Incentivizing Medicaid Expansion Act of 2016

Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 H.R. 5164 - Rural Hospital Regulatory Relief Act H.R. 5210/S. 2736 - Patient Access to Durable Medical Equipment Act H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 H.R. 5613/S. 3129 - Continuing Access to Hospitals Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act S. 2787 - States Achieve Medicaid Expansion (SAME) Act S. 3130 - Independence at Home Act of 2016

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Medicare and Medicaid issues, Medigap issues, Medicare Advantage, CHIP reform, chronic care reform HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (weather or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Taberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.

Medicare/Medicaid Issues; Medicare Advantage; CHIP Reform; Medicare Access & CHIP Reauthorization Act 2015 (MACRA); Chronic Care Reform; Exchanges; Site-neutral Payments; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; QHP Quality Rating System (QRS); MHP. HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. The Bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider termination, and for other purposes. HR 4588 Introduced February 23, 2016 by Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place.

Medigap; Medicare Advantage; CHIP Reform; Medicare Access & CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; Site-neutral Payments; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; QHP Quality Rating System (QRS); MHP; FAQ 8 and 9; Form 5500; Schedule J HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Tiberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.

Excellence in Mental Health Act (S.264); Medicaid and Medicare payment for Health Centers; Medicare Chronic Care Coordination; Medicaid quality reporting; Childrens Health Insurance Program (CHIP); Pharmacy Provider Status legislation(H.R.592/S.314); The Rural ACO Improvement Act of 2015(S.1456, S.2259 & S.2261); Telehealth legislation; Connect for Health Act (H.R.4442/S.2484); Incentivizing Medicaid Expansion Act(H.R.4588); ECHO Act (H.R.5395/S.2873); Rural ACO Provider Equity Act (H.R.5667); Rural Access to Hospice Act(H.R.5799); Rural ACO Provider Equity Act(H.R.5667).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 H.R. 5164 - Rural Hospital Regulatory Relief Act H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act S. 2787 - States Achieve Medicaid Expansion (SAME) Act

FQHCs and QHP payment rules per final rule on Establishment of Exchanges and Qualified Health Plans; QHP contracting requirements; Essential Community Provider rules; Excellence in Mental Health Act (S.264); Medicaid and Medicare payment for Health Centers; Medicare Chronic Care Coordination; Medicaid quality reporting; Childrens Health Insurance Program (CHIP); Pharmacy Provider Status legislation(H.R.592/S.314); The Rural ACO Improvement Act of 2015(S.1456, S.2259 & S.2261); Telehealth legislation; Connect for Health Act (H.R.4442/S.2484); Incentivizing Medicaid Expansion Act(H.R.4588); FQHC and hospice; ECHO Act (H.R.5395/S.2873); Rural ACO Provider Equity Act (H.R.5667).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Medigap; Medicare Advantage; CHIP Reform; Medicare Access & CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; ICD-10; Site-neutral Payments; Medicare Fraud; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; Medical Billing; Transparency Tools; QHP Quality Rating System (QRS) HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Taberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.

Medigap; Medicare Advantage; CHIP Reform; Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; ICD-10; Site-Neutral Payments; Medicare Fraud; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; Medical Billing; Transparency Tools; QHP Quality Rating System (QRS) HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21,2015 by Keith Rothfus (R-PA) this bill amends title XVII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (whether or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer treatment Act of 2015 to amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) to amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-Tx) To amend title XIX of the Social Security Act to provide the same levele of Federal Matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 1, 2016 by Patrick Taberi (R-OH) to amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data and for other purposes.

Medicare and Medicaid issues, Medigap issues, Medicare Advantage, CHIP reform, chronic care reform HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (weather or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Taberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.

Medicare and Medicaid issues, Medigap issues, Medicare Advantage, CHIP reform, chronic care reform HR 2488 Medicare Beneficiary Preservation of Choice Act of 2015 Introduced May 21, 2015 by Keith Rothfus (R-PA) This bill amends title XVIII (Medicare) of the Social Security Act to expand and modify enrollment and disenrollment options for Medicare Advantage (MA) eligible individuals. Specifically, the bill extends the annual period in which an individual enrolled in MA may elect to instead receive benefits under the original Medicare fee-for-service (FFS) program as well as elect to change qualified prescription drug coverage. Furthermore, any MA-eligible individual (weather or not enrolled in MA) may once per period change a previous election with respect to receiving benefits through MA or Medicare FFS, including changing from one MA plan to another. Unsolicited marketing during this period is prohibited. HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. HR 5273 Helping Hospitals Improve Patient Care Act of 2016 Introduced May 18, 2016 by Patrick Taberi (R-OH) To amend title XVIII of the Social Security Act to provide for regulatory relief under the Medicare program for certain providers of services and suppliers and increased transparency in hospital coding and enrollment data, and for other purposes.

