Notice of Observation Treatment and Implication for Care Eligibility Act

H.R.6 - 21st Century Cures Act H.R.3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 S.2148 - A bill to amend title XVIII of the Social Security Act to prevent an increase in the Medicare part B premium and deductible in 2016 H.R.3696 - Medicare Premium Fairness Act of 2015 P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 4302: Protecting Access to Medicare Act of 2014 (PL 113-93) on 4.1.2014 H.R. 1571: Improving Access to Medicare Coverage Act of 2015. S. 843: Improving Access to Medicare Coverage Act of 2015. S. 539 and H.R.775 The Medicare Access to Rehabilitation Services Act. H.R. 290: The Creating Access to Rehabilitation for Every Senior (CARES ACT). S. 1932: A bill to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program. Protect and Preserve Medicaid Provider Assessment. Protect and Preserve Medicare Bad Debt Reimbursement Improving the CMS State Plan Amdt. Process. Sustainable Growth Rate (SGR) and other reform proposals. Reducing hospital readmissions from skilled nursing facility. The Veteran Access to Long Term Care and Health Services Act (S.2000) and VA Provider Agreement and Proposal MedPAC site neutral payment system for post acute care. CME proposed Rule for SNF Prospective Payment System (PPS). PL. 113-185 Impact Act of 2014 H.R. 952: To amend titles XVIII and XIX of the Social Security Act to establish a minimum direct care registered nurse staffing requirement at nursing facilities and skilled nursing facilities under Medicare and Medicaid and for other purposes. H.R. 2: Medicare Access & CHIP Reauthorization Act of 2015 H.R. 876: Notice Act (P.L. 114-42) S.1916: The Rural Health Care Connectivity Act of 2015 (Public Law No. 114-182) H.R.4111 Rural Health Care Connectivity Act of 2015 (Public Law No. 114-182) Skilled Nursing Episodic Payment Reform

Client expense: $950,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE, Veterans Affairs, Dept of (VA)

Issues regarding reimbursement and Medicare program issues regarding long term care and post acute care vendors, suppliers, and providers including cuts to portable x-ray providers and including the following: HR 6 21st Century Cures Initiative, Medicare Tele Health Parity Act of 2015 H.R. 2948, improving information technology interoperability, electronic prescribing, S. 1349/H.R. 876, Improving Access to Medicare Coverage Act of 2015 S.843/H.R.1571, Medicare Post-Acute Care Value-Based Purchasing H.R. 3298,Protecting Seniors Access to Medicare Act of 2015 H.R. 1190, Medical Device Tax Repeal Bill H.R. 160, Audit and Appeals Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015, Consolidated Appropriations Act.

Client expense: $20,000 · Firm income: Not reported

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

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

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

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

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

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

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

Issues regarding reimbursement and Medicare program issues regarding long term care and post acute care vendors, suppliers, and providers including cuts to portable x-ray providers and including the following: HR 6 21st Century Cures Initiative, Medicare Tele Health Parity Act of 2015 H.R. 2948, improving information technology interoperability, electronic prescribing, S. 1349/H.R. 876, Improving Access to Medicare Coverage Act of 2015 S.843/H.R.1571, Medicare Post-Acute Care Value-Based Purchasing H.R. 3298,Protecting Seniors Access to Medicare Act of 2015 H.R. 1190, Medical Device Tax Repeal Bill H.R. 160, Audit and Appeals Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015, Consolidated Appropriations Act.

Client expense: $44,000 · Firm income: Not reported

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

H.R.6 - 21st Century Cures Act H.R.3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 S.2148 - A bill to amend title XVIII of the Social Security Act to prevent an increase in the Medicare part B premium and deductible in 2016 H.R.3696 - Medicare Premium Fairness Act of 2015 P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 4302: Protecting Access to Medicare Act of 2014 (PL 113-93) on 4.1.2014 H.R. 1571: Improving Access to Medicare Coverage Act of 2015. S. 843: Improving Access to Medicare Coverage Act of 2015. S. 539 and H.R.775 The Medicare Access to Rehabilitation Services Act. H.R. 290: The Creating Access to Rehabilitation for Every Senior (CARES ACT). S. 1932: A bill to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program. Protect and Preserve Medicaid Provider Assessment. Protect and Preserve Medicare Bad Debt Reimbursement Improving the CMS State Plan Amdt. Process. Sustainable Growth Rate (SGR) and other reform proposals. Reducing hospital readmissions from skilled nursing facility. The Veteran Access to Long Term Care and Health Services Act (S.2000) and VA Provider Agreement and Proposal MedPAC site neutral payment system for post acute care. CME proposed Rule for SNF Prospective Payment System (PPS). PL. 113-185 Impact Act of 2014 H.R. 952: To amend titles XVIII and XIX of the Social Security Act to establish a minimum direct care registered nurse staffing requirement at nursing facilities and skilled nursing facilities under Medicare and Medicaid and for other purposes. H.R. 2: Medicare Access & CHIP Reauthorization Act of 2015 H.R. 876: Notice Act (P.L. 114-42) S.1916: The Rural Health Care Connectivity Act of 2015 H.R.4111 Rural Health Care Connectivity Act of 2015 Skilled Nursing Episodic Payment Reform

