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Legislative Progress
Introduced
February 9, 2015
Latest Action
February 27, 2015
Primary Sponsor
Peter J. RoskamRepublican(IL)
Momentum (last 30 days)
0
score
0 actions · 0 new cosponsors · 0 votes
Speed vs cohort
57pct
18d open
vs 6,526 other HR bills in the 114th — cohort avg 56d
Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 Amends part D (Prescription Drug Benefits) of title XVIII (Medicare) of the Social Security Act (SSAct) to direct the Secretary of Health and Human Services (HHS) to prohibit sponsors of prescription drug plans from paying claims for prescription drugs that do not include the valid National Provider Identifier for the drug's prescriber. Requires the Secretary's annual report to Congress on the use of recovery audit contractors under the Medicare Integrity Program to: (1) describe the types and financial cost of improper payment vulnerabilities identified by recovery audit contractors and how the Secretary is addressing them, and (2) assess the effectiveness of changes made to Medicare payment policies and procedures in order to address those vulnerabilities. Requires the Secretary to address improper payment vulnerabilities in a timely manner, prioritized based on the risk to the Medicare program. Authorizes the Secretary, under recovery audit contracts under both Medicare and Medicaid (SSAct title XIX), to retain a certain portion of the recovered amounts for a program management account for activities addressing problems that contribute to improper payments and fraud. Requires the Secretary, under such contracts, to retain an additional 5% of the recovered amounts to be made available to the HHS Inspector General to investigate improper payments or audit internal controls associated with Medicare or Medicaid payments. Directs the Secretary to develop a plan to revise the incentive program under the Health Insurance Portability and Accountability Act of 1996 for the reporting of fraud and abuse to encourage greater participation by individuals reporting Medicare fraud and abuse. Requires the plan to include certain recommendations for: (1) ways to enhance rewards for individuals reporting, and (2) extension of the incentive program to the Medicaid program. Amends SSAct title XIX to cover the costs of equipment, salaries and benefits, and travel and training in appropriations for the Medicaid Integrity Program. Allows the Secretary to increase Centers for Medicare and Medicaid Services (CMS) staff whose duties consist solely of protecting the integrity of the Medicare program by a number determined necessary to carry out the Program (currently, by 100). Directs the Secretary to provide incentives for Medicare administrative contractors to reduce the improper payment error rates in their jurisdictions. Requires imprisonment for up to 10 years or a fine of up to $500,000 ($1 million in the case of a corporation), or both, for knowingly, intentionally, and with the intent to defraud purchasing, selling, distributing, or arranging for the purchase, sale, or distribution of a Medicare, Medicaid, or CHIP beneficiary identification number or billing privileges under SSAct titles XVIII, title XIX, or title XXI (Children's Health Insurance Program) (CHIP). Amends SSAct title IV part D (Child Support and Establishment of Paternity) with respect to the Federal Parent Locator Service to give the CMS Administrator access to information in the National Directory of New Hires to determine the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program under the Patient Protection and Affordable Care Act (PPACA). Requires the Secretary to disclose to the HHS Inspector General information on individuals and their employers in the National Directory of New Hires if the HHS Inspector General gives the Secretary their names and Social Security account numbers. Restricts the use of such information to: (1) determining the eligibility of an applicant for, or enrollee in, the Medicare program or an applicable state health subsidy program; or (2) evaluating the integrity of such programs. Sets forth rules for the use and disclosure of such information by state agencies. Directs the Secretary to establish a plan to encourage and facilitate the participation of states in the Medicare-Medicaid Data Match Program (Medi-Medi Program). Revises Medi-Medi Data Match Program purposes. Amends SSAct title XIX, as amended by PPACA, and SSAct XXI with respect to claims processing and detection of fraud within the Medicaid and CHIP programs.
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Filing registrants (14)
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congress.gov source codes: H11100, H11100-A
Introduced in House
Congress.gov source codes: 1000, Intro-H
Bills with similar content found using semantic analysis.
