Medicare Beneficiary Preservation of Choice Act of 2015

H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 5659, ESRD Choice Act (Smith) - option for ESRD patients to enroll in MA plans H.R. 5942, Dialysis PATIENTS Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 6265, Medigap Reforms (McDermott) S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

Client expense: $1,710,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office

H.R. 815 and S.1661: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. S. 620 and H.R. 1189: The Preserving Employee Wellness Programs Act, looks to reaffirm existing law allowing employee wellness programs tied to financial awards H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. H.R. 2712 and S. 1996: Commonsense Reporting and Verification Act of 2015, bill to ease PPACA employer reporting requirements. S. 1099: To amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1415: To amend the Internal Revenue Code of 1986 to modify the definition of large employer for purposes of applying the employer mandate. H.R. 879: This bill repeals, effective for taxable years beginning after 2017, the excise tax on the excess benefit portion of high-cost employer-sponsored health care plans. H.R. 2050: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). H.R.2570: Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R. 2911 and S. 1697: To provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market, and for other purposes. House passed budget resolution for upcoming fiscal year S. 2045: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). S. 2075: This bill amends the Internal Revenue Code to repeal, for taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). The bill expresses the sense of the Senate that the revenue loss resulting from the repeal of such excise tax should be offset by corresponding revenue. -H.R.3762: Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 -H.R.2029: The Omnibus Appropriations bill -2015 Reconciliation bill -H.R. 5447 and S. 3060: Small Business Health Care Relief Act of 2016 -H.R. 3463: Aligning Children's Dental Coverage Act (ACDC) -H.R. 5589: To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. -S. 3244: The legislation clarifies that people outside the public Exchanges can have the same choices for dental coverage as people inside the public Exchanges. -H.R. 2488: Medicare Beneficiary Preservation of Choice Act of 2015 -H.R. 6184: legislation that would allow seniors enrolled in COBRA coverage to transition to Medicare Part B without a penalty -H.R 2581: Preservation of Access for Seniors in Medicare Advantage Act of 2015

Issues related to agent compensation: H.R. 815. Issues related to the implementation of the Patient Protection and Affordable Care Act: H.R. 1624, H.R. 30, H.R. 588, S. 1099 and S. 30. Issues related to HSA/FSA reform. Issues related to the McCarran-Ferguson anti-trust exemption. Issues with respect to the small employer health care insurance tax credit including: S. 379, H.R. 762, H.R. 4469, S. 1653, S. 2045 and S. 2499.

Client expense: $568,000 · Firm income: Not reported

Issues relating to insurance regulatory reform and agent compensation. Issues related to the implementation of of the Patient Protection and Affordable Care Act: H.R. 1624, S. 1099, H.R. 30, H.R. 588, and S. 30. Issues related to terrorism risk insurance: H.R. 26. Issues related to flood risk insurance. Issues related to the regulation of insurance competition, products with guarantees, individual and employer owned policies, and fiduciary-client relationships.

Client expense: $568,000 · Firm income: Not reported

H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD Draft Bill on Option for ESRD Patients to Enroll in MA Plans (Ways and Means Committee) H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.

Issues related to agent compensation: H.R. 815. Issues related to the implementation of the Patient Protection and Affordable Care Act: H.R. 1624, H.R. 30, H.R. 588, S. 1099 and S. 30. Issues related to HSA/FSA reform. Issues related to the McCarran-Ferguson anti-trust exemption. Issues with respect to the small employer health care insurance tax credit including: S. 379, H.R. 762, H.R. 4469, S. 1653, S. 2045 and S. 2499.

Client expense: $568,000 · Firm income: Not reported

Issues relating to insurance regulatory reform and agent compensation. Issues related to the implementation of of the Patient Protection and Affordable Care Act: H.R. 1624, S. 1099, H.R. 30, H.R. 588, and S. 30. Issues related to terrorism risk insurance: H.R. 26. Issues related to flood risk insurance. Issues related to the regulation of insurance competition, products with guarantees, individual and employer owned policies, and fiduciary-client relationships.