Client expense: $920,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE, Veterans Affairs, Dept of (VA)

Health care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits. Monitor and advocate funding of Medicare/Medicaid benefits. Quality care of standards, survey and certification standards and procedures for long term care providers of Medicare/Medicaid programs; Nursing Homes, Hospice, Long Term Care Hospitals, Inpatient Rehab Facilities, and related businesses. Medicare reimbursement for skilled nursing facilities, Medicare Conditions of Participation for Hospice. H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015; H.R. 1458 - Bundling and Coordinating Post-Acute Care Act of 2015 of 2015; H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015; H.R. 1571/S. 843 - Improving Access to Medicare Coverage Act of 2015; H.R. 876 - NOTICE Act; H.R. 290 - Creating Access to Rehabilitation for Every Senior (CARES) Act of 2015; H.R. 1184 - Medicare Skilled Nursing and Home Health Services Continuity of Care Act of 2015

Client expense: $77,872 · Firm income: Not reported

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

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

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

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

Issues regarding reimbursement and Medicare program issues regarding long term care and post acute care vendors, suppliers, and providers including cuts to portable x-ray providers and including the following: HR 6 21st Century Cures Initiative, Medicare Tele Health Parity Act of 2015 H.R. 2948, improving information technology interoperability, electronic prescribing, S. 1349/H.R. 876, Improving Access to Medicare Coverage Act of 2015 S.843/H.R.1571, Medicare Post-Acute Care Value-Based Purchasing H.R. 3298,Protecting Seniors Access to Medicare Act of 2015 H.R. 1190, Medical Device Tax Repeal Bill H.R. 160, Audit and Appeals Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015, Consolidated Appropriations Act.

Client expense: $44,000 · Firm income: Not reported

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

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

H.R.6 - 21st Century Cures Act H.R.3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 S.2148 - A bill to amend title XVIII of the Social Security Act to prevent an increase in the Medicare part B premium and deductible in 2016 H.R.3696 - Medicare Premium Fairness Act of 2015 P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 4302: Protecting Access to Medicare Act of 2014 (PL 113-93) on 4.1.2014 H.R. 1571: Improving Access to Medicare Coverage Act of 2015. S. 843: Improving Access to Medicare Coverage Act of 2015. S. 539 and H.R.775 The Medicare Access to Rehabilitation Services Act. H.R. 290: The Creating Access to Rehabilitation for Every Senior (CARES ACT). S. 1932: A bill to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program. Protect and Preserve Medicaid Provider Assessment. Protect and Preserve Medicare Bad Debt Reimbursement Improving the CMS State Plan Amdt. Process. Sustainable Growth Rate (SGR) and other reform proposals. Reducing hospital readmissions from skilled nursing facility. The Veteran Access to Long Term Care and Health Services Act (S.2000) and VA Provider Agreement and Proposal MedPAC site neutral payment system for post acute care. CME proposed Rule for SNF Prospective Payment System (PPS). PL. 113-185 Impact Act of 2014 H.R. 952: To amend titles XVIII and XIX of the Social Security Act to establish a minimum direct care registered nurse staffing requirement at nursing facilities and skilled nursing facilities under Medicare and Medicaid and for other purposes. H.R. 2: Medicare Access & CHIP Reauthorization Act of 2015 H.R. 876: Notice Act (P.L. 114-42) S.1916: The Rural Health Care Connectivity Act of 2015 H.R.4111 Rural Health Care Connectivity Act of 2015 Skilled Nursing Episodic Payment Reform

Client expense: $920,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE, Veterans Affairs, Dept of (VA)

Health care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits. Monitor and advocate funding of Medicare/Medicaid benefits. Quality care of standards, survey and certification standards and procedures for long term care providers of Medicare/Medicaid programs; Nursing Homes, Hospice, Long Term Care Hospitals, Inpatient Rehab Facilities, and related businesses. Medicare reimbursement for skilled nursing facilities, Medicare Conditions of Participation for Hospice. H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015; H.R. 1458 - Bundling and Coordinating Post-Acute Care Act of 2015 of 2015; H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015; H.R. 1571/S. 843 - Improving Access to Medicare Coverage Act of 2015; H.R. 876 - NOTICE Act; H.R. 290 - Creating Access to Rehabilitation for Every Senior (CARES) Act of 2015; H.R. 1184 - Medicare Skilled Nursing and Home Health Services Continuity of Care Act of 2015