Sources: Congress.gov
2016 · fourth_quarter · Transportation
Port related issues - congestion, SOLAS, BTS Port Performance Task Force. Drivers Hours of Service Issues. Rhode Island application for grant under Dept. of Transportation to implement bridge tolling S.2848 - Water Resources Development Act of 2016, all provisions; H.R.818 - PRIME Act of 2015, all provisions; S.2844/H.R.5394 - Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2017, all provisions Dept. of Commerce 21st Century U.S. Port Competitiveness Initiative
Client expense: $1,640,000 · Firm income: Not reported
Government targets: Commerce, Dept of (DOC), Consumer Product Safety Commission (CPSC), Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Federal Aviation Administration (FAA), Federal Maritime Commission, Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office
2016 · fourth_quarter · Transportation
FAA Extension; HR 818; HR636; Application for Open Skies Agreement
Client expense: Not reported · Firm income: $90,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE, State, Dept of (DOS), Transportation, Dept of (DOT), White House Office
2016 · fourth_quarter · Medicare/Medicaid
H.R. 34, 21st Century Cures Act (Upton) - Medicare Advantage and Medicaid issues H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 5659, ESRD Choice Act (Smith) - option for ESRD patients to enroll in MA plans H.R. 5942, Dialysis PATIENTS Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 6265, Medigap Reforms (McDermott) S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD S. 3504, Chronic Care Act (Hatch-Wyden-Isakson-Warner) - chronic care reforms, Medicare Advantage provisions Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.
2016 · fourth_quarter · Medicare/Medicaid
no specific bill - Recovery Audit Contracts, program integrity, medicare appeals, improper payments, policy, program waste, fraud and abuse, hospital short stays, durable medical equipment, hospital bill H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1526 - Medicare Audit Improvement Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2652 - Protecting Patients and Physicians Against Coding Act of 2015 S. 861, H.R. 818 - Prime Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 2368 - Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015 H.R. 34 - 21st Century Cures Act
Client expense: Not reported · Firm income: $80,000
2016 · fourth_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 H.R. 5164 - Rural Hospital Regulatory Relief Act H.R. 5122 - To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models H.R. 5210/S. 2736 - Patient Access to Durable Medical Equipment Act H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 H.R. 5613/S. 3129 - Continuing Access to Hospitals Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act S. 2787 - States Achieve Medicaid Expansion (SAME) Act S. 3130 - Independence at Home Act of 2016
| Republican |
| FL |
| Charles W. Boustany Jr. | Republican | LA |
| Cheri Bustos | Democratic | IL |
| Chris Van Hollen | Democratic | MD |
| Daniel Lipinski | Democratic | IL |
| Daniel Webster | Republican | FL |
| David Loebsack | Democratic | IA |
| David P. Joyce | Republican | OH |
| Dennis A. Ross | Republican | FL |
| Diane Black | Republican | TN |
| Earl Blumenauer | Democratic | OR |
| Ed Perlmutter | Democratic | CO |
| Edward R. Royce | Republican | CA |
| Elise M. Stefanik | Republican | NY |
| Erik Paulsen | Republican | MN |
| Frank A. LoBiondo | Republican | NJ |
| Ileana Ros-Lehtinen | Republican | FL |
| Jackie Speier | Democratic | CA |
| James A. Himes | Democratic | CT |
| James B. Renacci | Republican | OH |
| Jim Cooper | Democratic | TN |
| John C. Carney Jr. | Democratic | DE |
| John K. Delaney | Democratic | MD |
| Joseph J. Heck | Republican | NV |
| Mark E. Amodei | Republican | NV |
| Markwayne Mullin | Republican | OK |
| Matt Cartwright | Democratic | PA |
| Michael K. Simpson | Republican | ID |
| Mike Bishop | Republican | MI |
| Pete Olson | Republican | TX |
| Peter Welch | Democratic | VT |
| Randy Hultgren | Republican | IL |
| Reid J. Ribble | Republican | WI |
| Richard L. Hanna | Republican | NY |
| Rod Blum | Republican | IA |
| Rodney Davis | Republican | IL |
| Ron Kind | Democratic | WI |
| Ryan A. Costello | Republican | PA |
| Scott H. Peters | Democratic | CA |
| Steve Womack | Republican | AR |
| Susan W. Brooks | Republican | IN |
| Tammy Duckworth | Democratic | IL |
| Thomas J. Rooney | Republican | FL |
| Tom Reed | Republican | NY |
| Zoe Lofgren | Democratic | CA |
Client expense: $1,330,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