Medicare Privatization. (No bill.) Proposals to transform traditional Medicare to a private insurance carrier program. Medicare Benefit Redesign. (No bill.) Proposals pertaining to Parts A and B deductibles; premiums, including means-testing; a catastrophic cap on out-of-pocket spending; the eligibility age; and proposals to privatize Medicare. Medicare Eligibility Age. (No bill.) Proposals to raise the eligibility age for Medicare from 65 to 67. Medicare Drug Savings. S. 1083, H.R. 2005, the Medicare Drug Savings Act: proposals to extend the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by Medicare-Medicaid eligible beneficiaries (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Prescription Drug Price Negotiation. H.R. 3061, S. 31, the Medicare Prescription Drug Price Negotiation Act of 2015: proposals to authorize the Secretary of the Department of Health and Human Services to negotiate discounts, rebates, and other price concessions to lower the cost paid by Medicare to pharmaceutical manufacturers. Medicare Prescription Drug Price Negotiation. H.R. 4207, Medicare Fair Drug Pricing Act of 2015: proposal to allow the Secretary of HHS to negotiate prices with manufacturers where little or no competition exists for drugs. Medicare Prescription Drug Plan Option. H.R. 3261, S. 1884, the Medicare Prescription Drug Savings and Choice Act of 2015: proposals to create one or more Medicare-administered drug plans with uniform premiums, providing seniors with the opportunity to purchase drugs directly through the Medicare program; requires the federal government to use its purchasing power to negotiate lower prices on prescription drugs for beneficiaries who enroll in the Medicare-administered plan. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Observation Status. S. 843, H.R. 1571, Improving Access to Medicare Coverage Act of 2015: proposal to count days in the hospital in observation status toward meeting the three-day prior hospitalization requirement for skilled nursing facility (SNF) care eligibility. Comprehensive Health Care Reform. P.L. 111-148, Patient Protection and Affordable Care Act; P.L. 111-152, Health Care and Education Reconciliation Act of 2010: implementation of provisions reducing Medicare Advantage plan payments; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); expanding coverage of prevention services; testing payment and delivery system reforms; and providing expanded Medicaid coverage. Patent Reform. S. 1137, Patent Act; H.R. 9, Innovation Act: proposal to carve brand-named pharmaceutical manufacturers out of an expedited United States Patent and Trademark Office (USPTO) review process that allows generic companies to bypass costly litigation when challenging drug patents. Expanding Drug Monopolies. H.R. 6, 21st Century Cures Act: proposal to extend orphan drug market exclusivity for existing drugs to new indications. Reducing Prescription Drug Costs. S. 2023, H.R. 3513, Prescription Drug Affordability Act: proposals to allow Medicare to negotiate drug prices, to allow Medicare and Medicaid to receive additional rebates from brand and generic drugs, and to allow for the re-importation of drugs from Canada. Reducing the cost of biologics. H.R. 5573, S. 3094, Price, Innovation and Competition for Essential Drugs (PRICED) Act: proposal to reduce the marketing exclusivity period for biologics from 12 to 7 years. Drug payment under Medicare Part B. H.R. 5122, to prohibit further action on the proposed rule regarding testing of Medicare Part B prescription drug models: proposal to prohibit implementation of a proposed demonstration testing new ways of paying physicians for drugs in order to eliminate incentives to unnecessarily prescribe high cost drugs. Medicare Fraud. H.R. 5340, Fighting Medicare Fraud Act: Legislation to close off a loophole allowing Medicare fraud offenders to evade enforcement authority when they move to a new company. Out-of-pocket drug costs. S.2864, RXCAP Act of 2016: proposal to cap out-of-pocket costs for Part D enrollees. Chronic Care Coordination. (No bill.) Proposals to facilitate the delivery of high-quality care for people with Medicare living with multiple chronic conditions. Medicare Vision, Dental and Hearing Coverage. H.R. 3308, Seniors Have Eyes, Ears and Teeth Act; H.R. 5396, the Medicare Dental, Vision, and Hearing Benefit Act of 2016: proposals to provide Medicare coverage for vision, hearing and dental services. Medicare Hearing Coverage. H.R. 1653, the Medicare Hearing Aid Coverage Act of 2015; H.R. 2748, the Help Extend Auditory Relief (HEAR) Act of 2015: proposals to provide Medicare coverage for the cost of hearing aids and examinations, to amend Medicare to cover aural rehabilitation services, hearing aids, audiology rehabilitation services, and related hearing services. Medicare Dental Coverage. S. 570, H.R. 1055, the Comprehensive Dental Reform Act: proposal to extend comprehensive dental coverage to all Medicare, Medicaid, and VA beneficiaries. Medicare Care Planning. S. 1549, the Care Planning Act of 2015: proposals to create a Medicare benefit for care planning, the coordination of services, to fill gaps in quality measurement in the advanced illness field. Medicare Private Plan Notification Improvements. (No bill.) Proposals to improve the annual notification Medicare private plans promulgate to Parts C and D enrollees pertaining to plan changes that will raise enrollee costs or limit access to products and services. Medicare Part B Payment Reforms. H.R. 5122: proposals to change the way Medicare pays doctors for administering drugs to eliminate incentives to prescribe drugs based on their expense instead of clinical need. Medicare Advantage Payment Reforms. (No bill.) Proposals to eliminate discrepancies in how much Medicare pays for services for similarly situated individuals in traditional Medicare and in Medicare Advantage plans. Medicare Access and CHIP Reauthorization Act. (Public Law 114-10). Comments to CMS/HHS proposing ways the proposed rule can be strengthened to ensure the new Quality Payment Program delivers on the promise of health system transformation. Medicaid Expansion. H.R. 4588 and S. 2787: proposal to provide a higher level of federal Medicaid funding for states that did not choose to expand Medicaid when the Affordable Care Act (ACA) first launched Medicaid expansion in 2014.