Client expense: $77,872 · Firm income: Not reported

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

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

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

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

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

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

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

H.R.6 - 21st Century Cures Act H.R.3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 S.2148 - A bill to amend title XVIII of the Social Security Act to prevent an increase in the Medicare part B premium and deductible in 2016 H.R.3696 - Medicare Premium Fairness Act of 2015 P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 4302: Protecting Access to Medicare Act of 2014 (PL 113-93) on 4.1.2014 H.R. 1571: Improving Access to Medicare Coverage Act of 2015. S. 843: Improving Access to Medicare Coverage Act of 2015. S. 367: The Medicare Access to Rehabilitation Services Act. H.R. 290: The Creating Access to Rehabilitation for Every Senior (CARES ACT). S. 1932: A bill to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program. Protect and Preserve Medicaid Provider Assessment. Protect and Preserve Medicare Bad Debt Reimbursement Improving the CMS State Plan Amdt. Process. Sustainable Growth Rate (SGR) and other reform proposals. Reducing hospital readmissions from skilled nursing facility. Improving Medicare Post-Acute Care Transformation Act (IMPACT) The Veteran Access to Long Term Care and Health Services Act (S.2000) and VA Provider Agreement and Proposal Repealing the Cap on Medicare Part B therapy services for seniors. MedPAC site neutral payment system for post acute care. CME proposed Rule for SNF Prospective Payment System (PPS). PL. 113-185 Impact Act of 2014 H.R. 952: To amend titles XVIII and XIX of the Social Security Act to establish a minimum direct care registered nurse staffing requirement at nursing facilities and skilled nursing facilities under Medicare and Medicaid and for other purposes. H.R. 2: Medicare Access & CHIP Reauthorization Act of 2015 H.R. 876: Notice Act (P.L. 114-42) S.1916: The Rural Health Care Connectivity Act of 2015 H.R.4111 Rural Health Care Connectivity Act of 2015 Skilled Nursing Episodic Payment Reform

Client expense: $980,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE, Veterans Affairs, Dept of (VA)

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

Issues regarding reimbursement and Medicare program issues regarding long term care and post acute care vendors, suppliers, and providers including cuts to portable x-ray providers and including the following: Physician Fee Schedule "SGR" doc fix legislation, HR 6 21st Century Cures Initiative, Medicare Tele Health Parity Act of 2015 H.R. 2948, improving information technology interoperability, electronic prescribing,Notice of Observation Treatment and Implication for Care Eligibility Act,S. 1349/H.R. 876, Improving Access to Medicare Coverage Act of 2015 S.843/H.R.1571, Medicare Post-Acute Care Value-Based Purchasing H.R. 3298,Protecting Seniors Access to Medicare Act of 2015 H.R. 1190, Medical Device Tax Repeal Bill H.R. 160, Audit and Appeals Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015, Consolidated Appropriations Act.

Client expense: $44,000 · Firm income: Not reported

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

H.R.6 - 21st Century Cures Act H.R.3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 S.2148 - A bill to amend title XVIII of the Social Security Act to prevent an increase in the Medicare part B premium and deductible in 2016 H.R.3696 - Medicare Premium Fairness Act of 2015 P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 4302: Protecting Access to Medicare Act of 2014 (PL 113-93) on 4.1.2014 H.R. 1571: Improving Access to Medicare Coverage Act of 2015. S. 843: Improving Access to Medicare Coverage Act of 2015. S. 367: The Medicare Access to Rehabilitation Services Act. H.R. 290: The Creating Access to Rehabilitation for Every Senior (CARES ACT). S. 1932: A bill to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program. Protect and Preserve Medicaid Provider Assessment. Protect and Preserve Medicare Bad Debt Reimbursement Improving the CMS State Plan Amdt. Process. Sustainable Growth Rate (SGR) and other reform proposals. Reducing hospital readmissions from skilled nursing facility. Improving Medicare Post-Acute Care Transformation Act (IMPACT) The Veteran Access to Long Term Care and Health Services Act (S.2000) and VA Provider Agreement and Proposal Repealing the Cap on Medicare Part B therapy services for seniors. MedPAC site neutral payment system for post acute care. CME proposed Rule for SNF Prospective Payment System (PPS). PL. 113-185 Impact Act of 2014 H.R. 952: To amend titles XVIII and XIX of the Social Security Act to establish a minimum direct care registered nurse staffing requirement at nursing facilities and skilled nursing facilities under Medicare and Medicaid and for other purposes. H.R. 2: Medicare Access & CHIP Reauthorization Act of 2015 H.R. 876: Notice Act (P.L. 114-42) S.1916: The Rural Health Care Connectivity Act of 2015 H.R.4111 Rural Health Care Connectivity Act of 2015 Skilled Nursing Episodic Payment Reform

Client expense: $930,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE, Veterans Affairs, Dept of (VA)

