Fair Medicare Hospital Payments Act of 2016

H.R.1190, Protecting Seniors Access to Medicare Act of 2015 (all sections of full text) S.141, Protecting Seniors Access to Medicare Act of 2015 (all sections of full text) S. 2680 Mental Health Reform Act of 2016 (all sections of full text)(support) S.1945 Mental Health Reform Act of 2015 (all sections of full text)(support) Monitored the HHS/CMS 'Two-Midnight' rule-making process and decision on inpatient payments Monitored H.R.1083, Medicaid Physician Self-Referral Act of 2015 (all sections of full text) Monitored H.R. 4273 Medicare and Medicaid Improvements and Adjustments Act of 2015; monitored the lowering of Medicare outpatient site neutral rate proposals Monitored H.R. 4428 Fair Medicare Hospital Payments Act of 2016 Monitored H.R. 5273 Helping Hospitals Improve Patient Care Act of 2016 Monitored H.R. 5547 Heath Care Price Transparency Promotion Act of 2016

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of the Vice President of the United States, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. H.R.5273 - Helping Hospitals Improve Patient Care Act of 2016 - Would provide some relief to hospitals in site-neutral payments, readmissions adjustments and other polices. Discussed with congressional staff about the bills limited impact to Texas hospitals in relation to hospital outpatient departments. Encouraged additional work in the Senate to help a broader range of hospitals that had their payment structure changed without notice.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. H.R.5273 - Helping Hospitals Improve Patient Care Act of 2016 - Would provide some relief to hospitals in site-neutral payments, readmissions adjustments and other polices. Discussed with congressional staff about the bills limited impact to Texas hospitals in relation to hospital outpatient departments. Encouraged additional work in the Senate to help a broader range of hospitals that had their payment structure changed without notice.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688, H.R. 5273) Medicare audit contractor program reforms (H.R. 2156, S. 2368) Rural hospital policies (H.R. 663 / S. 332, H.R. 169/S. 258, H.R. 1611/S. 257, S. 1461/H.R. 2878, H.R. 5164, H.R. 5613, CAH cost-based reimbursement) Telehealth, interoperability, health information technology (H.R. 6, S. 2511, S. 2484/H.R. 4442) Post-Acute Care policies (H.R. 3298), home health prior authorization S. 2108, H.R. 5713 Graduate Medical Education policy (H.R. 2124, S. 1148, H.R 3292) HR 976, HR 2513 DSH payment Bundled payment programs Clinical lab payment policy MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies (H.R. 5273) Stark Law reforms H.R. 4428 Star Ratings Medicare Part B drug payment model Medicare Advantage

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions pertinent to the proposed reduction in the amount of Medicare bad debt payments to hospitals for Medicare beneficiaries who fail to pay their cost sharing obligations for treatments provided by the hospital HR1190, Protecting Seniors' Access to Medicare Act of 2015 (all sections of full text) S141, Protecting Seniors' Access to Medicare Act of 2015 (all sections of full text) S.2680 Mental Health Reform Act of 2016 (all sections of full text) S.1945 Mental Health Reform Act of 2015 (all sections of full text) Issues involving nominations to federally authorized commissions HR2646, Helping Families in Mental Health Crisis Act of 2015 (all sections of full text) S.1893 Mental Health Awareness and Improvement Act of 2015 (all sections of full text) Monitored the HHS/CMS 'Two-Midnight' rule-making process and decision on inpatient payments Monitored HR1083, Medicaid Physician Self-Referral Act of 2015 (All sections of full text) Monitored HR4273 Medicare and Medicaid Improvements and Adjustments Act of 2015; monitored the lowering of Medicare outpatient site neutral proposals Monitored HR4428 Fair Medicare Hospital Payments Act of 2016 Monitored HR5273 Helping Hospitals Improve Patient Care Act of 2016 Monitored HR 5547 Health Care Price Transparency Promotion Act of 2016

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program Medicare audit contractor program reforms Telehealth, interoperability, health information technology Post Acute Care policies, home health prior authorization Graduate Medical Education policy DSH payment MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act/site neutral payment policies Stark law reforms HR 4428 Star Ratings

Client expense: $260,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 688 Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. All provisions. H.R. 1343 Establishing Beneficiary Equity in Hospital Readmission Program Act of 2015. All provisions. Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter. All Provisions. P.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. H.R. 2156 - Medicare Audit Improvement Act of 2015. All provisions. S. 1148 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 2124 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 3292 - Medicare IME Pool Act of 2015. H.R. 3288 - The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015. H.R. 3291- The Medicare Crosswalk Hospital Code Development Act of 2015. H.R. 4428 - Fair Medicare Hospital Payments Act CMS Hospital Compare star ratings - All provisions Comments invited by House Energy and Commerce Committee concerning Section 603 of the Bipartisan Budget Act of 2015, P.L. 114-74 - Site Neutral payment policy P.L. 114-10 - Medicare Access and CHIP Reauthorization Act of 2015 - Centers for Medicare and Medicaid Proposed Rule. All provisions Centers for Medicare and Medicaid Services Proposed Medicare Part B Drug Payment Model All provisions. H.R. 5723 - Helping Hospital Improve Patient Care Act of 2016. All provisions. Centers for Medicare and Medicaid Services Outpatient Prospective Payment System proposed rule for calendar year 2017 implementing Section 603 of the Bipartisan Budget Act of 2015, "Treatment of Off-Campus Outpatient Departments of a Provider" - All provisions.