Actuarial soundness; Appropriate payment, including risk adjustment, for D-SNPs and MMPs; Appropriate quality measurement for D-SNPs and MMPs; Changes to Medicare/Medicaid programs as part of entitlement reform and deficit reduction efforts; Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles; Fraud, waste, and abuse issues for Medicare and Medicaid; H.R. 2646, Helping Families in Mental Health Crisis Act of 2015; H.R. 546 and S. 298, The Advancing Care for Exceptional (ACE) Kids Act of 2015; H.R. 700, Stabilize Medicaid and CHIP Coverage Act; High cost specialty medications; Impact of significant budget cuts in Medicaid; Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs; Medicaid and Medicare reform discussions with MACPAC and MedPAC; Medicaid eligibility and enrollment issues; Medicaid health plans serving as qualified health plans in the Exchange; Medicaid managed care regulations; Medicaid quality measurement and improvement; Mental Health Issues and Legislation; Mental Health Parity; Network adequacy; Risk adjustment; S. 2438, Medicaid and CHIP Quality Improvement Act; S. 428, Stabilize Medicaid and CHIP Coverage Act; SNP reauthorization; SNP sustainability and improvements to MMPs; H.R. 4588, Incentivizing Medicaid Expansion Act of 2016; Amendment to S. Con. Res. 11 Regarding Continuous Eligibility in Medicaid; Capped Medicaid Funding Proposals; H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated; H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016

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

Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act

Medigap; Medicare Advantage; CHIP Reform; Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; ICD-10; Site-Neutral Payments; Medicare Fraud; Nondiscriminination Delivery System Reform; Provider Lookup Tool Enrollee Experience Survey-Technical Expert Panel; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; Medical Billing; Transparency Tools; All Payer Claims Databases HR 4588 Introduced February 23, 2016 by Gene Green (D-Tx) To amend title XIX of the Social Security Act to provide the same levele of Federal Matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