Client expense: $568,000 · Firm income: Not reported

H.R. 815 and S.1661: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. S. 620 and H.R. 1189: The Preserving Employee Wellness Programs Act, looks to reaffirm existing law allowing employee wellness programs tied to financial awards H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. H.R. 2712 and S. 1996: Commonsense Reporting and Verification Act of 2015, bill to ease PPACA employer reporting requirements. S. 1099: To amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1415: To amend the Internal Revenue Code of 1986 to modify the definition of large employer for purposes of applying the employer mandate. H.R. 879: This bill repeals, effective for taxable years beginning after 2017, the excise tax on the excess benefit portion of high-cost employer-sponsored health care plans. H.R. 2050: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). H.R.2570: Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R. 2911 and S. 1697: To provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market, and for other purposes. House passed budget resolution for upcoming fiscal year S. 2045: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). S. 2075: This bill amends the Internal Revenue Code to repeal, for taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). The bill expresses the sense of the Senate that the revenue loss resulting from the repeal of such excise tax should be offset by corresponding revenue. -H.R.3762: Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 -H.R.2029: The Omnibus Appropriations bill -2015 Reconciliation bill -H.R. 5447 and S. 3060: Small Business Health Care Relief Act of 2016 -H.R. 3463: Aligning Children's Dental Coverage Act (ACDC) -H.R. 5589: To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. -S. 3244: The legislation clarifies that people outside the public Exchanges can have the same choices for dental coverage as people inside the public Exchanges. -H.R. 2488: Medicare Beneficiary Preservation of Choice Act of 2015

H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, , enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

Issues relating to insurance regulatory reform and agent compensation. Issues related to the implementation of of the Patient Protection and Affordable Care Act: H.R. 1624, S. 1099, H.R. 30, H.R. 588, and S. 30. Issues related to terrorism risk insurance: H.R. 26. Issues related to flood risk insurance. Issues related to the regulation of insurance competition, products with guarantees, individual and employer owned policies, and fiduciary-client relationships.

Client expense: $566,425 · Firm income: Not reported

Issues related to agent compensation: H.R. 815. Issues related to the implementation of the Patient Protection and Affordable Care Act: H.R. 1624, H.R. 30, H.R. 588, S. 1099 and S. 30. Issues related to HSA/FSA reform. Issues related to the McCarran-Ferguson anti-trust exemption. Issues with respect to the small employer health care insurance tax credit including: S. 379 and H.R. 762.

Client expense: $566,425 · Firm income: Not reported

H.R. 815 and S.1661: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. S. 620 and H.R. 1189: The Preserving Employee Wellness Programs Act, looks to reaffirm existing law allowing employee wellness programs tied to financial awards H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. H.R. 2712 and S. 1996: Commonsense Reporting and Verification Act of 2015, bill to ease PPACA employer reporting requirements. S. 1099: To amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1415: To amend the Internal Revenue Code of 1986 to modify the definition of large employer for purposes of applying the employer mandate. H.R. 879: This bill repeals, effective for taxable years beginning after 2017, the excise tax on the excess benefit portion of high-cost employer-sponsored health care plans. H.R. 2050: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). H.R.2570: Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R. 2911 and S. 1697: To provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market, and for other purposes. House passed budget resolution for upcoming fiscal year S. 2045: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). S. 2075: This bill amends the Internal Revenue Code to repeal, for taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). The bill expresses the sense of the Senate that the revenue loss resulting from the repeal of such excise tax should be offset by corresponding revenue. -H.R.3762: Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 -H.R.2029: The Omnibus Appropriations bill -2015 Reconciliation bill

H.R. 815: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. S. 620 and H.R. 1189: The Preserving Employee Wellness Programs Act, looks to reaffirm existing law allowing employee wellness programs tied to financial awards H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. House passed budget resolution for upcoming fiscal year

Issues related to agent compensation: H.R. 815. Issues related to the implementation of the Patient Protection and Affordable Care Act: H.R. 1624, H.R. 30, H.R. 588, and S. 30. Issues related to HSA/FSA reform. Issues related to the McCarran-Ferguson anti-trust exemption.

