom to price their drug liberally at whatever price they deem appropriate, on the basis of what they presume the market will bear. The fact that the largest purchaser of drugs, the US Government, via Medicare and VA, is obligated to purchase the drug at that price and is barred by law from negotiating price, is illogical, disturbing, and unfortunate for public beneficiaries throughout the country. We believe manufacturers should be transparent about their research and development, marketing, advertising and other costs in getting a drug to market and setting prices that reasonably reflect the true costs. MCHS encourages CMS to work further with stakeholders to address the pricing side of the ledger with the expectation that this will enable it to move beyond shortsighted modifications in the Average Sales Price (ASP)-based payment methodology. To be very explicit we are not recommending that this proposal be withdrawn, but we do believe it is a long way from perfect policy. We believe that some necessary preconditions should be met before this program is implemented. The first of which must be to de-link physician payment entirely from the drugs they prescribe for patients. In addition, we believe manufacturers should be transparent about their research and development, marketing, advertising and other costs in getting a drug to market and setting prices that reasonably reflect the true costs. Advance Care Planning MCHS supports S. 1549 Care Planning Act of 2015, introduced by Senators Mark Warner, Johnny Isakson and Tammy Baldwin which Amends titles XVIII of Medicare) of the Social Security Act (SSAct) to cover advanced illness planning and coordination services furnished to an eligible individual with progressive illness, including Alzheimer's disease, by a hospice or other provider through an interdisciplinary team.

Client expense: $90,000 · Firm income: Not reported

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

HR 4275: Discussions regarding the Medicare Advantage Benchmark Cap.

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

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

Health care affordability and coverage, health care delivery reform, chronic care, MACRA, Medicare Advantage reform and Medicaid. Specifically HR 4212, The Community Based Care for Seniors Act of 2016 and HR 4275, the Medicare Advantage Quality Payment Relief Act.

Client expense: Not reported · Firm income: $12,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocacy with House and Senate offices on behalf of and related to proposals to improve chronic care in Medicare and elsewhere in the health care system. Advocacy with House and Senate offices on behalf of the Community based Independence for Seniors Act (S. 4212/HR 2704) and the CONNECT for Health Act (S.2484/HR 4442). Advocacy with House and Senate offices on behalf of HR 4275, the Medicare Advantage Quality Payment Relief Act. Advocacy with House and Senate offices regarding the importance of moving forward with reauthorization of the Children's Health Insurance Program in 2017. Submission of comments to the Centers for Medicare and Medicaid Services regarding MACRA's Quality Payment Program NPRM. Discussion with House and Senate staff regarding possible avenues to improve the Medicare Advantage program.

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

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

Chronic care (including HR 4212, The Community Based Independence for Seniors Act), Medicare Advantage (including HR 4275,the Medicare Advantage Quality Payment Relief Act) health care affordability, MACRA and CHIP.

Client expense: Not reported · Firm income: Not reported

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter. Advancing Care for Exceptional Kids Act of 2015 (H.R. 546. S. 298).

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

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 3292 Medicare IME Pool Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter; S. 2484 CONNECT for Health Act; MACRA payment models & reimbursement policies; Hospital Inpatient Payment Systems; Acute Care Hospitals and the Long Term Care Hospital PPS; policy changes to FY 2017 Rates-CMS-1655-P proposed rule

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

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

(1) Issues related to Public Law 111-148 - The Patient Protection and Affordable Care Act (provisions related to Medicaid and Medicare) (2) Issues related to Public Law 111-152 - Health Care and Education Reconciliation Act of 2010 (provisions related to Medicaid and Medicare) (3) Issues pertaining to entitlement reform, Medicare Advantage, Part D, Medicaid Dual Eligibles, and Medicare reimbursement and enrollment (4) Issues related to S.2498 - Medicare Program Linking Uncoordinated Services (PLUS) Act (5) Issues related to H.R. 2581 - Preservation of Access for Seniors in Medicare Advantage Act (6) Issues related to H.R. 1190 - Protecting Seniors Access to Medicare Act of 2015 (7) Issues related to H.R. 2505 - Medicare Advantage Coverage Transparency Act of 2015 (8) Issues related to H.R. 2506 - Seniors Health Care Plan Protection Act of 2015 (9 Issues related to H.R. 2507 - Increasing Regulatory Fairness Act of 2015 (10)Issues related to H.R. 2579 - Securing Care for Seniors Act of 2015 (11) Issues related to H.R.3244 - Providing Innovative Care for Complex Cases Demonstration Act of 2015 (12) Issues related to H.R.3288 - Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 (13) Issues related to H.R. 4275 - Medicare Advantage Quality Payment Relief Act of 2015 (14) Issues related to H.R.3831 - Securing Fairness in Regulatory Timing Act of 2015 (15) Issues related to H.R.2582 - Seniors' Health Care Plan Protection Act of 2015 (16) Issues related to CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter

Client expense: $610,000 · 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), Labor, Dept of (DOL), SENATE, Treasury, Dept of

Affordable Care Act Issues - Chronic Care Innovations; Payment reform; 2017 Notice of Benefit and Payment Parameters (NBPP); ACA Regulations; Implementation; Cyber Security;Open Enrollment; Market Stability; Department of Labor Fiduciary Rule; Grace Periods; Special Enrollment Periods (SEPs); Reinsurance; Taskforce; Premiums; Health Reimbursement Arrangements (HRAs) Legislation; Individual Market Reform Other Health Care Issues - Mental Health Parity; Opioid Education; End Stage Renal Disease (ESRD); Zika Virus; Air Ambulances Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) This bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1934 Cancer Care Payment Reform Act of 2015 Introduced April 22, 2015 by Cathy McMorris Rodgers To amend title XVIII of the Social Security Act to establish a national Oncology Medical Home Demonstration Project under the Medicare program for the purpose of changing the Medicare payment for cancer care in order to enhance the quality of care and to improve cost efficiency, and for other purposes. 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 2646 Helping Families in Mental Health Crisis Act of 2015 Introduced May 4, 2015 by Tim Murphy (R-PA) To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes HR 3244 Providing Innovative Care for Complex Cases Demonstration Act of 2015 Introduced July 28, 2015 by Cathy McMorris Rodgers (R-WA) To amend title XVIII of the Social Security Act to establish a pilot program to improve care for the most costly Medicare fee-for-service beneficiaries through the use of comprehensive and effective care management while reducing costs to the Federal Government for these beneficiaries, and for other purposes. HR 3463 Aligning Childrens Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) To amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes as introduced. HR 3742 Access to Marketplace Insurance Act Introduced October 9, 2015 by Kevin Cramer (R-ND) To amend the Patient Protection and Affordable Care Act to allow for certain third party payments. HR 4275 Medicare Advantage Quality Payment Relief Act of 2015 Introduced December 16, 2015 by Mike Kelly (R-PA) To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. 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. HR 5410 Health Coverage State Flexibility Act of 2016 Introduced June 8, 2016 by Bill Flores (R-TX) to amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. HR 5447 Small Business Health Care Relief Act of 2016 Introduced June 21, 2016 by Charles Boustany, Jr. (R-LA) To provide an exception from certain group health plan requirements for qualified small employer health reimbursement arrangements. HR 5506 Introduced June 15, 2016 by Todd Young (R-IN) To amend title XVIII of the Social Security Act to establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and for other purposes. HR 5547 Health Care Price Transparency Promotion Act of 2016 Introduced by Michael Burgess (R-IN) To amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. HR 5589 Plan Verification and Fairness Act of 2016 Introduced June 28, 2016 by Marsha Blackburn (R-TN) To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. S. 524 Comprehensive Addiction and Recovery Act of 2016 Introduced February 12, 2015 by Sheldon Whitehouse (D-RI) Overdoses from heroin, prescription drugs, and opioid pain relievers last year surpassed car accidents as the leading cause of injury-related death in America, according to the Centers for Disease Control. Deaths have reached their highest levels of the 21st century in 2014, the most recent year for which data is available, according to the National Institute on Drug Abuse. Heroin overdoses have more than tripled in the last five years, an issue receiving outsize attention nationally but especially during the presidential campaign season as New Hampshire has been one of the hardest-hit states. S. 1697 Small Business Healthcare Relief Act Introduced June 25, 2015 by Charles Grassley (R-IA) A bill to provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market, and for other purposes. S. 1945 Mental Health Reform Act of 2015 Introduced August 5, 2015 by Bill Cassidy (R-LA) A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes. S. 2713 Introduced March 17, 2016 by Lamar Alexander (R-TN) Advancing Precision Medicine Act of 2016 A bill to provide for the implementation of a Precision Medicine Initiative.