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/ S. 688) Medicare audit contractor program reforms (H.R. 2156, AFIRM Act) Health information technology (H.R. 270, H.R. 3309, H.R. 3940, S. 2425) Medicare Access and CHIP Reauthorization Act (H.R. 2) Patient status notification (H.R. 876, S. 1349) Rural hospital policies (H.R. 663 / S. 332, H.R. 169 / S. 258, H.R. 1611 / S. 257, S. 1461 / H.R. 2878) Telehealth, interoperability (H.R. 6) Physician self-referral (H.R. 2027, H.R. 976) Hospital Improvements for Payment Act (H.R. 3291) Post-Acute Care policies (H.R. 1458, H.R. 3298) Graduate Medical Education policy reforms (H.R. 2124, S. 1148, H.R 3292) DSH payment (H.R. 3288) Bipartisan Budget Act (H.R. 1314) Clinical lab payment policy

Client expense: $73,623 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.6-21st Century Cures Act H.R.33-Protecting Volunteer Firefighters and Emergency Responders Act H.R.203-Clay Hunt Suicide Prevention for American Veterans Act H.R.293-To amend title XI of the Social Security Act to exempt from manufacturer transparency reporting certain transfers used for educational purposes, and for other purposes. H.R.398-Trafficking Awareness Training for Health Care Act H.R.639-Improving Regulatory Transparency for New Medical Therapies Act H.R.647-Access to Life-Saving Trauma Care for All Americans Act H.R.648-Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R.836-Health Care Safety Net Enhancement Act H.R.876-Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R.1190-Protecting Seniors Access to Medicare Act of 2015 H.R.1571-Improving Access to Medicare Coverage Act of 2015 H.R.1725-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 H.R.1786-James Zadroga 9/11 Health and Compensation Reauthorization Act H.R.1818-Veteran Emergency Medical Technician Support Act of 2015 H.R.1821-Opioid Overdose Reduction Act of 2015 H.R.1854-Comprehensive Justice and Mental Health Act of 2015 H.R.1877-Mental Health First Aid Act of 2015 H.R.2050-Middle Class Health Benefits Tax Repeal Act of 2015 H.R.2366-Field EMS Modernization and Innovation Act H.R.2603-Saving Lives, Saving Costs Act H.R.2646-Helping Families in Mental Health Crisis Act of 2015 H.R.2850-Stop Overdose Stat Act of 2015 H.R.3081-TELEmedicine for MEDicare (TELE-MED) Act of 2015 H.R.3379-Airplane Kids In Transit Safety (KITS) Act of 2015 H.R.3537-Synthetic Drug Control Act of 2015 H.R.3681-Improving Access to Emergency Psychiatric Care Act H.R.3682-Reducing Employer Burdens, Unleashing Innovation, and Labor Development Act of 2015 H.R.3762-Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 H.R.3770-End Surprise Billing Act of 2015 H.R.4059-Medicare Choices Empowerment and Protection Act H.R.4150-Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act S.141-Protecting Seniors Access to Medicare Act of 2015 S.167-Clay Hunt Suicide Prevention for American Veterans Act S.425-Homeless Veterans' Reintegration Programs Reauthorization Act of 2015 S.453-Veteran Emergency Medical Technician Support Act of 2015 S.480-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 S.599-Improving Access to Emergency Psychiatric Care Act S.707-Opioid Overdose Reduction Act of 2015 S.711-Mental Health First Act of 2015 S.763-Trauma Systems and Regionalization of Emergency Care Reauthorization Act S.810-SGR Repeal and Medicare Provider Payment Modernization Act of 2015 S.884-Health Care Safety Net Enhancement Act S.843-Improving Access to Medicare Coverage Act of 2015 S.928-James Zadroga 9/11 Health and Compensation Reauthorization Act S.993-Comprehensive Justice and Mental Health Act of 2015 S.1446-SOAR to Health and Wellness Act of 2015 S.1450-Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act S.1452-Veterans Emergency Health Safety Net Expansion Act of 2015 S.1475-Saving Lives, Saving Costs Act S.1549-Care Planning Act of 2015 S.1648-Rural Emergency Acute Care Hospital (REACH) Act S.1654-Overdose Prevention Act S.1693-To amend title 38, United States Code, to expand eligibility for reimbursement for emergency medical treatment to certain veterans that were unable to receive care from the Department of Veterans Affairs in the 24-month period preceding the furnishing of such emergency treatment, and for other purposes. S.1778-TELEmedicine for MEDicare (TELE-MED) Act of 2015 S.1893-Mental Health Awareness and Improvement Act of 2015 S.1945-Mental Health Reform Act of 2015 S.2002-Mental Health and Safe Communities Act of 2015 S.2045-Middle Class Health Benefits Tax Repeal Act of 2015 S.2297-Medicare Choices Empowerment and Protection Act