2016 · fourth_quarter · Transportation
Port related issues - congestion, SOLAS, BTS Port Performance Task Force. Drivers Hours of Service Issues. Rhode Island application for grant under Dept. of Transportation to implement bridge tolling S.2848 - Water Resources Development Act of 2016, all provisions; H.R.818 - PRIME Act of 2015, all provisions; S.2844/H.R.5394 - Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2017, all provisions Dept. of Commerce 21st Century U.S. Port Competitiveness Initiative
Client expense: $1,640,000 · Firm income: Not reported
Government targets: Commerce, Dept of (DOC), Consumer Product Safety Commission (CPSC), Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Federal Aviation Administration (FAA), Federal Maritime Commission, Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office
2016 · fourth_quarter · Medicare/Medicaid
General Medicare Protection, Repeal of Sustainable Growth Rate Formula, Prevention of Fraud, Waste, and Abuse: H.R. 818, Repeal of Independent Payment Advisory Board: H.R. 1190 and S. 141, Prescription Drug Re-Importation: S. 122, Negotiation of Prescription Drug Prices: S. 31 and H.R. 3061 and H.R. 3513 and S. 2023, Prevention of Catastrophic Spending on Prescription Drugs: S. 2864.
Client expense: Not reported · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · third_quarter · Government Issues
General Medicare Protection, Repeal of Sustainable Growth Rate Formula, Prevention of Fraud, Waste, and Abuse: H.R. 818, Repeal of Independent Payment Advisory Board: H.R. 1190, Negotiation of Prescription Drug Prices: H.R. 3061 and H.R. 3513. General Social Security issues, reforms to protect Social Security benefits and Social Security Trust Fund solvency (H.R. 918 and H.R. 1936), and reforms to the way Social Security COLAs are calculated (H.R. 3074 and H.R. 3500).
Client expense: Not reported · Firm income: $10,500
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · third_quarter · Transportation
Aviation Innovation, Reform, and Reauthorization Act of 2016 (H.R. 4441) - issues involving drone registration, transportation of lithium batteries, trucking provisions, Passenger Facility Charge (PFC). Federal Aviation Administration Reauthorization Act of 2016 (S.2658)- issues involving drone registration, transportation of lithium batteries, trucking provisions, Passenger Facility Charge (PFC). Port related issues - congestion, SOLAS, BTS Port Performance Task Force. Drivers Hours of Service Issues. Rhode Island application for grant under Dept. of Transportation to implement bridge tolling S.2848 - Water Resources Development Act of 2016, all provisions; H.R.818 - PRIME Act of 2015, all provisions; S.2844/H.R.5394 - Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2017, all provisions Dept. of Commerce 21st Century U.S. Port Competitiveness Initiative
Client expense: $1,760,000 · Firm income: Not reported
Government targets: Commerce, Dept of (DOC), Consumer Product Safety Commission (CPSC), Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Federal Aviation Administration (FAA), Federal Maritime Commission, Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office
2016 · third_quarter · Transportation
FAA Extension; HR 818; HR636
Client expense: Not reported · Firm income: $90,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE, State, Dept of (DOS), White House Office
2016 · third_quarter · Transportation
Aviation Innovation, Reform, and Reauthorization Act of 2016 (H.R. 4441) - issues involving drone registration, transportation of lithium batteries, trucking provisions, Passenger Facility Charge (PFC). Federal Aviation Administration Reauthorization Act of 2016 (S.2658)- issues involving drone registration, transportation of lithium batteries, trucking provisions, Passenger Facility Charge (PFC). Port related issues - congestion, SOLAS, BTS Port Performance Task Force. Drivers Hours of Service Issues. Rhode Island application for grant under Dept. of Transportation to implement bridge tolling S.2848 - Water Resources Development Act of 2016, all provisions; H.R.818 - PRIME Act of 2015, all provisions; S.2844/H.R.5394 - Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2017, all provisions Dept. of Commerce 21st Century U.S. Port Competitiveness Initiative
Client expense: $1,760,000 · Firm income: Not reported
Government targets: Commerce, Dept of (DOC), Consumer Product Safety Commission (CPSC), Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Federal Aviation Administration (FAA), Federal Maritime Commission, Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office