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

Affordable Care Act Issues - Chronic Care Innovations; Payment reform; 2017 Notice of Benefit and Payment Parameters (NBPP); ACA Regulations; Implementation; Cyber Security;Open Enrollment; Market Stability; Grace Periods; Special Enrollment Periods (SEPs); Reinsurance; Taskforce; Premiums; Health Reimbursement Arrangements (HRAs) Legislation; Individual Market Reform; Tobacco Cessation Programs Other Health Care Issues - Mental Health Parity; Opioid Education; End Stage Renal Disease (ESRD) HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) This bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. 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 2646 Helping Families in Mental Health Crisis Act of 2015 Introduced May 4, 2015 by Tim Murphy (R-PA) To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes HR 3463 Aligning Childrens Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) To amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes as introduced. HR 4275 Medicare Advantage Quality Payment Relief Act of 2015 Introduced December 16, 2015 by Mike Kelly (R-PA) To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. HR 5410 Health Coverage State Flexibility Act of 2016 Introduced June 8, 2016 by Bill Flores (R-TX) to amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State law. HR 5447 Small Business Health Care Relief Act of 2016 Introduced June 21, 2016 by Charles Boustany, Jr. (R-LA) To provide an exception from certain group health plan requirements for qualified small employer health reimbursement arrangements. HR 5506 Introduced June 15, 2016 by Todd Young (R-IN) To amend title XVIII of the Social Security Act to establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and for other purposes. HR 5589 Plan Verification and Fairness Act of 2016 Introduced by Marsha Blackburn (R-TN) To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. S. 524 Comprehensive Addiction and Recovery Act of 2016 Introduced February 12, 2015 by Sheldon Whitehouse (D-RI) Overdoses from heroin, prescription drugs, and opioid pain relievers last year surpassed car accidents as the leading cause of injury-related death in America, according to the Centers for Disease Control. Deaths have reached their highest levels of the 21st century in 2014, the most recent year for which data is available, according to the National Institute on Drug Abuse. Heroin overdoses have more than tripled in the last five years, an issue receiving outsize attention nationally but especially during the presidential campaign season as New Hampshire has been one of the hardest-hit states.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage Policy and Reimbursement Part D Policy and Reimbursement Medicaid and Dual Eligible Issues Pharmacy Reimbursement Issues Medicare Access and CHIP Reauthorization Act (MACRA) Implementation Chronic Care Working Group Issues H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act H.R. 2507, Increasing Regulatory Fairness Act H.R. 2582, Seniors' Health Care Plan Protection Act H.R. 3831, Securing Fairness in Regulatory Timing Act H.R. 4275, Medicare Advantage Quality Payment Relief Act S. 1913, Stopping Medication Abuse and Protecting Seniors Act S. 524/H.R. 953, Comprehensive Addiction and Recovery Act Opioid and Drug Abuse Issues

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

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

Affordable Care Act Issues - Chronic Care Innovations; Payment reform 2017 Notice of Benefit and Payment Parameters (NBPP); ACA Regulations, Implementation; Cyber Security; Open Enrollment; Market Stability; Department of Labor Fiduciary Rule; Grace Periods; Special Enrollment Periods (SEPs); Reinsurance; Taskforce; Premiums; Health Reimbursement Arrangements (HRAs) Legislation; Individual Market Reform Other Health Care Issues - Mental Health Parity; Opioid Education, End Stage Renal Disease (ESRD); Zika Virus; Air Ambulances Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) this bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1934 Cancer Care Payment Reform Act of 2015 Introduced April 22, 2015 by Cathy McMorris Rodgers to amend title XVIII of the Social Security Act to establish a national Oncology Medical Home demonstration Project under the Medicare program for the purpose of changing the Medicare payment for cancer care in order to enhance the quality of care and to improve cost efficiency and for other purposes. 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 2646 Helping Families i Mental Health Crisis Act of 2015 introduced May 4, 2015 by Tim Murphy (R-PA) to make available needed psychiatric, psychological and supportive services for individuals with mental illness and families in mental health crisis and for other purposes. HR 3244 Providing Innovative Care for Complex Cases Demonstration Act of 2015 Introduced July 28, 2015 by Cathy McMorris Rodgers (R-WA) to amend title XVIII of the Social Security Act to establish a pilot program to improve care for the most costly Medicare fee-for-service beneficiaries through the use of comprehensive and effective care management while reducing costs to the Federal Government for these beneficiaries, and for other purposes. HR 3463 Aligning Children's Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) to amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes as introduced. HR 3742 Access to Marketplace Insurance Act Introduced October 9, 2015 by Kevin Cramer (R-ND) to amend the Patient Protection and Affordable Care Act to allow for certain third party payments. HR 4275 Medicare Advantage Quality Payment Relief Act of 2015 Introduced December 16, 2015 by Mike Kelly (R-PA) to amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. 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. HR 5410 Health Coverage State Flexibility Act of 2016 Introduced June 8, 2016 by Bill Flores (R-TX) to amend the Patient Protection and Affordable Care Act to better align the grace period required for non-payment of premiums before discontinuing coverage under qualified health plans with such grace periods provided for under State Law. HR 5447 Small Business Health Care Relief Act of 2016 Introduced June 21, 2016 by Charles Boustany, Jr. (R-LA) to provide an exception from certain group health plan requirements for qualified small employer health reimbursement arrangements. HR 5506 Introduced June 15, 2016 by Todd Young (R-IN) to amend title XVIII of the Social Security Act to establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and for other purposes. HR 5547 Health Care Price Transparency Promotion Act of 2016 Introduced by Michael Burgess (R-IN) to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. HR 5589 Plan Verification and Fairness Act of 2016 Introduced June 28, 2016 by Marsha Blackburn (R-TN) to amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. S. 524 Comprehensive Addiction and Recovery Act of 2016 Introduced February 12, 2015 by Sheldon Whitehouse (D-RI) overdoses from heroin prescription drugs and opioid pain relievers last year surpassed car accidents as the leading cause of injury-related death in America, according to the Center for Disease Control. Deaths have reached their highest levels of the 21st Century in 2014, the most recent year for which data is available, according to the National Institute on Drug Abuse. Heroin overdoses have more than tripled in the last five years, an issue receiving outsize attention nationally but especially during the presidential campaign season as New Hampshire has been one of the hardest-hit states. S. 1697 Small Business Healthcare Relief Act Introduced June 25, 2015 by Charles Grassley (R-IA) a bill to provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market and for other purposes. S. 1945 Introduced August 5, 2015 by Bill Cassidy (R-LA) A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes. S. 2713 Introduced March 17, 2016 by Lamar Alexander (R-TN) Advancing Precision Medicine Act of 2016 A bill to provide for the implementation of a Precision Medicine Initiative.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage Policy and Reimbursement. Part D Policy and Reimbursement. Medicaid and Dual Eligible issues. Pharmacy Reimbursement Issues. MACRA Implementation. H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act. H.R. 2507, Increasing Regulatory Fairness Act. H.R. 2582, Seniors' Health Care Plan Protection Act. H.R. 3831, Securing Fairness and Regulatory Timing. H.R. 4275, Medicare Advantage Quality Payment Relief Act. S. 1913, Stopping Medication Abuse and Protecting Seniors ACt. S. 524 and H.R. 953, Comprehensive Addiction and Recovery Act. Opioid and Drug Abuse Issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Department of Health & Human Services: Medicare Advantage: operational issues, annual payment updates and policy changes. HR 2505 - Medicare Advantage Coverage Transparency Act of 2015: To amend title XVIII of the Social Security Act to require the annual reporting of data on enrollment in Medicare Advantage plans. Kelly (R-PA) HR 2507 - Increasing Regulatory Fairness Act of 2015: To amend title XVIII of the Social Security Act to establish an annual rulemaking schedule for payment rates under Medicare Advantage. Brady (R-TX) HR 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015: To amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, establish a demonstration program requiring the utilization of Value-Based Insurance Design to demonstrate that reducing the co-payments or coinsurance charged to Medicare beneficiaries for selected high-value prescription medications and clinical services can increase their utilization and ultimately improve clinical outcomes and lower health care expenditures, and for other purposes. Black (R-TN) HR 2581 - Preservation of Access for Seniors in Medicare Advantage Act of 2015: To amend title XVIII of the Social Security Act to establish a 3-year demonstration program to test the use of value-based insurance design methodologies under eligible Medicare Advantage plans, to preserve Medicare beneficiary choice under Medicare Advantage, to revise the treatment under the Medicare program of infusion drugs furnished through durable medical equipment, and for other purposes. Brady (R-TX) HR 2582 - Seniors' Health Care Plan Protection Act of 2015: To amend title XVIII of the Social Security Act to delay the authority to terminate Medicare Advantage contracts for MA plans failing to achieve minimum quality ratings, to make improvements to the Medicare Adjustment risk adjustment system, and for other purposes. Buchanan (R-FL) HR 4275 - Medicare Advantage Quality Payment Relief Act of 2015: To amend title XVIII of the Social Security Act to eliminate a provision under the Medicare Advantage program that inadvertently penalizes Medicare Advantage plans for providing high quality care to Medicare beneficiaries. Kelly (R-PA) S 2425 - Patient Access and Medicare Protection Act: 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. Portman (R-OH) S 2484 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act: To amend titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program through the use of Telehealth and remote patient monitoring services, and for other purposes. Schatz (D-HI)

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

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