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

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

Graduate Medical Education (GME) issues (including Resident Physician Shortage Reduction Act (H.R.2124/S.1148) - support); provided comments to Congress in response to Energy and Commerce Committee request for input on GME; amendments to the Medicare hospital re-admissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.1343/S.688 - support; proposals to amend the 2 midnight policy - support; hospital issues included in President Obama's FY 16 budget - oppose; hospital issues included in H.R.2, the Medicare Access and CHIP Re-authorization Act of 2015 - support; legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; Strengthening Medicare Advantage through Innovation and Transparency for Seniors (H.R.2570) - oppose; Medicare Inpatient Prospective Payment System FY 2016 proposed rule (CMS 1632-P) - detailed comment letter; legislation to improve the recovery audit contractor program (H.R.2156); Audit and Appeal Fairness, Integrity and Reforms in Medicare Act (AFIRM) - provided comments to the Senate Finance Committee; Ensuring Seniors Access to Local Pharmacies Act of 2015 (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Act (S.776) - support; CMS-4159-F2 - comments on daily dispensing fees; Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (P.L.114-39) - support; provided comments on the proposed Medicare outpatient prospective payment system rule (CMS-1633-P); Medicare IME Pool Act of 2015 (H.R.3292) - oppose; Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act (H.R.3288) - oppose; Medicare Crosswalk Hospital Code Development Act (H.R. 3291) - oppose; sign-on letter to CMS urging it to reconsider negative update for CY 2016 (CMS-1633-P) - support; proposed Medicare and Medicaid cuts as offsets to pay for budget increases, raising the debt ceiling, etc. - oppose; site neutral hospital outpatient cuts and other hospital related provisions included in the Bipartisan Budget Act of 2015 (H.R. 1314) - oppose; legislative proposals (H.R. 5273)and Congressional letters to amend the Bipartisan Budget Acts site neutral hospital outpatient payment cut to grandfather sites under development as well as other legislative changes (support) - advocated for their inclusion in the Consolidated Appropriations Act of 2016 (Omnibus legislation/Senate amendment to H.R. 2029); provided comments to Congress regarding provisions in the Mental Health Reform Act of 2015 (S. 1945), that would reform how health care information for substance abuse patients is shared; met with HHS officials on Medicare and Medicaid issues of importance to the Commonwealth of Puerto Rico and Puerto Rican health care providers; submitted comments on Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (CMS-3260-P); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913) - support (with some concerns about pharmacy lock-in policy); hospital issues included in House FY 17 budget - oppose; hosptial issues included in President Obama's FY 17 budget proposal - oppose; provided comments in response to Energy and Commerce Committee request for input on hospital site-neutral issues; Medicaid provisions included in the Common Sense Savings Act of 2016 (H.R.4725) - oppose; provided comments to CMS and Congress regarding the Hospital Compare Star Ratings for hospitals - support for delay and fixing measures; The Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) - oppose; provided comments to CMS on hospital site-neutral proposals - argued for flexibility in the anticipated OPPS proposed rule; provided comments to CMS on the FY 17 IPPS proposed rule (CMS-1655-P) with a focus on opposition to the proposed Medicare DSH policy and provided input to Capitol Hill and the Administration;submitted comments on Medicaid Program,Covered Outpatient Drugs (CMS-2345-FC); asked Congressional members to urge CMS to finalize its 2014 proposed guidance to Part D drug plans and PBMs regarding consistent reporting of Direct and Indirect Remuneration (DIR); Improving Transparency & Accuracy in Medicare Part D Spending (S.3308/H.R.5957) - support; testified at House Ways and Means Health Subcommittee hearing entitled "Incentivizing Quality Outcomes in Medicare Part A" in support of streamlining hospital measures and reporting; provided comments regarding the Medicare OPPS CY2017 proposed rule (81 FR 45603), in particular in opposition to implementation of site-neutral proposals; provided comments on Merit Based Incentive Payment System (MIPS)and Alternative Payment Models (APMs) under MACRA 2015 (81 FR 28161); discussions with CMS regarding priority categories for redistribution of Medicare-funded residency slots; discussions with CMS to encourage consistency in hospital surveys; submitted comments on the Part B Drug Payment Model proposed rule (CMS-1670-P) - serious concerns; submitted comments on the SNF PPS proposed rule (CMS-1645-P) - serious concerns; Texas proposed Medicaid State Plan Amendment (15-005) in response to the CMS Covered Outpatient Drug Rule (CMS-2345-FC) - concerns.