Client expense: $374,793 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits. Monitor and advocate funding of Medicare/Medicaid benefits. Quality care of standards, survey and certification standards and procedures for long term care providers of Medicare/Medicaid programs; Nursing Homes, Hospice, Long Term Care Hospitals, Inpatient Rehab Facilities, and related businesses. Medicare reimbursement for skilled nursing facilities, Medicare Conditions of Participation for Hospice. H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015; H.R. 1458 - Bundling and Coordinating Post-Acute Care Act of 2015 of 2015; H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015; H.R. 1571/S. 843 - Improving Access to Medicare Coverage Act of 2015; H.R. 876 - NOTICE Act; H.R. 290 - Creating Access to Rehabilitation for Every Senior (CARES) Act of 2015; H.R. 1184 - Medicare Skilled Nursing and Home Health Services Continuity of Care Act of 2015

Client expense: $77,872 · Firm income: Not reported

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

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

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

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

S. 1916 Rural Health Care Connectivity Act of 2015 (entire legislation) H.R. 876 NOTICE Act (entire legislation)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.2-Medicare Access and CHIP Reauthorization Act of 2015 H.R.876-Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R.1190-Protecting Seniors Access to Medicare Act of 2015 H.R.1470-SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R.1571-Improving Access to Medicare Coverage Act of 2015 H.R.2646-Helping Families in Mental Health Crisis Act of 2015 H.R.3081-TELEmedicine for MEDicare (TELE-MED) Act of 2015 H.R.3288-Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R.3291-Medicare Crosswalk Hospital Code Development Act of 2015 H.R.3292-Medicare IME Pool Act of 2015 S.141-Protecting Seniors Access to Medicare Act of 2015 S.599-Improving Access to Emergency Psychiatric Care Act S.810-SGR Repeal and Medicare Provider Payment Modernization Act of 2015 S.843-Improving Access to Medicare Coverage Act of 2015 S.1349-Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S.1549-Care Planning Act of 2015 S.1648-Rural Emergency Acute Care Hospital (REACH) Act

Client expense: $491,382 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.Con.Res 27-Concurrent Resolution on the Budget for Fiscal Year 2016 H.R.2-Medicare Access and CHIP Reauthorization Act of 2015 H.R.6-21st Century Cures Act H.R.33-Protecting Volunteer Firefighters and Emergency Responders Act H.R.203-Clay Hunt Suicide Prevention for American Veterans Act H.R.293-To amend title XI of the Social Security Act to exempt from manufacturer transparency reporting certain transfers used for educational purposes, and for other purposes. H.R.398-Trafficking Awareness Training for Health Care Act H.R.639-Improving Regulatory Transparency for New Medical Therapies Act H.R.647-Access to Life-Saving Trauma Care for All Americans Act H.R.648-Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R.836-Health Care Safety Net Enhancement Act H.R.876-Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R.1190-Protecting Seniors Access to Medicare Act of 2015 H.R.1470-SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R.1571-Improving Access to Medicare Coverage Act of 2015 H.R.1725-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 H.R.1821-Opioid Overdose Reduction Act of 2015 H.R.1854-Comprehensive Justice and Mental Health Act of 2015 H.R.2366-Field EMS Modernization and Innovation Act H.R.2603-Saving Lives, Saving Costs Act H.R.2646-Helping Families in Mental Health Crisis Act of 2015 H.R.2850-Stop Overdose Stat Act of 2015 H.R.3379-Airplane Kids In Transit Safety (KITS) Act of 2015 H.R.3537-Synthetic Drug Control Act of 2015 S.Con.Res.11-Concurrent Resolution on the Budget for Fiscal Year 2016 S.141-Protecting Seniors Access to Medicare Act of 2015 S.167-Clay Hunt Suicide Prevention for American Veterans Act S.480-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 S.599-Improving Access to Emergency Psychiatric Care Act S.707-Opioid Overdose Reduction Act of 2015 S.763-Trauma Systems and Regionalization of Emergency Care Reauthorization Act S.810-SGR Repeal and Medicare Provider Payment Modernization Act of 2015 S.884-Health Care Safety Net Enhancement Act S.843-Improving Access to Medicare Coverage Act of 2015 S.993-Comprehensive Justice and Mental Health Act of 2015 S.1349-Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act S.1446-SOAR to Health and Wellness Act of 2015 S.1450-Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act S.1452-Veterans Emergency Health Safety Net Expansion Act of 2015 S.1475-Saving Lives, Saving Costs Act S.1549-Care Planning Act of 2015 S.1648-Rural Emergency Acute Care Hospital (REACH) Act S.1654-Overdose Prevention Act S.1693-To amend title 38, United States Code, to expand eligibility for reimbursement for emergency medical treatment to certain veterans that were unable to receive care from the Department of Veterans Affairs in the 24-month period preceding the furnishing of such emergency treatment, and for other purposes. S.1893-Mental Health Awareness and Improvement Act of 2015 S.1945-Mental Health Reform Act of 2015 S.2002-Mental Health and Safe Communities Act of 2015