FQHCs and QHP payment rules per final rule on Establishment of Exchanges and Qualified Health Plans; QHP contracting requirements; Essential Community Provider rules; Excellence in Mental Health Act (S.264); Medicaid and Medicare payment for Health Centers; Medicare Chronic Care Coordination; Medicaid quality reporting; Childrens Health Insurance Program (CHIP); Pharmacy Provider Status legislation(H.R.592/S.314); The Rural ACO Improvement Act of 2015(S.1456, S.2259 & S.2261); Telehealth legislation; Connect for Health Act (H.R.4442/S.2484); Incentivizing Medicaid Expansion Act(H.R.4588); FQHC and hospice.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Medigap; Medicare Advantage; CHIP Reform; Medicare Access & CHIP Reauthorization Act of 2015 (MACRA); Chronic Care Reform; Exchanges; ICD-10; Site-neutral Payments; Medicare Fraud; Nondiscrimination Delivery System Reform; Provider Lookup Tool; Enrollee Experience Survey-Technical Expert Panel; Quality Improvement Strategy for QHPs; Rate Notice and Call Letter; Medical Billing; Transparency Tools; All Payer Claims Databases HR 2895 Introduced June 25, 2015 by Mike Pompeo (R-KS) Medicare Patient Access to Cancer Treatment Act of 2015 To amend title XVIII of the Social Security Act to establish payment parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting. HR 3716 Introduced October 8, 2015 by Larry Bucshon (R-IN) To amend title XIX of the Social Security Act to require States to provide to the Secretary of Health and Human Services certain information with respect to provider terminations, and for other purposes. HR 4588 Introduced February 23, 2016 by Gene Green (D-TX) To amend title XIX of the Social Security Act to provide the same level of Federal matching assistance for every State that chooses to expand Medicaid coverage to newly eligible individuals, regardless of when such expansion takes place. S. 2425 Patient Access and Medicare Protection Act Introduced December 18, 2015 by Robert Portman (R-OH) A bill to amend titles XVIII and XIX of the Social Security Act to improve payments for complex rehabilitation technology and certain radiation therapy services, to ensure flexibility in applying the hardship exception for meaningful use for the 2015 EHR reporting period for 2017 payment adjustments, and for other purposes

Client expense: $1,940,000 · Firm income: Not reported

Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical Education Medicaid provider taxes Medicare bad debt payments Medicare and Medicaid payment H.R.2 the Medicare Access and CHIP Reauthorization Act of 2015, all provisions H.R.1343/S.688 Establishing Equity in the Hospital Readmissions Program Act of 2015, all provisions Medicaid Waivers Medicaid Expansion Issues Medicaid disproportionate share hospital payments Medicare disproportionate share hospital payments Medicare hospital readmissions program Funding for the Children's Health Insurance Program Medicaid primary care payment parity Issues related to Medicaid reform including Medicaid block grants and per capita caps Medicare evaluation and management codes and other Medicare outpatient codes/ Medicare site neutral documents Meaningful Use stage 2 and 3 Medicare Shared Savings Program HR2151 Improving Oversight and Accountability in Medicaid Non-DSH Supplemental Payments Act HR1362 Medicaid Reports Act HR1400 Medicaid Tax Fairness Act HR1361 Medicaid Home Improvement HR2119 To amend title XI of the Social Security Act to require that state applications for state plan waivers under the Medicaid program be approved only if such applications are budget neutral, and for other purposes Legislation related to chronic care treatment H.R. 3292 Medicare IME Pool Act of 2015 H.R. 3288 Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act H.R. 3291 Medicare Crosswalk Hospital Code Development Act Medicaid data and transparency Medicaid Managed Care Policies/ rulemaking Medicaid supplemental payments Medicare Site Neutral payments for hospital outpatient departments H.R.4442/S.2484 Connect for Health Act H.R.3309 Flex-It 2 Act H.R.4774 Training tomorrow's doctors today act H.R.4588 Incentivizing Medicaid expansion act S.2787 States achieve Medicaid expansion act

340B drug discount program; Actuarial soundness; Appropriate payment, including risk adjustment, for D-SNPs and MMPs; Appropriate quality measurement for D-SNPs and MMPs; Changes to Medicare/Medicaid programs as part of entitlement reform and deficit reduction efforts; Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles; Fraud, waste, and abuse issues for Medicare and Medicaid; H.R. 2646, Helping Families in Mental Health Crisis Act of 2015; H.R. 3821, Medicaid Directory of Caregivers Act; H.R. 546 and S. 298, The Advancing Care for Exceptional (ACE) Kids Act of 2015; H.R. 700, Stabilize Medicaid and CHIP Coverage Act; High cost specialty medications; Impact of significant budget cuts in Medicaid; Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs; Medicaid and Medicare reform discussions with MACPAC and MedPAC; Medicaid eligibility and enrollment issues; Medicaid health plans serving as qualified health plans in the Exchange; Medicaid managed care best practices; Medicaid managed care regulations; Medicaid Provider Payments; Medicaid quality measurement and improvement; Mental Health Issues and Legislation; Mental Health Parity; Network adequacy; Protecting Medicaid from reductions made during budget reconciliation; Provider Directories; Regulatory and systematic impact of Medicaid continuous coverage; Risk adjustment; S. 2438, Medicaid and CHIP Quality Improvement Act; S. 428, Stabilize Medicaid and CHIP Coverage Act; SNP reauthorization; SNP sustainability and improvements to MMPs; H.R. 4588, Incentivizing Medicaid Expansion Act of 2016; Medicaid expansion activities; Medicaid state financing mechanisms

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