2016 · third_quarter · Medicare/Medicaid
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
2016 · third_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 H.R. 5164 - Rural Hospital Regulatory Relief Act H.R. 5210/S. 2736 - Patient Access to Durable Medical Equipment Act H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 H.R. 5613/S. 3129 - Continuing Access to Hospitals Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act S. 2787 - States Achieve Medicaid Expansion (SAME) Act S. 3130 - Independence at Home Act of 2016
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
2016 · third_quarter · Medicare/Medicaid
no specific bill - Recovery Audit Contracts, program integrity, medicare appeals, improper payments, policy, program waste, fraud and abuse, hospital short stays, durable medical equipment, hospital bill H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1526 - Medicare Audit Improvement Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2652 - Protecting Patients and Physicians Against Coding Act of 2015 S. 861, H.R. 818 - Prime Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 2368 - Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015
Client expense: Not reported · Firm income: $80,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2016 · third_quarter · Medicare/Medicaid
General Medicare Protection, Repeal of Sustainable Growth Rate Formula, Prevention of Fraud, Waste, and Abuse: H.R. 818, Repeal of Independent Payment Advisory Board: H.R. 1190 and S. 141, Prescription Drug Re-Importation: S. 122, Negotiation of Prescription Drug Prices: S. 31 and H.R. 3061 and H.R. 3513 and S. 2023, Prevention of Catastrophic Spending on Prescription Drugs: S. 2864.
Client expense: $14,758 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Transportation
Aviation Innovation, Reform, and Reauthorization Act of 2016 (H.R. 4441) - issues involving drone registration, transportation of lithium batteries, trucking provisions, Passenger Facility Charge (PFC). Federal Aviation Administration Reauthorization Act of 2016 (S.2658)- issues involving drone registration, transportation of lithium batteries, trucking provisions, Passenger Facility Charge (PFC). Port related issues - congestion, SOLAS, BTS Port Performance Task Force. Drivers Hours of Service Issues. Rhode Island application for grant under Dept. of Transportation to implement bridge tolling S.2848 - Water Resources Development Act of 2016, all provisions; H.R.818 - PRIME Act of 2015, all provisions; S.2844/H.R.5394 - Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2017, all provisions
Client expense: $1,680,000 · Firm income: Not reported
Government targets: Commerce, Dept of (DOC), Consumer Product Safety Commission (CPSC), Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Federal Aviation Administration (FAA), Federal Maritime Commission, Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office
2016 · second_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 H.R. 5164 - Rural Hospital Regulatory Relief Act H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act S. 2787 - States Achieve Medicaid Expansion (SAME) Act
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
2016 · second_quarter · Transportation
Aviation Innovation, Reform, and Reauthorization Act of 2016 (H.R. 4441) - issues involving drone registration, transportation of lithium batteries, trucking provisions, Passenger Facility Charge (PFC). Federal Aviation Administration Reauthorization Act of 2016 (S.2658)- issues involving drone registration, transportation of lithium batteries, trucking provisions, Passenger Facility Charge (PFC). Port related issues - congestion, SOLAS, BTS Port Performance Task Force. Drivers Hours of Service Issues. Rhode Island application for grant under Dept. of Transportation to implement bridge tolling S.2848 - Water Resources Development Act of 2016, all provisions; H.R.818 - PRIME Act of 2015, all provisions; S.2844/H.R.5394 - Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2017, all provisions
Client expense: $1,550,000 · Firm income: Not reported
Government targets: Commerce, Dept of (DOC), Consumer Product Safety Commission (CPSC), Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Federal Aviation Administration (FAA), Federal Maritime Commission, Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office
2016 · second_quarter · Medicare/Medicaid
H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD Draft Bill on Option for ESRD Patients to Enroll in MA Plans (Ways and Means Committee) H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.