Client expense: $410,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Discussions pertinent to the proposed reduction in the amount of Medicare bad debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital H.R.1190, Protecting Seniors Access to Medicare Act of 2015 (all sections of full text) S.141, Protecting Seniors Access to Medicare Act of 2015 (all sections of full text) S. 2680 Mental Health Reform Act of 2016 (all sections of full text)(support) S.1945 Mental Health Reform Act of 2015 (all sections of full text)(support) H.R. 2646, Helping Families in Mental Health Crisis Act of 2015 (all sections of full text)(support) S. 1893 Mental Health Awareness and Improvement Act of 2015 (all sections of full text)(support) Monitored the HHS/CMS 'Two-Midnight' rule-making process and decision on inpatient payments Monitored H.R.1083, Medicaid Physician Self-Referral Act of 2015 (all sections of full text) Monitored H.R. 4273 Medicare and Medicaid Improvements and Adjustments Act of 2015; monitored the lowering of Medicare outpatient site neutral rate proposals Monitored H.R. 4428 Fair Medicare Hospital Payments Act of 2016 Monitored H.R. 5273 Helping Hospitals Improve Patient Care Act of 2016 Monitored H.R. 5547 Heath Care Price Transparency Promotion Act of 2016

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5273, the Helping Hospitals Improve Patient Care Act of 2016 - provisions related to SES adjustment for the hospital readmissions reduction program and off campus HOPD billing under OPPS H.R. 4428, the Fair Hospital Payments Act of 2016 - provisions related to Medicare geographic wage index Issues related to extension of the TennCare Medicaid 1115 waiver Issues related to CMS audits of TennCare Medicaid DSH H.R. 5001, the Flexibility in Electronic Health Record Reporting Act - provisions related to EHR Meaningful Use stage 3 General issues around outlook for legislation related to hospitals Issues related to Graduate Medical Education (GME) Issues related to CMS star ratings Issues related to CMS Comprehensive Care for Joint Replacement Model Issues around EHR Meaningful Use Stage 3

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 2832 - Fair Medicare Hospital Payments Act of 2016 H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 H.R. 3299 - Strengthening Public Health Emergency Response Act of 2015 H.R. 4428 - To amend title XVIII of the Social Security Act to ensure fairness in Medicare hospital payments by establishing a floor for the area wage index applied with respect to certain hospitals. H.R. 3716 - Ensuring Terminated Providers are Removed from Medicaid and CHIP Act S.2467 - The Patient Safety Improvement Act H.R. 4725 - The Common Sense Savings Act H.R. 2156 - Medicare Audit Improvement Act H.R. 1342 / S.688 - Establishing Beneficiary Equity in the Hospital Readmission Program Act Critical Access Hospital Reimbursement CMS-5517-P, Medicare Program: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models; Proposed Rule, May 9, 2016 CMS-1645-P, Medicare Program: Skilled Nursing Facility Prospective Payment System for Federal Fiscal Year 2017; Proposed Rule, April 25, 2016 CMS-1647-P, Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2016; Proposed Rule, April 25, 2016 CMS-1655-P, Medicare Program: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; and Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Proposed Rule, April 27, 2016 (CMS-1655-P) CMS-1655-P, Medicare Program: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; and Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Proposed Rule, April 27, 2016 Public Law 114-74 CMS-1670-P, Medicare Program: Part B Drug Payment Model, Proposed Rule (Vol. 81, No. 48, March 11, 2016) CMS 10599; Home health prior authorization

Client expense: $285,512 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Social Security Administration (SSA)

Discussions pertinent to the proposed reduction in the amount of Medicare bad debt payments to hospitals for Medicare beneficiaries who fail to pay their cost sharing obligations for treatments provided by the hospital HR1190, Protecting Seniors' Access to Medicare Act of 2015 (all sections of full text) S141, Protecting Seniors' Access to Medicare Act of 2015 (all sections of full text) S.2680 Mental Health Reform Act of 2016 (all sections of full text) S.1945 Mental Health Reform Act of 2015 (all sections of full text) Issues involving nominations to federally authorized commissions HR2646, Helping Families in Mental Health Crisis Act of 2015 (all sections of full text) S.1893 Mental Health Awareness and Improvement Act of 2015 (all sections of full text) Monitored the HHS/CMS 'Two-Midnight' rule-making process and decision on inpatient payments Monitored HR1083, Medicaid Physician Self-Referral Act of 2015 (All sections of full text) Monitored HR4273 Medicare and Medicaid Improvements and Adjustments Act of 2015; monitored the lowering of Medicare outpatient site neutral proposals Monitored HR4428 Fair Medicare Hospital Payments Act of 2016 Monitored HR5273 Helping Hospitals Improve Patient Care Act of 2016 Monitored HR 5547 Health Care Price Transparency Promotion Act of 2016