Client expense: $721,220 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

Issues relating to insurance regulatory reform and agent compensation. Issues related to the implementation of of the Patient Protection and Affordable Care Act: H.R. 1624, H.R. 30, H.R. 588, and S. 30. Issues related to terrorism risk insurance: H.R. 26. Issues related to flood risk insurance. Issues related to the regulation of insurance competition, products with guarantees, individual and employer owned policies, and fiduciary-client relationships.

Client expense: $721,220 · Firm income: Not reported

H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - rulemaking schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

H.R. 2, Medicare Access and CHIP Reauthorization Act - Medicare physician payment reform, CHIP funding, Medigap, Medicare Advantage Special Needs Plans, Medicare Cost Plans, fraud provisions, QI and TMA programs H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 919, CHIP Extension and Improvement Act (Green) - federal CHIP funding H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1470, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - Medicare physician payment reforms H.Con.Res. 27, Budget Resolution (Price) - Medicare, Medicaid, CHIP issues S. 522, Protecting And Retaining Our CHIP Act (Brown) - federal CHIP funding S. 810, SGR Repeal and Medicare Provider Payment Modernization Act (Hatch) - Medicare physician payment reforms S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S.Con.Res. 11, Budget Resolution (Enzi) - Medicare, Medicaid, CHIP issues Discussion Draft for CHIP Legislation (Hatch-Upton-Pitts) - federal CHIP funding Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease such as Ebola; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1314, Bipartisan Budget Act - Medicare Part B premium and deductible, Medicare sequestration cuts H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3696, Protecting Medicare Beneficiaries Act (Titus) - Medicare Part B premiums and deductibles H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3831, Securing Fairness in Regulatory Timing Act (Brady) - revised schedule for MA payment rates H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2148, Protecting Medicare Beneficiaries Act (Wyden) - Medicare Part B premiums and deductibles S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2351, Securing Fairness in Regulatory Timing Act (Isakson) - revised schedule for MA payment rates Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; Center for Medicare and Medicaid Innovation demonstrations for MA and PDP plans; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

Discussed Affordable Care Act Medicaid expansion issues, including AARP comments on state 1115 waiver proposals to expand Medicaid. H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015 - Discussed Sustainable Growth Rate with Hill staffers. Discussed Medicare Supplemental Insurance with Hill staffers. (no bill) Discussed the Affordable Care Act with Hill staffers. (no bill) Discussed Medicare Advantage with Hill staffers. (no bill) S.Con.Res.11, Budget Resolution, FY 2016 - Lobbied to protect various programs serving Americans age 50 and above, including employment training, health and human services, and energy assistance for seniors, the disabled and other low-income assistance. H.R. 2029,H.J.Res.75, H.J.Res.78, Labor, HHS, Education and Related Agencies Appropriations, FY2016 - Lobbied to protect and enhance funding for various programs serving older and low-income Americans. Also lobbied to protect access to affordable health care and financial security, including support of DOL's conflict of interest rulemaking. H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 - staff discussions. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015 - staff discussion. H.R. 588, Medicare Beneficiary Preservation of Choice Act of 2015 - staff discussions. Sent email communication about AARP paper on generic drug prices. Sent email communication on the 21st Century Cures legislation. Sent invitation for the AARP Foundation and Feeding Americas Facing Hunger After Fifty briefing. HR 1270, S.709 - Restoring Access to Medication Act - meetings, calls and emails urging support. H.R. 3590, Helping Every American Limit Their Health Expenses Act - Provided feedback to members offices. S.1397, Value Based Insurance Design Seniors Copayment Reduction Act of 2015 - met with Senate Finance Committee D and R Staff and spoke with personal staff on both sides. Reached out to W&M staff on Cadillac Tax. Provided feedback to staff on draft bill to provide safe harbor to HSA use in high-deductible health plans. Discussed Medicare-Medicaid integration efforts and financial alignment demonstrations, other CMS demonstration initiatives. (no bill) S. 192, Discussed Older Americans Act reauthorization legislation. Discussed older worker employment programs including the Senior Community Service Employment Program (SCSEP) under the Older Americans Act. Discussed nutrition programs including the Supplemental Nutrition Assistance Program (SNAP). H.R.1220, S.624, Discussed the removing barriers to Colorectal Cancer Screening Act. H.R. 815, Discussed Access to Professional Health Insurance Act of 2015.