Client expense: $1,710,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office
2016 · second_quarter · Medicare/Medicaid
no specific bill - Recovery Audit Contracts, program integrity, medicare appeals, improper payments, 2 midnight policy, program waste, fraud and abuse, hospital short stays, durable medical equipment, hospital bill H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1526 - Medicare Audit Improvement Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2652 - Protecting Patients and Physicians Against Coding Act of 2015 S. 861, H.R. 818 - Prime Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 2368 - Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015
Client expense: Not reported · Firm income: $80,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Science/Technology
NASA Space Suit Program, HR 818
Client expense: $2,208,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Aviation/Airlines/Airports
FAA Reauthorization, HR 818, HR 636
Client expense: $2,208,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Health Issues
Affordable Care Act -- Section 4980I -- 40% Excise tax on Health Benefits; Implementation of excise tax and application to large employers. H.R. 818 -- Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act of 2015; to combat waste, fraud, and abuse in Medicare and Medicaid
Client expense: $220,000 · Firm income: Not reported
Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Council of Economic Advisers (CEA), HOUSE OF REPRESENTATIVES, Intl Trade Administration (ITA), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)
2016 · second_quarter · Government Issues
General Medicare Protection, Repeal of Sustainable Growth Rate Formula, Prevention of Fraud, Waste, and Abuse: H.R. 818, Repeal of Independent Payment Advisory Board: H.R. 1190, Negotiation of Prescription Drug Prices: H.R. 3061 and H.R. 3513. General Social Security issues, reforms to protect Social Security benefits and Social Security Trust Fund solvency (H.R. 918 and H.R. 1936), and reforms to the way Social Security COLAs are calculated (H.R. 3074 and H.R. 3500).
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES
2016 · second_quarter · Medicare/Medicaid
General Medicare Protection, Repeal of Sustainable Growth Rate Formula, Prevention of Fraud, Waste, and Abuse: H.R. 818, Repeal of Independent Payment Advisory Board: H.R. 1190 and S. 141, Prescription Drug Re-Importation: S. 122, Negotiation of Prescription Drug Prices: S. 31 and H.R. 3061 and H.R. 3513 and S. 2023, Prevention of Catastrophic Spending on Prescription Drugs: S. 2864.
Client expense: $34,846 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · first_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821/S. 2618 - Medicaid Directory of Caregivers (Medicaid DOC) Act H.R. 4588 - Incentivizing Medicaid Expansion Act of 2016 H.R. 4725 - Common Sense Savings Act of 2016 S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
2016 · first_quarter · Medicare/Medicaid
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.
Client expense: $2,210,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
2016 · first_quarter · Government Issues
General Medicare Protection, Repeal of Sustainable Growth Rate Formula, Prevention of Fraud, Waste, and Abuse: H.R. 818, Repeal of Independent Payment Advisory Board: H.R. 1190, Negotiation of Prescription Drug Prices: H.R. 3061 and H.R. 3513. General Social Security issues, reforms to protect Social Security benefits and Social Security Trust Fund solvency (H.R. 918 and H.R. 1936), and reforms to the way Social Security COLAs are calculated (H.R. 3074 and H.R. 3500).
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES
2016 · first_quarter · Health Issues
Affordable Care Act -- Section 4980I -- 40% Excise tax on Health Benefits; Implementation of excise tax and application to large employers. H.R.818 -- Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act of 2015; to combat waste, fraud, and abuse in Medicare and Medicaid
Client expense: $370,000 · Firm income: Not reported
Government targets: Bureau of the Census, Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Intl Trade Administration (ITA), Pension Benefit Guaranty Corporation (PBGC), SENATE, Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office
2016 · first_quarter · Medicare/Medicaid
no specific bill - Recovery Audit Contracts, program integrity, medicare appeals, improper payments, 2 midnight policy, program waste, fraud and abuse, hospital short stays, durable medical equipment, Icd-10 Implementation, hospital bill H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1526 - Medicare Audit Improvement Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2652 - Protecting Patients and Physicians Against Coding Act of 2015 S. 861, H.R. 818 - Prime Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 2368 - Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015
Client expense: Not reported · Firm income: $90,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2016 · first_quarter · Medicare/Medicaid
General Medicare Protection, Repeal of Sustainable Growth Rate Formula, Prevention of Fraud, Waste, and Abuse: H.R. 818, Repeal of Independent Payment Advisory Board: H.R. 1190 and S. 141, Prescription Drug Re-Importation: S. 122, Negotiation of Prescription Drug Prices: S. 31 and H.R. 3061 and H.R. 3513 and S. 2023.