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. Provided education to members of Congress and their staff about the importance of adequate funding for the Hospital Preparedness Program. Worked with members of Congress and staff on proposals for combating the Zika virus and encouraged adequate funding of these plans. H.R. 2646 - Helping Families in Mental Health Crisis Act of 2016 - Would make a variety of sweeping changes to the mental health infrastructure and while also reforming provider outreach, community-based treatment options, and justice system reform. - Discussed with staff how THA support the overall direction this bill would take the mental health system, and encouraged the use of community care in reforming the way we address mental health issues. Encouraged congressional staff to approve the bill, but expressed concern for lack of funding. Without adequate funding, states cannot properly implement the programs in the legislation. S.524 Comprehensive Addiction and Recovery Act (CARA) - wound enact policies intended to re-engineer how health care providers, communities and the criminal justice system coordinates care to treat addiction. - Expressed support for the overall goals of the bill and the programs to be established by the legislation, but THA is concerned with the lack of funding in the legislation. Without funding, states and localities cannot adequately address and combat the opioid addiction crisis. H.R.5273 - Helping Hospitals Improve Patient Care Act of 2016 - Would provide some relief to hospitals in site-neutral payments, readmissions adjustments and other polices. Discussed with congressional staff about the bills limited impact to Texas hospitals in relation to hospital outpatient departments. Encouraged additional work in the Senate to help a broader range of hospitals who had their payment structure changed without notice. H.R.2745 - Standard Merger and Acquisition Reviews Through Equal Rules Act of 2015 - Would standardize the merger review process for the Department of Justice (DOJ) and Federal Trade Commission (FTC). Met with congressional staff on how the merger review process impacts hospital mergers and how this legislation would eliminate disparities between the two reviewing agencies. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. H.R.1343/S.688 - Would require CMS to take into account patients' sociodemographic status when imposing financial penalties for excessive hospital readmissions for Medicare patients. - Met with congressional staff on how socioeconomic status impacts health and the importance of this legislation, especially to large safety net hospitals. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. Discussed with members of Congress and staff the implications, concerns with and the misguided policies in the proposed rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. H.R.5273 - Helping Hospitals Improve Patient Care Act of 2016 - Would provide some relief to hospitals in site-neutral payments, readmissions adjustments and other polices. Discussed with congressional staff about the bills limited impact to Texas hospitals in relation to hospital outpatient departments. Encouraged additional work in the Senate to help a broader range of hospitals that had their payment structure changed without notice. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Graduate Medical Education (GME) issues (including Resident Physician Shortage Reduction Act (H.R.2124/S.1148) - support); provided comments to Congress in response to Energy and Commerce Committee request for input on GME; amendments to the Medicare hospital re-admissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.1343/S.688 - support; proposals to amend the 2 midnight policy - support; hospital issues included in President Obama's FY 16 budget - oppose; hospital issues included in H.R.2, the Medicare Access and CHIP Re-authorization Act of 2015 - support; legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; Strengthening Medicare Advantage through Innovation and Transparency for Seniors (H.R.2570) - oppose; Medicare Inpatient Prospective Payment System FY 2016 proposed rule (CMS 1632-P) - detailed comment letter; legislation to improve the recovery audit contractor program (H.R.2156); Audit and Appeal Fairness, Integrity and Reforms in Medicare Act (AFIRM) - provided comments to the Senate Finance Committee; Ensuring Seniors Access to Local Pharmacies Act of 2015 (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Act (S.776) - support; CMS-4159-F2 - comments on daily dispensing fees; Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (P.L.114-39) - support; provided comments on the proposed Medicare outpatient prospective payment system rule (CMS-1633-P); Medicare IME Pool Act of 2015 (H.R.3292) - oppose; Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act (H.R.3288) - oppose; Medicare Crosswalk Hospital Code Development Act (H.R. 3291) - oppose; sign-on letter to CMS urging it to reconsider negative update for CY 2016 (CMS-1633-P) - support; proposed Medicare and Medicaid cuts as offsets to pay for budget increases, raising the debt ceiling, etc. - oppose; site neutral hospital outpatient cuts and other hospital related provisions included in the Bipartisan Budget Act of 2015 (H.R. 1314) - oppose; legislative proposals (H.R. 5273)and Congressional letters to amend the Bipartisan Budget Acts site neutral hospital outpatient payment cut to grandfather sites under development as well as other legislative changes (support) - advocated for their inclusion in the Consolidated Appropriations Act of 2016 (Omnibus legislation/Senate amendment to H.R. 2029); provided comments to Congress regarding provisions in the Mental Health Reform Act of 2015 (S. 1945), that would reform how health care information for substance abuse patients is shared; met with HHS officials on Medicare and Medicaid issues of importance to the Commonwealth of Puerto Rico and Puerto Rican health care providers; submitted comments on Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (CMS-3260-P); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913) - support (with some concerns about pharmacy lock-in policy); hospital issues included in House FY 17 budget - oppose; hosptial issues included in President Obama's FY 17 budget proposal - oppose; provided comments in response to Energy and Commerce Committee request for input on hospital site-neutral issues; Medicaid provisions included in the Common Sense Savings Act of 2016 (H.R.4725) - oppose; provided comments to CMS and Congress regarding the Hospital Compare Star Ratings for hospitals - support for delay and fixing measures; The Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) - oppose; provided comments to CMS on hospital site-neutral proposals - argued for flexibility in the anticipated OPPS proposed rule; provided comments to CMS on the FY 17 IPPS proposed rule (CMS-1655-P) with a focus on opposition to the proposed Medicare DSH policy and provided input to Capitol Hill and the Administration;submitted comments on Medicaid Program,Covered Outpatient Drugs (CMS-2345-FC); asked Congressional members to urge CMS to finalize its 2014 proposed guidance to Part D drug plans and PBMs regarding consistent reporting of Direct and Indirect Remuneration (DIR).