Client expense: $491,382 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues regarding reimbursement and Medicare program issues regarding long term care and post acute care vendors, suppliers, and providers including cuts to portable x-ray providers and including the following: Physician Fee Schedule "SGR" doc fix legislation, HR 6 21st Century Cures Initiative, Medicare Tele Health Parity Act of 2015 H.R. 2948, improving information technology interoperability, electronic prescribing,Notice of Observation Treatment and Implication for Care Eligibility Act,S. 1349/H.R. 876, Improving Access to Medicare Coverage Act of 2015 S.843/H.R.1571, Medicare Post-Acute Care Value-Based Purchasing H.R. 3298,Protecting Seniors Access to Medicare Act of 2015 H.R. 1190, Medical Device Tax Repeal Bill H.R. 160, Audit and Appeals Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 (No bill number yet).

Client expense: $44,000 · Firm income: Not reported

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

H.R.6 - 21st Century Cures Act H.R.3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 S.2148 - A bill to amend title XVIII of the Social Security Act to prevent an increase in the Medicare part B premium and deductible in 2016 H.R.3696 - Medicare Premium Fairness Act of 2015 P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 4302: Protecting Access to Medicare Act of 2014 (PL 113-93) on 4.1.2014 H.R. 1571: Improving Access to Medicare Coverage Act of 2015. S. 843: Improving Access to Medicare Coverage Act of 2015. S. 367: The Medicare Access to Rehabilitation Services Act. H.R. 290: The Creating Access to Rehabilitation for Every Senior (CARES ACT). S. 1932: A bill to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program. Protect and Preserve Medicaid Provider Assessment. Protect and Preserve Medicare Bad Debt Reimbursement Improving the CMS State Plan Amdt. Process. Sustainable Growth Rate (SGR) and other reform proposals. Reducing hospital readmissions from skilled nursing facility. Improving Medicare Post-Acute Care Transformation Act (IMPACT) The Veteran Access to Long Term Care and Health Services Act (S.2000) and VA Provider Agreement and Proposal Repealing the Cap on Medicare Part B therapy services for seniors. MedPAC site neutral payment system for post acute care. CME proposed Rule for SNF Prospective Payment System (PPS). PL. 113-185 Impact Act of 2014 H.R. 952: To amend titles XVIII and XIX of the Social Security Act to establish a minimum direct care registered nurse staffing requirement at nursing facilities and skilled nursing facilities under Medicare and Medicaid and for other purposes. H.R. 2: Medicare Access & CHIP Reauthorization Act of 2015 H.R. 876: Notice Act (P.L. 114-42) S.1916: The Rural Health Care Connectivity Act of 2015

Client expense: $930,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE, Veterans Affairs, Dept of (VA)

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/ S. 688) Medicare audit contractor program reforms (H.R. 2156, AFIRM Act) Flexibility in Health IT (H.R. 270, H.R. 3309) Medicare Access and CHIP Reauthorization Act (H.R. 2) Patient status notification (H.R. 876, S. 1349) Rural hospital policies (H.R. 663 / S. 332, H.R. 169 / S. 258, H.R. 1611 / S. 257, S. 1461 / H.R. 2878) Telehealth, interoperability (H.R. 6) Medicare Advantage (H.R. 2505, H.R. 2506, H.R. 2507, H.R. 2579, H.R. 2581) Physician self-referral (H.R. 2027, H.R. 976) Hospital Improvements for Payment Act (H.R. 3291) Post-Acute Care policies (H.R. 1458, H.R. 3298) Graduate Medical Education policy reforms (H.R. 2124, S. 1148, H.R 3292) DSH payment (H.R. 3288) ICD-10

Client expense: $67,490 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

Health care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits. Monitor and advocate funding of Medicare/Medicaid benefits. Quality care of standards, survey and certification standards and procedures for long term care providers of Medicare/Medicaid programs; Nursing Homes, Hospice, Long Term Care Hospitals, Inpatient Rehab Facilities, and related businesses. Medicare reimbursement for skilled nursing facilities, Medicare Conditions of Participation for Hospice. H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015; H.R. 1458 - Bundling and Coordinating Post-Acute Care Act of 2015 of 2015; H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015; H.R. 1571/S. 843 - Improving Access to Medicare Coverage Act of 2015; H.R. 876 - NOTICE Act; H.R. 290 - Creating Access to Rehabilitation for Every Senior (CARES) Act of 2015; H.R. 1184 - Medicare Skilled Nursing and Home Health Services Continuity of Care Act of 2015

Client expense: $77,872 · Firm income: Not reported

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

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

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

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

S. 1916 Rural Health Care Connectivity Act of 2015 (entire legislation) H.R. 876 NOTICE Act (entire legislation)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 876, S 1349, PL 114-42 NOTICE Act-Notice of Observation Treatment and Implication for Care Eligibility Act of 2015 HR 290 Creating Access to Rehabilitation for Every Senior (CARE) Act of 2015 HR 3298 Medicare Post Acute Care Value Based Purchasing Act of 2015

