Medigap Consumer Protection Act of 2016

Medicare Part B Premium. (No bill.) Proposals to mitigate the expected increase in the 2017 Part B premium for beneficiaries not protected by the "hold harmless" provision. Medicare Part B Enrollment. Comments on the CMS/HHS Proposed Notice of Benefit and Payment Parameters for 2018. Medicare Supplemental Insurance. H.R. 6265, the Medigap Consumer Protection Act of 2016: proposal to improve access to and improve beneficiary information about Medigap for seniors and disabled individuals in the traditional Medicare program. Medicare Affordability. S. 3371, H.R. 6109, Medicare Affordability and Enrollment Act of 2016: proposals to improve Medicare for beneficiaries by capping out-of-pocket costs in traditional Medicare; increasing financial assistance for low-income beneficiaries; aligning the Medicare Savings Programs and Low-Income Subsidy; eliminating the 24- month waiting period for Medicare coverage for people receiving Social Security Disability Insurance benefits; making changes in the enrollment period for Medicare; eliminating gaps between enrollment and when actual coverage begins; limiting the Part B late enrollment penalty; and providing permanent funding for the State Health Insurance Assistance Programs (SHIPs), Area Agencies on Aging (AAAs), Aging and Disability Resource Centers ADRCs) and the National Center for Benefits Outreach and Enrollment. Medicare Part B Enrollment. S. 3236, H.R. 5772, the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act: legislation to modernize and simplify Part B enrollment. Medicare Hearing Coverage. H.R. 1653, the Medicare Hearing Aid Coverage Act of 2015: proposal to provide Medicare coverage for the cost of hearing aids and examinations. Medicare Dental Coverage. S. 570, H.R. 1055, the Comprehensive Dental Reform Act of 2015: proposal to expand Medicare coverage to include dental care. Medicare Dental, Vision, and Hearing Coverage. H.R. 5396, H.R. 3308: Proposals to expand Medicare coverage to include comprehensive coverage of dental, vision, and hearing care. Home-based Primary Medical Care. S. 3130, Independence at Home Act of 2016: legislation to expand the Independence at Home Medicare demonstration project providing home-based primary medical care to elders with severe chronic illness and disability. Continuous Glucose Monitoring Devices. S. 804, Medicare CGM Access Act: legislation to provide Medicare coverage of continuous glucose monitoring (CGM) devices for beneficiaries with diabetes who meet specified medical criteria. Biologics Market Exclusivity Period. S. 3094, H.R. 5573, Price Relief, Innovation and Competition for Essential Drugs (PRICED) Act: legislation to reduce the market exclusivity period for biologics from its current 12 years to seven years. Drug Manufacture Transparency. S. 3335, H.R. 6043, Fair Accountability and Innovative Research Drug Pricing Act of 2016: proposal to require drug manufacturers to be more transparent about justification for increases in drug prices over ten percent, namely to report their spending on a drug's research and development as well as their profits on a drug each year since its approval. Drug Importation. H.R. 2623, the Personal Drug Importation Fairness Act: proposal to establish policies for the safe reimportation of pharmaceutical drugs by individuals for their personal use. Containment of Prescription Drug Costs. S. 2023, the Prescription Drug Affordability Act: proposals to require Medicare to negotiate drug prices under the Medicare Part D prescription drug program; allow for importation of prescription drugs from licensed Canadian pharmacies; require manufacturers to provide a rebate to the federal government for drugs covered under Medicare Part D for low-income Medicare beneficiaries; require generic drug manufacturers to pay an additional rebate to Medicaid if their drug prices rise faster than inflation; close the Medicare Part D donut hole for brand and generic drugs by 2017; and prohibit anti-competitive pay-for-delay arrangements between brand and generic drug makers. Medicare Prescription Drug Negotiation Authority. H.R. 4207, Medicare Fair Drug Pricing Act: proposal to allow the Secretary of Health and Human Services (HHS) to negotiate prices with pharmaceutical companies when drugs lack sufficient competition. Medicare Observation Status. S. 843, H.R. 1571, Improving Access to Medicare Coverage Act of 2015: proposal to count days in the hospital in observation status toward meeting the three-day prior hospitalization requirement for skilled nursing facility (SNF) care eligibility. Medicare Privatization. (No bill.) Proposals to transform traditional Medicare to a private insurance carrier program. Medicare Eligibility Age. (No bill.) Proposals to raise the eligibility age for Medicare from 65 to 67. Medicaid Restructuring. (No bill.) Proposals to change Medicaid from an entitlement program to block grants or per capita caps, forms of lump sum payments from the federal government. Affordable Care Act (ACA) repeal. (No bill.) Proposals to repeal the ACA affecting the closing of the Medicare Part D donut hole, Medicare coverage of ACA-mandated preventive services, and payment and delivery reforms that extend the life of the Medicare Part A Trust Fund. Childrens Health Insurance Program (CHIP) extension. (No bill.) Proposal to add an extension of the Medicare therapy cap exceptions process.

Client expense: $200,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Office of Management & Budget (OMB), President of the U.S., SENATE, Social Security Administration (SSA), Treasury, Dept of, Vice President of the U.S.

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

Medicare Part B Premium. (No bill.) Proposals to mitigate the expected increase in the 2017 Part B premium for beneficiaries not protected by the hold harmless provision. Medigap. H.R. 6265, the Medigap Consumer Protection Act of 2016: proposal to improve access to and improve beneficiary information about Medigap for seniors and disabled individuals in the traditional Medicare program. Medicare Affordability. S. 3371, H.R. 6109, Medicare Affordability and Enrollment Act of 2016: proposals to improve Medicare for beneficiaries by capping out-of-pocket costs in traditional Medicare; increasing financial assistance for low-income beneficiaries; aligning the Medicare Savings Programs and Low-Income Subsidy; eliminating the 24-month waiting period for Medicare coverage for people receiving Social Security Disability Insurance benefits; making commonsense changes in the enrollment period for Medicare; eliminating gaps between enrollment and when actual coverage begins; limiting the Part B late enrollment penalty; and providing permanent funding for the State Health Insurance Assistance Programs (SHIPs), Area Agencies on Aging (AAAs), Aging and Disability Resource Centers (ADRCs) and the National Center for Benefits Outreach and Enrollment. Medicare Part B Enrollment. S. 3236, H.R. 5772, the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act: legislation to modernize and simplify Part B enrollment. Medicare Observation Status. Public Law 114-42, Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act): comments on the CMS/HHS proposed rule to strengthen protections for Medicare beneficiaries who are hospitalized in observation status. Medicare Hearing Coverage. H.R. 1653, the Medicare Hearing Aid Coverage Act of 2015: proposal to provide Medicare coverage for the cost of hearing aids and examinations. Expanding Drug Monopolies. H.R. 6, 21st Century Cures Act. Proposal to extend orphan drug market exclusivity for existing drugs to new indications. Medicare Part B Drug Payments. H.R. 5122: legislation to prohibit the Department of Health and Human Services from taking any further action on a proposed rule to change how Medicare pays for certain drugs that are typically not self-administered (such as some intravenous medications and chemotherapy drugs). Drug Manufacture Transparency. S. 3335, H.R. 6043, Fair Accountability and Innovative Research Drug Pricing Act of 2016: proposal to require drug manufacturers to be more transparent about justification for increases in drug prices over ten percent, namely to report their spending on a drugs research and development as well as their profits on a drug each year since its approval. Biologics Market Exclusivity Period. S. 3094, H.R. 5573, Price Relief, Innovation and Competition for Essential Drugs (PRICED) Act: legislation to reduce the market exclusivity period for biologics from its current 12 years to seven years. Continuous Glucose Monitoring Devices. S. 804, Medicare CGM Access Act: legislation to provide Medicare coverage of continuous glucose monitoring (CGM) devices for beneficiaries with diabetes who meet specified medical criteria. Home-based Primary Medical Care. S. 3130, Independence at Home Act of 2016: legislation to expand the Independence at Home Medicare demonstration project providing home-based primary medical care to elders with severe chronic illness and disability. Alzheimers Beneficiary and Caregiver Assistance. S. 3137, H.R. 5681, Alzheimers Beneficiary and Caregiver Support Act: proposals to improve the quality of life for people living with Alzheimers disease and other forms of dementia, support family care partners, and reduce costs to federal and state health programs. Alzheimers Caregiver Support. S. 3113, H.R. 3039, Alzheimers Caregiver Support Act: legislation to provide vital support and training to people living with Alzheimers disease and other forms of dementia and to their caregivers. Medicare Payment Policy. Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017 (CMS-16545-P): comments to CMS/HHS pertaining to the proposed rule for Sec. II. E. 5, Assessment and Care Planning for Patients with Cognitive Impairment, which recognizes the value of assessment and care planning services for patients with cognitive impairment, including people living with Alzheimers disease and other forms of dementia. Medicare End-Stage Renal Disease Prospective Payment System. End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model (CMS-1651-P): comments to CMS/HHS regarding obstacles in many states to obtaining DME among people with Medicaid and Medicare benefits (dual eligibles).

Client expense: $180,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Office of Management & Budget (OMB), President of the U.S., SENATE, Social Security Administration (SSA), Treasury, Dept of, Vice President of the U.S.