Client expense: $330,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688, H.R. 5273) Medicare audit contractor program reforms (H.R. 2156, S. 2368) Rural hospital policies (H.R. 663 / S. 332, H.R. 169/S. 258, H.R. 1611/S. 257, S. 1461/H.R. 2878, H.R. 5164) Telehealth, interoperability, health information technology (H.R. 6, S. 2511, S. 2484/H.R. 4442) Post-Acute Care policies, home health prior authorization Graduate Medical Education policy (H.R. 2124, S. 1148, H.R 3292) DSH payment Clinical lab payment policy MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies (H.R. 5273) Stark Law reforms H.R. 4428 Star Ratings Medicaid Managed Care rule Medicare Part B drug payment model Medicare Advantage

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions pertinent to the proposed reduction in the amount of Medicare bad debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital H.R.1190, Protecting Seniors Access to Medicare Act of 2015 (all sections of full text) S.141, Protecting Seniors Access to Medicare Act of 2015 (all sections of full text) S. 2680 Mental Health Reform Act of 2016 (all sections of full text) S.1945 Mental Health Reform Act of 2015 (all sections of full text) Issues involving nominations to federally authorized commissions H.R. 2646, Helping Families in Mental Health Crisis Act of 2015 (all sections of full text) S. 1893 Mental Health Awareness and Improvement Act of 2015 (all sections of full text) Monitored the HHS/CMS 'Two-Midnight' rule-making process and decision on inpatient payments Monitored H.R.1083, Medicaid Physician Self-Referral Act of 2015 (all sections of full text) Monitored H.R. 4273 Medicare and Medicaid Improvements and Adjustments Act of 2015; monitored the lowering of Medicare outpatient site neutral rate proposals Monitored H.R. 4428 Fair Medicare Hospital Payments Act of 2016 Monitored H.R. 5273 Helping Hospitals Improve Patient Care Act of 2016 Monitored H.R. 5547 Heath Care Price Transparency Promotion Act of 2016

Client expense: Not reported · Firm income: $230,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Extending the imputed floor policy for all-urban states, Medicare legislation regarding the face-to-face documentation requirement for home health payments, legislative proposals to require a field for unique device indicators on health insurance forms, the Trauma Systems and Regionalization of Emergency Care Reauthorization Act (S. 763), the Fair Medicare Hospital Payments Act of 2016 (H.R. 4428), legislation to alter Section 603 of the Bipartisan Budget Act of 2015, efforts to eliminate Medicare Sequestration, efforts to oppose site-neutral Medicare payments, S.688 - the Establishing Beneficiary Equity in the Hospital Readmission Program Act, H.R.2156 - the Medicare Audit Improvement Act, S.1148, the Resident Physician Shortage Reduction Act, H.R. 1604, the Veterans' Mental Health Care Access Act, S.524 the Comprehensive Addiction and Recovery Act, implementation of the Medicare Access & CHIP Reauthorization Act, the Hospital Compare Star Rating System, Stark Law reform, mental health reform, H.R. 5273 - the Helping Hospitals Improve Patient Care Act of 2016.