Client expense: $34,846 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2015 · third_quarter · Medicare/Medicaid
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
Client expense: $2,470,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Patent & Trademark Office (PTO), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
2015 · first_quarter · Medicare/Medicaid
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
Client expense: $2,960,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
2015 · fourth_quarter · Government Issues
General Medicare Protection, Repeal of Sustainable Growth Rate Formula, Prevention of Fraud, Waste, and Abuse: H.R. 818, Repeal of Independent Payment Advisory Board: H.R. 1190, Negotiation of Prescription Drug Prices: H.R. 3061 and H.R. 3513. General Social Security issues, reforms to protect Social Security benefits and Social Security Trust Fund solvency (H.R. 918 and H.R. 1936), and reforms to the way Social Security COLAs are calculated (H.R. 3074 and H.R. 3500).
Client expense: Not reported · Firm income: $10,000
Government targets: HOUSE OF REPRESENTATIVES
2015 · fourth_quarter · Medicare/Medicaid
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
Client expense: $1,850,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
2015 · fourth_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1362 - Medicaid Requiring Expenditures for Public Objectives to be Reflective of Total Spending (Medicaid REPORTS) Act H.R. 2151 - Improving Oversight and Accountability in Medicaid Non-DSH Supplemental Payments Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3014 - Medical Controlled Substances Transportation Act H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act H.R. 3716 - Ensuring Terminated Providers Are Removed From Medicaid and CHIP Act H.R. 3821 - Medicaid Directory of Caregivers (Medicaid DOC) Act S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015 S. 2425 - Patient Access and Medicare Protection Act
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
2015 · fourth_quarter · Medicare/Medicaid
S. 688 and HR 1343 -- Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, all issues. S. 861 and HR 818 -- PRIME Act of 2015, all issues. Issues pertaining to Hospitals Outpatient Department (HOPD) provisions in the 2015 Bipartisan Budget Act.
Client expense: $80,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2015 · fourth_quarter · Medicare/Medicaid
no specific bill - Recovery Audit Contracts, program integrity, medicare appeals, improper payments, 2 midnight policy, program waste, fraud and abuse, hospital short stays, durable medical equipment, Icd-10 Implementation, hospital bill H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1526 - Medicare Audit Improvement Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2652 - Protecting Patients and Physicians Against Coding Act of 2015 S. 861, H.R. 818 - Prime Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015 S. 2368 - Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015
Client expense: Not reported · Firm income: $100,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2015 · fourth_quarter · Health Issues
Affordable Care Act -- Section 4980I -- 40% Excise tax on Health Benefits; Implementation of excise tax and application to large employers. H.R.818 -- Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act of 2015; to combat waste, fraud, and abuse in Medicare and Medicaid
Client expense: $350,000 · Firm income: Not reported
Government targets: Bureau of the Census, Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Intl Trade Administration (ITA), Labor, Dept of (DOL), Natl Security Council (NSC), SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office
2015 · fourth_quarter · Medicare/Medicaid
General Medicare Protection, Repeal of Sustainable Growth Rate Formula, Prevention of Fraud, Waste, and Abuse: H.R. 818, Repeal of Independent Payment Advisory Board: H.R. 1190 and S. 141, Prescription Drug Re-Importation: S. 122, Negotiation of Prescription Drug Prices: S. 31 and H.R. 3061 and H.R. 3513 and S. 2023.
Client expense: $34,846 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2015 · third_quarter · Medicare/Medicaid
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
Client expense: $2,450,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Patent & Trademark Office (PTO), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
Discussed the Protecting the Integrity of Medicare Act. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H.R. 2005, S. 1083, Medicare Drugs Savings Act, Discussed legislation to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. House and Senate H.R. 2624, S.1488, Discussed the Part D Beneficiary Appeals Fairness Act, a bill that would allow seniors to appeal the placement of their medications on a Medicare Part D specialty tier. Discussed Medicare Part D fraud and abuse legislation including lock-in provisions for high risk enrollees. (no bill) Discussed legislation to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. (no bill) Discussed pending U.S.Trade agreement negotiations on the Trans Pacific Partnership and their potential impact on prescription drug access and affordabillity.(no bill) H.R.919, S.522, Childrens's Health Insurance Program - Discussed Children's Health Insurance Program (CHIP) extension. Discussed Medicare coverage of hearing aids. (no bill) H.R. 1571, S.843, Improving Access to Medicare Coverage Act - Discussed the bill and urged movement of the bill. H.R.1470, SGR Repeal and Medicare Provider Payment Modernization Act of 2015 - Advocated for greater beneficiary protections. H.R.605, S.275, Home Infusion Site of Care Act - Sent letter of endorsement. H.R. 818, S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME)Act - Sent letter of endorsement. H.R. 876, S.1349, Notice of Observation Treatment and Implication for Care Eligibility (NOTICE)Act - Sent letter of endorsement. Discussed changes to the Medicare benefit design, such as copays, premiums, and deductibles.(no bill) Discussed Medicare health information technology, data transparency, and Qualifying Entities. (no bill) Discussed health care quality and measurement. (no bill) H.R. 3020, S. 1695, S.2132, H.Con.Res.27, S.Con.Res.11, Labor, HHS, Education and Related Agencies Appropriations, FY2016 - Lobbied to protect vital health and social services programs, and to prevent repeal of certain financial and healthcare legislation. Discussed structural changes to Medicaid. (no bill) S. 1549, Care Planning Act, Discussed the bill which provides for advanced illness care coordination services. Met with Senate Finance Committee to discuss recommendations on chronic care, including independence at home expansion and family caregiving support. Discussed family caregiver assessment in Medicaid home and community-based services with CMS (no bill). Attended LTSS financing colloquium with HHS ASPE. (no bill) H.R. 1202, Discussed Medicare Patient Access to Hospice Act. Discussed nursing home care, staffing data, value-based purchasing for SNFs and nursing home quality measures. Attended HHS event on 50th anniversary of Medicare and Medicaid. (no bill) Shared comments on Medicaid and managed care and long-term care facility requirements proposed regulations. Discussed GAO report on Medicaid personal care services. H.R. 3220, S. 1871, Endorsed Medicare Smartcard legislation. H.R. 2948, Endorsed Telehealth Parity Act. Discussed Medicare telemedicine policy. Discussed Medicare Part B premiums and deductibles in 2016. Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes (no bill number). Discussed legislation (no bill) to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. H.R. 2624, S. 1488, Discussed the Part D Beneficiary Appeals Fairness Act, a bill that would allow seniors to appeal the placement of their medications on a Medicare Part D specialty tier. Discussed Medicare Part D fraud and abuse legislation including lock-in provisions for high risk enrollees (no bill). H.R.1220, S.624, Discussed the removing barriers to Colorectal Cancer Screening Act. Discussed legislation with staff regarding PRIME ACT-HR 818 Preventing and reducing improper Medicare expenditures act.