H.R. 815 and S.1661: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. S. 620 and H.R. 1189: The Preserving Employee Wellness Programs Act, looks to reaffirm existing law allowing employee wellness programs tied to financial awards H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. H.R. 2712 and S. 1996: Commonsense Reporting and Verification Act of 2015, bill to ease PPACA employer reporting requirements. S. 1099: To amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1415: To amend the Internal Revenue Code of 1986 to modify the definition of large employer for purposes of applying the employer mandate. H.R. 879: This bill repeals, effective for taxable years beginning after 2017, the excise tax on the excess benefit portion of high-cost employer-sponsored health care plans. H.R. 2050: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). H.R.2570: Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R. 2911 and S. 1697: To provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market, and for other purposes. House passed budget resolution for upcoming fiscal year S. 2045: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). S. 2075: This bill amends the Internal Revenue Code to repeal, for taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). The bill expresses the sense of the Senate that the revenue loss resulting from the repeal of such excise tax should be offset by corresponding revenue. -H.R.3762: Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 -H.R.2029: The Omnibus Appropriations bill -2015 Reconciliation bill

Issues related to agent compensation: H.R. 815. Issues related to the implementation of the Patient Protection and Affordable Care Act: H.R. 1624, H.R. 30, H.R. 588, S. 1099 and S. 30. Issues related to HSA/FSA reform. Issues related to the McCarran-Ferguson anti-trust exemption.

Client expense: $563,000 · Firm income: Not reported

Issues relating to insurance regulatory reform and agent compensation. Issues related to the implementation of of the Patient Protection and Affordable Care Act: H.R. 1624, S. 1099, H.R. 30, H.R. 588, and S. 30. Issues related to terrorism risk insurance: H.R. 26. Issues related to flood risk insurance. Issues related to the regulation of insurance competition, products with guarantees, individual and employer owned policies, and fiduciary-client relationships.

Client expense: $563,000 · Firm income: Not reported

H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - rulemaking schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

Discussed Affordable Care Act Medicaid expansion issues, including AARP comments on state 1115 waiver proposals to expand Medicaid. Discussed employer wellness programs and the ACA. (no bill) Responded to inquiry regarding marketplaces. (no bill) H.R. 1270, The Restoring Access to Medications Act - Discussed bill with Hill staffers. H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015 - Discussed Sustainable Growth Rate with Hill staffers. Discussed Medicare Supplemental Insurance with Hill staffers. (no bill) Discussed the Affordable Care Act with Hill staffers. (no bill) Discussed Medicare Advantage with Hill staffers. (no bill) S.Con.Res.11, Budget Resolution, FY 2016 - Lobbied to protect various programs serving Americans age 50 and above, including employment training, health and human services, and energy assistance for seniors, the disabled and other low-income assistance. H.R. 3020, S. 1695, S.2132, Labor, HHS, Education and Related Agencies Appropriations, FY2016 - Lobbied to protect and enhance funding for various programs serving older and low-income Americans. Also lobbied to protect access to affordable health care and financial security, including support of DOL's conflict of interest rulemaking. H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 - staff discussions. H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015 - staff discussion. H.R. 588, Medicare Beneficiary Preservation of Choice Act of 2015 - staff discussions. Sent email communication about AARP paper on generic drug prices. Sent email communication on the 21st Century Cures legislation. Sent invitation for the AARP Foundation and Feeding Americas Facing Hunger After Fifty briefing. HR 1270, S.709 - Restoring Access to Medication Act - meetings, calls and emails urging support. H.R. 3590, Helping Every American Limit Their Health Expenses Act - Provided feedback to members offices. S.1397, Value Based Insurance Design Seniors Copayment Reduction Act of 2015 - met with Senate Finance Committee D and R Staff and spoke with personal staff on both sides. Reached out to W&M staff on Cadillac Tax. Provided feedback to staff on draft bill to provide safe harbor to HSA use in high-deductible health plans. Discussed Affordable Care Act Medicaid expansion issues, including AARP comments on state 1115 waiver proposals to expand Medicaid. Discussed Medicare-Medicaid integration efforts and financial alignment demonstrations, other CMS demonstration initiatives (no bill number). S. 192, Discussed Older Americans Act reauthorization legislation. Discussed older worker employment programs including the Senior Community Service Employment Program (SCSEP) under the Older Americans Act. Discussed nutrition programs including the Supplemental Nutrition Assistance Program (SNAP). H.R.1220, S.624, Discussed the removing barriers to Colorectal Cancer Screening Act.

H.R. 815 and S.1661: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. S. 620 and H.R. 1189: The Preserving Employee Wellness Programs Act, looks to reaffirm existing law allowing employee wellness programs tied to financial awards H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. H.R. 2712 and S. 1996: Commonsense Reporting and Verification Act of 2015, bill to ease PPACA employer reporting requirements. S. 1099: To amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1415: To amend the Internal Revenue Code of 1986 to modify the definition of large employer for purposes of applying the employer mandate. H.R. 879: This bill repeals, effective for taxable years beginning after 2017, the excise tax on the excess benefit portion of high-cost employer-sponsored health care plans. H.R. 2050: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). H.R.2570: Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 H.R. 2911 and S. 1697: To provide an exception from certain group health plan requirements to allow small businesses to use pre-tax dollars to assist employees in the purchase of policies in the individual health insurance market, and for other purposes. House passed budget resolution for upcoming fiscal year S. 2045: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). S. 2075: This bill amends the Internal Revenue Code to repeal, for taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). The bill expresses the sense of the Senate that the revenue loss resulting from the repeal of such excise tax should be offset by corresponding revenue.

Issues related to agent compensation: H.R. 815. Issues related to the implementation of the Patient Protection and Affordable Care Act: H.R. 1624, H.R. 30, H.R. 588, S. 1099 and S. 30. Issues related to HSA/FSA reform. Issues related to the McCarran-Ferguson anti-trust exemption.

Client expense: $529,000 · Firm income: Not reported

Issues relating to insurance regulatory reform and agent compensation. Issues related to the implementation of of the Patient Protection and Affordable Care Act: H.R. 1624, S. 1099, H.R. 30, H.R. 588, and S. 30. Issues related to terrorism risk insurance: H.R. 26. Issues related to flood risk insurance. Issues related to the regulation of insurance competition, products with guarantees, individual and employer owned policies, and fiduciary-client relationships.

Client expense: $529,000 · Firm income: Not reported

H.R. 2, Medicare Access and CHIP Reauthorization Act - Medicare physician payment reform, CHIP funding, Medigap, Medicare Advantage Special Needs Plans, Medicare Cost Plans, fraud provisions, QI and TMA programs H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 919, CHIP Extension and Improvement Act (Green) - federal CHIP funding H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1470, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - Medicare physician payment reforms H.Con.Res. 27, Budget Resolution (Price) - Medicare, Medicaid, CHIP issues S. 522, Protecting And Retaining Our CHIP Act (Brown) - federal CHIP funding S. 810, SGR Repeal and Medicare Provider Payment Modernization Act (Hatch) - Medicare physician payment reforms S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S.Con.Res. 11, Budget Resolution (Enzi) - Medicare, Medicaid, CHIP issues Discussion Draft for CHIP Legislation (Hatch-Upton-Pitts) - federal CHIP funding Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease such as Ebola; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

H.R. 2, Medicare Access and CHIP Reauthorization Act - Medicare physician payment reform, CHIP funding, Medigap, Medicare Advantage Special Needs Plans, Medicare Cost Plans, fraud provisions, QI and TMA programs H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1892, Trade Adjustment Assistance Reauthorization Act (Reichert) - Medicare sequestration cuts H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - rulemaking schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.Con.Res. 27, Budget Resolution (Price) - Medicare, Medicaid, health policy issues S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1268, Trade Adjustment Assistance Reauthorization Act (Hatch) - Medicare sequestration cuts S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S.Con.Res. 11, Budget Resolution (Enzi) - Medicare, Medicaid, health policy issues Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, Recovery Audit Contractor (RAC) audits, Part D prescriber enrollment requirement, and provider directories and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); ICD-10; Value-Based Insurance Design; Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

Issues related to agent compensation: H.R. 815. Issues related to the implementation of the Patient Protection and Affordable Care Act: H.R. 1624, H.R. 30, H.R. 588, and S. 30. Issues related to HSA/FSA reform. Issues related to the McCarran-Ferguson anti-trust exemption.

Client expense: $635,370 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

Issues relating to insurance regulatory reform and agent compensation. Issues related to the implementation of of the Patient Protection and Affordable Care Act: H.R. 1624, S. 1099, H.R. 30, H.R. 588, and S. 30. Issues related to terrorism risk insurance: H.R. 26. Issues related to flood risk insurance. Issues related to the regulation of insurance competition, products with guarantees, individual and employer owned policies, and fiduciary-client relationships.

Client expense: $635,370 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

Discussed Affordable Care Act Medicaid expansion issues, including AARP comments on state 1115 waiver proposals to expand Medicaid. Discussed Medicare-Medicaid integration efforts and financial alignment demonstrations, and other CMS demonstration initiatives. (no bill) S. 192, Older Americans Act - Discussed Older Americans Act reauthorization legislation. Discussed employer wellness programs and the ACA. (no bill) Discussed the Removing Barriers to Colorectal Cancer Screening Act. (no bill) Responded to inquiry regarding marketplaces. (no bill) Made inquiry related to the Advisory Council on Alzheimer's, Research, Care and Services. (no bill) H.R.1270, The Restoring Access to Medications Act - Discussed bill with Hill staffers. H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015 - Discussed Sustainable Growth Rate with Hill staffers. Discussed Medicare Supplemental Insurance with Hill staffers. (no bill) Discussed the Affordable Care Act with Hill staffers. (no bill) Discussed Medicare Advantage with Hill staffers. (no bill) S.Con.Res.11, Budget Resolution, FY 2016 - Lobbied to protect various programs serving Americans age 50 and above, including employment training, health and human services, and energy assistance for seniors, the disabled and other low-income assistance. S. 1695, Labor, HHS, Education and related agencies, Approrpiations Committee/FY2016 - Lobbied to protect various health care, supportive services and nutrition programs serving seniors. H.R.2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 - staff discussions. H.R.2581, Preservation of Access for Seniors in Medicare Advantage Act of 2015 - staff discussion. H.R.588, Medicare Beneficiary Preservation of Choice Act of 2015 - staff discussions. Sent email communication about AARP paper on generic drug prices. Sent email communication on the 21st Century Cures legislation.

H.R. 815 and S.1661: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. S. 620 and H.R. 1189: The Preserving Employee Wellness Programs Act, looks to reaffirm existing law allowing employee wellness programs tied to financial awards H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. H.R. 2712: Commonsense Reporting and Verification Act of 2015, bill to ease PPACA employer reporting requirements. S. 1099: To amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1415: To amend the Internal Revenue Code of 1986 to modify the definition of large employer for purposes of applying the employer mandate. H.R. 879: This bill repeals, effective for taxable years beginning after 2017, the excise tax on the excess benefit portion of high-cost employer-sponsored health care plans. H.R. 2050: Amends the Internal Revenue Code to repeal, beginning with taxable years beginning after December 31, 2017, the excise tax on employer-sponsored health care coverage for which there is an excess benefit (high-cost plans). H.R.2570: Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 House passed budget resolution for upcoming fiscal year

H.R. 2, Medicare Access and CHIP Reauthorization Act - Medicare physician payment reform, CHIP funding, Medigap, Medicare Advantage Special Needs Plans, Medicare Cost Plans, fraud provisions, QI and TMA programs H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 919, CHIP Extension and Improvement Act (Green) - federal CHIP funding H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1470, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - Medicare physician payment reforms H.Con.Res. 27, Budget Resolution (Price) - Medicare, Medicaid, CHIP issues S. 522, Protecting And Retaining Our CHIP Act (Brown) - federal CHIP funding S. 810, SGR Repeal and Medicare Provider Payment Modernization Act (Hatch) - Medicare physician payment reforms S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S.Con.Res. 11, Budget Resolution (Enzi) - Medicare, Medicaid, CHIP issues Discussion Draft for CHIP Legislation (Hatch-Upton-Pitts) - federal CHIP funding Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease such as Ebola; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

Issues related to agent compensation: H.R. 815. Issues related to the implementation of the Patient Protection and Affordable Care Act: H.R. 1624, H.R. 30, H.R. 588, and S. 30. Issues related to HSA/FSA reform. Issues related to the McCarran-Ferguson anti-trust exemption.

Client expense: $721,220 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

Issues relating to insurance regulatory reform and agent compensation. Issues related to the implementation of of the Patient Protection and Affordable Care Act: H.R. 1624, H.R. 30, H.R. 588, and S. 30. Issues related to terrorism risk insurance: H.R. 26. Issues related to flood risk insurance. Issues related to the regulation of insurance competition, products with guarantees, individual and employer owned policies, and fiduciary-client relationships.

Client expense: $721,220 · Firm income: Not reported

H.R. 815: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. S. 620 and H.R. 1189: The Preserving Employee Wellness Programs Act, looks to reaffirm existing law allowing employee wellness programs tied to financial awards H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. House passed budget resolution for upcoming fiscal year

H.R. 815: Legislation which removes broker commissions from the MLR calculation in the health reform law. H.R. 30 and S. 40: To restore the traditional 40-hour workweek from 30-hours H.R. 762 and S. 379: To increase the eligibility and effectiveness of the small business tax credit H.R. 928 and S.183: Legislation to eliminate the new national premium tax H.R. 588: Legislation to restore the open-enrollment period for Medicare beneficiaries to make a one-time plan switch to another Medicare Advantage plan or return to traditional Medicare for 90 days after the beginning of each calendar year. H.R. 290: the CARES act, which would change the three-day inpatient hospital admission requirement for Medicare beneficiaries who are in need of skilled nursing facility services to also allow hospital stays under observation status to count. H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1624: To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. Senator Burr, Hatch, and Uptons Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act which would replace the Affordable Care Act H.R. 876: Amends title XVIII (Medicare) of the Social Security Act to require a hospital with an agreement with the Secretary of Health and Human Services to give each individual entitled to benefits under Medicare part A (Hospital Insurance), whom the hospital classifies for more than 24 hours as an outpatient under observation status or any other similar status, an adequate oral and written notification within 36 hours of that classification. H.R. 1533: To amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and for other purposes. H.R. 1547: To amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted as part of the Patient Protection and Affordable Care Act. H.R. 887: Electronic Health Fairness Act of 2015, Amends title XVIII (Medicare) of the Social Security Act to prohibit any patient encounter of an eligible professional occurring at an ambulatory surgical center from being treated as such an encounter in determining whether an eligible professional qualifies as a meaningful electronic health record (EHR) user. H.R. 1570: To provide for greater transparency and information with respect to Federal expenditures under the Medicaid and CHIP programs in the territories of the United States, and for other purposes. S. 254: Small Business Health Relief Act of 2015 H.R. 1270: Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). S. 884: A bill to improve access to emergency medical services, and for other purposes. S. 836: A bill to amend the Internal Revenue Code of 1986 to repeal certain limitations on health care benefits enacted by the Patient Protection and Affordable Care Act. S. 839: A bill to amend title XVIII of the Social Security Act to extend the rural add-on payment in the Medicare home health benefit, and for other purposes. S. 844: A bill to repeal the medical device excise tax, and for other purposes. S. 861: A bill to amend titles XVIII and XIX of the Social Security Act to curb waste, fraud, and abuse in the Medicare and Medicaid programs. House passed budget resolution for upcoming fiscal year