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

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

Extending the imputed floor policy for all-urban states, Medicare legislation regarding the face-to-face documentation requirement for home health payments, legislative proposals to require a field for unique device indicators on health insurance forms, the Trauma Systems and Regionalization of Emergency Care Reauthorization Act (S. 763), the Fair Medicare Hospital Payments Act of 2016 (H.R. 4428), legislation to alter Section 603 of the Bipartisan Budget Act of 2015, efforts to eliminate Medicare Sequestration, efforts to oppose site-neutral Medicare payments, S.688 - the Establishing Beneficiary Equity in the Hospital Readmission Program Act, H.R.2156 - the Medicare Audit Improvement Act, S.1148, the Resident Physician Shortage Reduction Act, H.R. 1604, the Veterans' Mental Health Care Access Act, S.524 the Comprehensive Addiction and Recovery Act, implementation of the Medicare Access & CHIP Reauthorization Act, the Hospital Compare Star Rating System, Stark Law reform, mental health reform, H.R. 5273 - the Helping Hospitals Improve Patient Care Act of 2016

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

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

S. 688 Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. All provisions. H.R. 1343 Establishing Beneficiary Equity in Hospital Readmission Program Act of 2015. All provisions. Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter. All Provisions. P.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. H.R. 2156 - Medicare Audit Improvement Act of 2015. All provisions. S. 1148 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 2124 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 3292 - Medicare IME Pool Act of 2015. H.R. 3288 - The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015. H.R. 3291- The Medicare Crosswalk Hospital Code Development Act of 2015. H.R. 4428 - Fair Medicare Hospital Payments Act CMS Hospital Compare star ratings - All provisions Comments invited by House Energy and Commerce Committee concerning Section 603 of the Bipartisan Budget Act of 2015, P.L. 114-74 - Site Neutral payment policy P.L. 114-10 - Medicare Access and CHIP Reauthorization Act of 2015 - Centers for Medicare and Medicaid Proposed Rule. All provisions Centers for Medicare and Medicaid Services Proposed Medicare Part B Drug Payment Model All provisions. H.R. 5723 - Helping Hospital Improve Patient Care Act of 2016. All provisions.

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

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

H.R. 4428 - To amend title XVIII of the Social Security Act to ensure fairness in Medicare hospital payments by establishing a floor for the area wage index applied with respect to certain hospitals. H.R. 3716 - Ensuring Terminated Providers are Removed from Medicaid and CHIP Act S.2467 - The Patient Safety Improvement Act H.R. 4725 - The Common Sense Savings Act H.R. 2156 - Medicare Audit Improvement Act H.R. 1342 / S.688 - Establishing Beneficiary Equity in the Hospital Readmission Program Act

Client expense: $313,500 · Firm income: Not reported

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

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. Provided education to members of Congress and their staff about the importance of adequate funding for the Hospital Preparedness Program. Worked with members of Congress and staff on proposals for combating the Zika virus and encouraged adequate funding of these plans. H.R.2745 - Standard Merger and Acquisition Reviews Through Equal Rules Act of 2015 - Would standardize the merger review process for the Department of Justice (DOJ) and Federal Trade Commission (FTC). Met with congressional staff on how the merger review process impacts hospital mergers and how this legislation would eliminate disparities between the two reviewing agencies. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R. 953 Comprehensive Addiction and Recovery Act - Discussed with congressional staff how hospitals are involved with treating and caring for opioid and other substance abuse patients. Discussed limitations and flexibility within current law and congressional proposals. S.2002 - Mental Health and Safe Communities Act of 2015 - Talked with Senate staff about the importance of adequate funding and coordination of care across multiple disciplines, including hospitals, law enforcement, judicial system, outpatient clinics, community-based treatment and more. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. H.R.1343/S.688 - Would require CMS to take into account patients' sociodemographic status when imposing financial penalties for excessive hospital readmissions for Medicare patients. - Met with congressional staff on how socioeconomic status impacts health and the importance of this legislation, especially to large safety net hospitals. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. H.R. 2646 - Helping Families in Mental Health Crisis Act of 2015 - Would make a variety of sweeping changes to the mental health infrastructure and while also reforming provider outreach, community-based treatment options, and justice system reform. - Discussed with staff how THA support the overall direction this bill would take the mental health system, and encouraged the use of community care in reforming the way we address mental health issues. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provided education to Members of Congress and their staff about renewal of a Texas Medicaid 1115 demonstration waiver, the impact of Delivery System Reform Improvement Projects across the state and the role of hospitals in the waiver. Also provided information on the states 1115 waiver renewal application submitted to CMS in September and the timeline for negotiation over the next year. Provided data to Members of the Texas congressional delegation and their staff on the number of uninsured individuals in each district and statewide. Provided information on the uncompensated care burden in the state and how that impacts the 1115 waiver renewal as well as the safety net in the state. H.R.4428 - Fair Medicare Hospital Payments Act of 2016 - would establish a national minimum of 0.874 for the Medicare Area Wage Index for Hospital Inpatient Services (Medicare Part A) and the Medicare Area Wage Adjustment Factor for Hospital Outpatient Department Services (Medicare Part B). Discussed with congressional staff the importance of leveling the Area Wage Index playing field for hospitals across the nation. Dozens of hospitals in Texas are negatively impacted by low AWI. While he AWI is designed so the average AWI is 1.0, Texas does not contain a single CBSA with an AWI at 1.0 or greater. H.R.1479 - Repeal of the Obamacare Bay State Boondoogle Act - Would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. - Discussed with congressional staff and members of Congress that provisions related to how the current Medicare Area Wage Index impacts hospitals in Texas, and how the implementation of a rural floor would help rural hospitals across the state and country. H.R. 2124, Resident Physician Shortage Reduction Act -- Would prevent a looming doctor shortage by ensuring additional residency slots are available for teaching hospitals. Educated members of congress and staff on Graduate Medical Education and why we must increase residency slots to meet the growing demand by medical students and to help counteract the ever-growing physician shortage . Teaching hospitals and academic medical centers rely on support from the GME program to fulfill their mission of training physicians for the public good, furnishing highly-specialized care to the most medically complex patients, and delivering essential health care services to the community. H.R. 3119 - Palliative Care and Hospice Education and Training Act - Would authorize grants to improve the training of health professionals in palliative care. S.2425 - Patient Access and Medicare Protection Act - would allow CMS to create a blanket hardship exemption from 2015 electronic health record meaningful use requirements and related payment adjustments to all providers who ask for it. The penalties would have been assessed in 2017. Rural Hospital Issues: Discussed a variety of issues impacting rural and critical access hospitals with members of congress and their staff. Rural hospitals would greatly benefit from the passage of several pieces of legislation that would relieve onerous burdens and help the facilities better serve their communities. Specific legislation discussed includes: H.R.1479, S.1648, S.332, H.R.169/S.258, H.R.3225