Client expense: Not reported · Firm income: $18,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits. Monitor and advocate funding of Medicare/Medicaid benefits. Quality care of standards, survey and certification standards and procedures for long term care providers of Medicare/Medicaid programs; Nursing Homes, Hospice, Long Term Care Hospitals, Inpatient Rehab Facilities, and related businesses. Medicare reimbursement for skilled nursing facilities, Medicare Conditions of Participation for Hospice. H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015; H.R. 1458 - Bundling and Coordinating Post-Acute Care Act of 2015 of 2015; H.R. 1470/S. 810 - SGR Repeal and Medicare Provider Payment Modernization Act of 2015; H.R. 1571/S. 843 - Improving Access to Medicare Coverage Act of 2015; H.R. 876 - NOTICE Act; H.R. 290 - Creating Access to Rehabilitation for Every Senior (CARES) Act of 2015; H.R. 1184 - Medicare Skilled Nursing and Home Health Services Continuity of Care Act of 2015

Client expense: $95,997 · Firm income: Not reported

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

H.R.2-Medicare Access and CHIP Reauthorization Act of 2015 H.R.876-Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R.1190-Protecting Seniors Access to Medicare Act of 2015 H.R.1470-SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R.1571-Improving Access to Medicare Coverage Act of 2015 H.R.2646-Helping Families in Mental Health Crisis Act of 2015 S.141-Protecting Seniors Access to Medicare Act of 2015 S.599-Improving Access to Emergency Psychiatric Care Act S.810-SGR Repeal and Medicare Provider Payment Modernization Act of 2015 S.843-Improving Access to Medicare Coverage Act of 2015 S.1549-Care Planning Act of 2015

Client expense: $741,468 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.Con.Res 27-Concurrent Resolution on the Budget for Fiscal Year 2016 H.R.2-Medicare Access and CHIP Reauthorization Act of 2015 H.R.6-21st Century Cures Act H.R.33-Protecting Volunteer Firefighters and Emergency Responders Act H.R.203-Clay Hunt Suicide Prevention for American Veterans Act H.R.293-To amend title XI of the Social Security Act to exempt from manufacturer transparency reporting certain transfers used for educational purposes, and for other purposes. H.R.398-Trafficking Awareness Training for Health Care Act H.R.639-Improving Regulatory Transparency for New Medical Therapies Act H.R.647-Access to Life-Saving Trauma Care for All Americans Act H.R.648-Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R.836-Health Care Safety Net Enhancement Act H.R.876-Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act H.R.1190-Protecting Seniors Access to Medicare Act of 2015 H.R.1470-SGR Repeal and Medicare Provider Payment Modernization Act of 2015 H.R.1571-Improving Access to Medicare Coverage Act of 2015 H.R.1725-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 H.R.1821-Opioid Overdose Reduction Act of 2015 H.R.2366-Field EMS Modernization and Innovation Act H.R.2603-Saving Lives, Saving Costs Act H.R.2646-Helping Families in Mental Health Crisis Act of 2015 H.R.2850-Stop Overdose Stat Act of 2015 S.Con.Res.11-Concurrent Resolution on the Budget for Fiscal Year 2016 S.141-Protecting Seniors Access to Medicare Act of 2015 S.167-Clay Hunt Suicide Prevention for American Veterans Act S.480-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 S.599-Improving Access to Emergency Psychiatric Care Act S.707-Opioid Overdose Reduction Act of 2015 S.763-Trauma Systems and Regionalization of Emergency Care Reauthorization Act S.810-SGR Repeal and Medicare Provider Payment Modernization Act of 2015 S.884-Health Care Safety Net Enhancement Act S.843-Improving Access to Medicare Coverage Act of 2015 S.1446-SOAR to Health and Wellness Act of 2015 S.1450-Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act S.1452-Veterans Emergency Health Safety Net Expansion Act of 2015 S.1475-Saving Lives, Saving Costs Act S.1549-Care Planning Act of 2015 S.1654-Overdose Prevention Act S.1693-To amend title 38, United States Code, to expand eligibility for reimbursement for emergency medical treatment to certain veterans that were unable to receive care from the Department of Veterans Affairs in the 24-month period preceding the furnishing of such emergency treatment, and for other purposes.