Client expense: $1,930,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Consumer Financial Protection Bureau (CFPB), Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), White House Office
2015 · third_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act Telehealth provisions of the discussion draft 21st Century Cures legislation HHS study on the comparability of CHIP coverage and benefits with those of marketplace health plans Medicare provisions of H.R. 1892, the Trade Adjustment Assistance Act H.R. 2 - Medicare Access and CHIP Reauthorization Act H.R. 160/S. 149 - Protect Medical Innovation Act H.R. 546/S. 298 - Advancing Care for Exceptional Kids (ACE Kids) Act H.R. 700 - Stabilize Medicaid and CHIP Coverage Act H.R. 818/S. 861 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act H.R. 876 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R. 919 - CHIP Extension and Improvement Act H.R. 1021 - Protecting Integrity of Medicare Act (PIMA) H.R. 1190/S. 141 - Protecting Seniors Access to Medicare Act H.R. 1458 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 1470 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 2339 - To amend title XIX of the Social Security Act to clarify the treatment of lottery winnings and other lump sum income for purposes of income eligibility under the Medicaid program H.R. 3134 - Defund Planned Parenthood Act of 2015 H.R. 3292 - Medicare IME Pool Act H.R. 3298 - Medicare Post-Acute Care Value-Based Purchasing Act S. 257/H.R. 1611 - Protecting Access to Rural Therapy Services Act S. 578/H.R. 1342 - Home Health Care Planning Improvement Act S. 737/H.R. 2253 - Ensuring Access to Primary Care for Women & Children Act S. 1349 - Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S. 1456 - Rural ACO Improvement Act S. 1461 - Extending a moratorium on enforcement of direct physician supervision of outpatient therapeutic services in critical access and small rural hospitals through 2015
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
2015 · third_quarter · Medicare/Medicaid
no specific bill - Recovery Audit Contracts, program integrity, medicare appeals, improper payments, 2 midnight policy, program waste, fraud and abuse, hospital short stays, durable medical equipment, Icd-10 Implementation H.R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R. 1526 - Medicare Audit Improvement Act of 2015 H.R. 1021 - Protecting the Integrity of Medicare Act of 2015 H.R. 2652 - Protecting Patients and Physicians Against Coding Act of 2015 S. 861, H.R. 818 - Prime Act of 2015 H.R. 2156 - Medicare Audit Improvement Act of 2015
Client expense: Not reported · Firm income: $100,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2015 · third_quarter · Health Issues
Affordable Care Act -- Section 4980I -- 40% Excise tax on Health Benefits; Implementation of excise tax and application to large employers. H.R.818 - Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act of 2015; to combat waste, fraud, and abuse in Medicare and Medicaid
Client expense: $410,000 · Firm income: Not reported
Government targets: Bureau of the Census, Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Intl Trade Administration (ITA), Natl Security Council (NSC), SENATE, Securities & Exchange Commission (SEC), State, Dept of (DOS), Treasury, Dept of, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office
2015 · third_quarter · Medicare/Medicaid
H.R.1470 SGR Repeal and Medicare Provider Payment Modernization Act of 2015, all issues. H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, all issues. S. 688 and HR 1343 -- Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, all issues. S. 861 and HR 818 -- PRIME Act of 2015, all issues.
Client expense: $90,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2015 · third_quarter · Medicare/Medicaid
General Medicare Protection, Repeal of Sustainable Growth Rate Formula, Prevention of Fraud, Waste, and Abuse: H.R. 818, Repeal of Independent Payment Advisory Board: H.R. 1190 and S. 141, Prescription Drug Re-Importation: S. 122, Negotiation of Prescription Drug Prices: S. 31 and H.R. 3061 and H.R. 3513 and S. 2023.
Client expense: $34,847 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2015 · first_quarter · Medicare/Medicaid
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
Client expense: $2,870,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
2015 · second_quarter · Medicare/Medicaid
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
Client expense: $2,310,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office
2015 · second_quarter · Medicare/Medicaid
Legislative and regulatory issues that affect the prescription drug benefit or prescription drug affordability, including: HR244 (MAC Pricing); HR471 (Controlled Substances Registration); HR592 (Pharmacy Provider Status); HR69 (ASP Prompt Pay Exclusion); HR793 (Any Willing Pharmacy); HR804 (Access to Medicare Data); HR818 (PRIME Act); HR971 (OPEN Act); HR1021 (PIMA); HR1353 (New Therapeutic Entities); HR1735 (NDAA); HR2175 (FEHBP Transparency); HR2298 (Medicare Rx Abuse Prevention); S31 (Direct Negotiation); S314 (Pharmacy Provider Status); S1083 (Medicare Rebates); S1190 (Any Willing Pharmacy); S1364 (Medicaid Generic Rebates); S1376 (NDAA); S1431(Rx Abuse Prevention & Treatment).
Client expense: Not reported · Firm income: Not reported