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688) Medicare audit contractor program reforms (H.R. 2156, S. 2368) Rural hospital policies (H.R. 663 / S. 332, H.R. 169/S. 258, H.R. 1611/S. 257, S. 1461/H.R. 2878) Telehealth, interoperability, health information technology (H.R. 6, S. 2511, S. 2484/H.R. 4442) Physician self-referral (H.R. 2027, H.R. 976) Hospital Improvements for Payment Act (H.R. 3291) Post-Acute Care policies (H.R. 1458, H.R. 3298) Graduate Medical Education policy reforms (H.R. 2124, S. 1148, H.R 3292) DSH payment (H.R. 3288) H.R. 4428 Clinical lab payment policy Discharge planning MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies Stark Law reforms

Client expense: $83,731 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions pertinent to the proposed reduction in the amount of Medicare bad debt payments to hospitals for Medicare beneficiaries who fail to pay their cost sharing obligations for treatments provided by the hospital HR1190, Protecting Seniors' Access to Medicare Act of 2015 (all sections of full text) S141, Protecting Seniors' Access to Medicare Act of 2015 (all sections of full text) Monitored delay of the HHS/CMS 'Two-Midnight' rule-making process Monitored HR2646, Helping Families in Mental Health Crisis Act of 2015 S.2680 Mental Health Reform Act of 2016 (all sections of full text) S.1945 Mental Health Reform Act of 2015 (all sections of full text) Monitored S.1893 Mental Health Awareness and Improvement Act of 2015 Monitored HR1083, Medicaid Physician Self-Referral Act of 2015 (All sections of full text) Issues involving nominations to federally authorized commissions Monitored HR4273 Medicare and Medicaid Improvements and Adjustments Act of 2015; monitored the lowering of Medicare outpatient site neutral proposals Monitored HR4428 Fair Medicare Hospital Payments Act of 2016

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions pertinent to the proposed reduction in the amount of Medicare bad debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital H.R.1190, Protecting Seniors Access to Medicare Act of 2015 (all sections of full text) S.141, Protecting Seniors Access to Medicare Act of 2015 (all sections of full text) S. 2680 Mental Health Reform Act of 2016 (all sections of full text) S.1945 Mental Health Reform Act of 2015 (all sections of full text) Issues involving nominations to federally authorized commissions Monitored H.R. 2646, Helping Families in Mental Health Crisis Act of 2015 Monitored S. 1893 Mental Health Awareness and Improvement Act of 2015 Monitored the delay of the HHS/CMS 'Two-Midnight' rule-making process Monitored H.R.1083, Medicaid Physician Self-Referral Act of 2015 (all sections of full text) Monitored H.R. 4273 Medicare and Medicaid Improvements and Adjustments Act of 2015; monitored the lowering of Medicare outpatient site neutral rate proposals Monitored H.R. 4428 Fair Medicare Hospital Payments Act of 2016

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Graduate Medical Education (GME) issues (including Resident Physician Shortage Reduction Act (H.R.2124/S.1148) - support); provided comments to Congress in response to Energy and Commerce Committee request for input on GME; amendments to the Medicare hospital re-admissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.1343/S.688 - support; proposals to amend the 2 midnight policy - support; hospital issues included in President Obama's FY 16 budget - oppose; hospital issues included in H.R.2, the Medicare Access and CHIP Re-authorization Act of 2015 - support; legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; Strengthening Medicare Advantage through Innovation and Transparency for Seniors (H.R.2570) - oppose; Medicare Inpatient Prospective Payment System FY 2016 proposed rule (CMS 1632-P) - detailed comment letter; legislation to improve the recovery audit contractor program (H.R.2156); Audit and Appeal Fairness, Integrity and Reforms in Medicare Act (AFIRM) - provided comments to the Senate Finance Committee; Ensuring Seniors Access to Local Pharmacies Act of 2015 (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Act (S.776) - support; CMS-4159-F2 - comments on daily dispensing fees; Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (P.L.114-39) - support; provided comments on the proposed Medicare outpatient prospective payment system rule (CMS-1633-P); Medicare IME Pool Act of 2015 (H.R.3292) - oppose; Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act (H.R.3288) - oppose; Medicare Crosswalk Hospital Code Development Act (H.R. 3291) - oppose; sign-on letter to CMS urging it to reconsider negative update for CY 2016 (CMS-1633-P) - support; proposed Medicare and Medicaid cuts as offsets to pay for budget increases, raising the debt ceiling, etc. - oppose; site neutral hospital outpatient cuts and other hospital related provisions included in the Bipartisan Budget Act of 2015 (H.R. 1314) - oppose; legislative proposals and Congressional letters to amend the Bipartisan Budget Acts site neutral hospital outpatient payment cut to grandfather sites under development as well as other legislative changes (support) - advocated for their inclusion in the Consolidated Appropriations Act of 2016 (Omnibus legislation/Senate amendment to H.R. 2029); provided comments to Congress regarding provisions in the Mental Health Reform Act of 2015 (S. 1945), that would reform how health care information for substance abuse patients is shared; met with HHS officials on Medicare and Medicaid issues of importance to the Commonwealth of Puerto Rico and Puerto Rican health care providers; submitted comments on Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (CMS-3260-P); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913) - support (with some concerns about pharmacy lock-in policy); hospital issues included in House FY 17 budget - oppose; hosptial issues included in President Obama's FY 17 budget proposal - oppose; provided comments in response to Energy and Commerce Committee request for input on hospital site-neutral issues; Medicaid provisions included in the Common Sense Savings Act of 2016 (H.R.4725) - oppose; provided comments to CMS and Congress regarding the Hospital Compare Star Ratings for hospitals - support for delay and fixing measures; The Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) - oppose.

Client expense: $320,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Extending the imputed floor policy for all-urban states, Medicare legislation regarding the face-to-face documentation requirement for home health payments, legislative proposals to require a field for unique device indicators on health insurance forms, the Trauma Systems and Regionalization of Emergency Care Reauthorization Act (S. 763), the Fair Medicare Hospital Payments Act of 2016 (H.R. 4428), legislation to alter Section 603 of the Bipartisan Budget Act of 2015, efforts to eliminate Medicare Sequestration, efforts to oppose site-neutral Medicare payments, S.688 - the Establishing Beneficiary Equity in the Hospital Readmission Program Act, H.R.2156 - the Medicare Audit Improvement Act, S.1148, the Resident Physician Shortage Reduction Act, H.R. 1604, the Veterans' Mental Health Care Access Act

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

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

Extending the imputed floor policy for all-urban states, Medicare legislation regarding the face-to-face documentation requirement for home health payments, legislative proposals to require a field for unique device indicators on health insurance forms, the Trauma Systems and Regionalization of Emergency Care Reauthorization Act (S. 763), the Fair Medicare Hospital Payments Act of 2016 (H.R. 4428), legislation to alter Section 603 of the Bipartisan Budget Act of 2015, efforts to eliminate Medicare Sequestration, efforts to oppose site-neutral Medicare payments, S.688 - the Establishing Beneficiary Equity in the Hospital Readmission Program Act, H.R.2156 - the Medicare Audit Improvement Act, S.1148, the Resident Physician Shortage Reduction Act, H.R. 1604, the Veterans' Mental Health Care Access Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 688 Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. All provisions. H.R. 1343 Establishing Beneficiary Equity in Hospital Readmission Program Act of 2015. All provisions. Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter. All Provisions. P.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. H.R. 2156 - Medicare Audit Improvement Act of 2015. All provisions. S. 1148 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 2124 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 3292 - Medicare IME Pool Act of 2015. H.R. 3288 - The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015. H.R. 3291- The Medicare Crosswalk Hospital Code Development Act of 2015. H.R. 4428 - Fair Medicare Hospital Payments Act CMS Hospital Compare star ratings - All provisions Comments invited by House Energy and Commerce Committee concerning Section 603 of the Bipartisan Budget Act of 2015, P.L. 114-74 - Site Neutral payment policy

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

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