Client expense: $741,468 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

P.L. 111-148: The Patient Protection and Affordable Care Act. H.R. 4302: Protecting Access to Medicare Act of 2014 (PL 113-93) on 4.1.2014 H.R. 1571: Improving Access to Medicare Coverage Act of 2015. S. 843: Improving Access to Medicare Coverage Act of 2015. S. 367: The Medicare Access to Rehabilitation Services Act. H.R. 290: The Creating Access to Rehabilitation for Every Senior (CARES ACT). S. 1932: A bill to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program. Protect and Preserve Medicaid Provider Assessment. Protect and Preserve Medicare Bad Debt Reimbursement Improving the CMS State Plan Amdt. Process. Sustainable Growth Rate (SGR) and other reform proposals. Reducing hospital readmissions from skilled nursing facility. Improving Medicare Post-Acute Care Transformation Act (IMPACT) S.739/H.R. 1369: Veterans Access to Extended Care Act and VA Provider Agreement and Proposal Repealing the Cap on Medicare Part B therapy services for seniors. MedPAC site neutral payment system for post acute care. CME proposed Rule for SNF Prospective Payment System (PPS). PL. 113-185 Impact Act of 2014 H.R. 952: To amend titles XVIII and XIX of the Social Security Act to establish a minimum direct care registered nurse staffing requirement at nursing facilities and skilled nursing facilities under Medicare and Medicaid and for other purposes. H.R. 2: Medicare Access & CHIP Reauthorization Act of 2015 H.R. 876: Notice Act

Client expense: $960,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), SENATE, Veterans Affairs, Dept of (VA)

H.R.2, Medicare Access and CHIP Reauthorization Act of 2015 - Advocated for changes to budget offsets and for Medicare beneficiary protections. Discussed Medicare Physician payment/SGR reform legislation and health care extenders. 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 #) 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. House and Senate S.1488/H.R.2624, 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) S.843/H.R.1571, Improving Access to Medicare Coverage Act - Discussed the bill. Signed letter urging cosponsorship of the bill and supported the bill in Aging Committee statement. Discussed PPI observation paper with Senate Aging Committe staff. 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. S. 861/H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME)Act - Sent letter of endorsement. S.1349/H.R.876, 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) S. 1695, S.Con.Res. 11, Budget Resolution, Labor, HHS, Education and related agencies, Appropriations Committee/FY 2016 - Lobbied to protect vital health and social services programs, and to prevent repeal of certain financial and healthcare related legislation. Wrote letter to CMS about Louisiana Medicaid and including nursing homes in managed LTSS. Wrote letter to HHS urging response and questions in Davis v. Shah case. Wrote letter to HHS in support of Medicaid reimbursement of advance care planning services and payment for these codes in 2016. Shared PPI observation paper with House and Senate staff, CBO, MedPac, and CMS Office of the Actuary. Discussed structural changes to Medicaid. (no bill) S. 1549, Care Planning Act - Sent letter of endorsement and provided feedback on bill and quote for press release. The bill provides for advanced illness care coordination services. Submitted Statement for the Record for Senate Aging Committee hearing on observation, discussed observation, and the two midnight. Wrote letter to Senate Finance Committee with recommendations on chronic care. Discussed Personalize your Care Act Advance Care planning bill (no bill #). S. 704, Discussed feedback on the Community-based Independence for Seniors Act to establish a Medicare demonstration program to provide LTSS to certain seniors. Inquired regarding the Balancing Incentive Payments Program (no bill #). Discussed community care program with CMS. Inquired regarding Medicaid estate recovery with CMS. Discussed technology and aging in place, including AARP comments on net neutrality. (no bill #) Extended invitation and discussed Medicaid managed LTSS and family caregiving, including Medicaid managed care regulations with CMS and ACL (no bill). Inquired to CMS regarding WI dual eligibles and family care (no bill). Discussed family caregiver assessment in Medicaid home and community-based services with CMS (no bill #). Discussed LTSS financing options with HHS ASPE. (no bill) Discussed the SAVE Medicare Homoe Health Act. Drafted comment letter on Medicare and chronic care for Senate Finance committee. S. 192, Discussed Older Americans Act reauthorization legislation. Discussed nutrition programs including the Supplemental Nutrition Assistance Program (SNAP).

Client expense: $1,889,000 · 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), 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), 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

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

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

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

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/ S. 688) Medicare audit contractor program reforms (H.R. 2156, AFIRM Act) Flexibility in Health IT Reporting Act (H.R. 270) Medicare Access and CHIP Reauthorization Act (H.R. 2) Patient status notification (H.R. 876, S. 1349) Rural hospital policies (H.R. 663 / S. 332, H.R. 169 / S. 258, H.R. 1611 / S. 257, S. 1461 / H.R. 2878) Telehealth, interoperability (H.R. 6) Medicare Advantage (H.R. 2505, H.R. 2506, H.R. 2507, H.R. 2579, H.R. 2581) Physician self-referral (H.R. 2027, H.R. 976) Hospital Improvements for Payment Act Post Acute Care policies (H.R. 1458) Graduate Medical Education policy reforms (H.R. 2124, S. 1148) ICD-10

Client expense: $74,950 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

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

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

HR 876, S 1349 NOTICE Act-Notice of Observation Treatment and Implication for Care Eligibility Act of 2015 HR 290 Creating Access to Rehabilitation for Every Senior (CARE) Act of 2015

Client expense: Not reported · Firm income: $18,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE