Patient Access to Higher Quality Health Care Act of 2015

General issues relating to physicians, ownership at hospitals; H.R.976 Patient Access Higher Quality Health Care Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

HR976, Patient Access to Higher Quality Health Care Act of 2015 (All sections of full text) HR2513:Promoting Access, Competition and Equity Act of 2015 or the PACE Act of 2015 (All sections of full text) S.2511 Improving Health Information Technology Act - Discussions involving new HHS/OCR HIPAA guidance to providers for release of information(ROI) Discussions involving White House Cancer research task force initiative Discussions involving potential reform of health care delivery and payment systems implemented by The Affordable Care Act Monitored P.L. 114-255 To accelerate the discovery, development, and delivery of 21st century cures, and for other purposes (all sections of full text) Monitored HR 4784 Lower Drug Costs through Competition Act Monitored S.2615 Increasing Competition in Pharmaceuticals Act; discussions regarding price escalation of certain orphan or generic drugs Monitored HR776 Stark Administrative Simplification Act of 2015 Monitored Hatch white paper examining potential reforms to the Stark Law Monitored HR2300 Empowering Patients First Act of 2015 Monitored P.L. 114-198 Comprehensive Addiction and Recovery Act of 2016 Monitored H.R. 6018 Ensuring Health Care Opportunities Act Monitored S. 3320 Ensuring Health Care Opportunities Act Monitored S.3326 State Flexibility to Provide Affordable Health Options Act

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of the Vice President of the United States, SENATE

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,970,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R.976, Patient Access to Higher Quality Health Care Act of 2015 Issues Related to SGR Reform Issues Related to the 340B Program Issues Related to Medicare Inpatient and Outpatient Hospital Payment Rates Issues Related to Signatures for CMS regarding implementation of Section 603 of The Bipartisan Budget Act of 2015

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Policies affecting hospitals in the Affordable Care Act (P.L. 111-148 and P.L. 111-152; H.R. 2513, The Promoting Access, Competition, and Equity Act of 2015; H.R. 976, the Patient Access to Higher Quality Health Care Act; H.R. 5273, Helping Hospitals Improve Patient Care Act; and issues related to hospitals, including hospital outpatient departments (HOPD), in H.R.34, the 21st Century Cures Act (P.L. 114-255).

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.976, Patient Access to Higher Quality Health Care Act of 2015 (all sections of full text) H.R. 2513: Promoting Access, Competition, and Equity Act of 2015 or the PACE Act of 2015 (all sections of full text) S. 2511 Improving Health Information Technology Act; discussions involving new HHS/OCR HIPAA guidance to providers for release of information(ROI) Discussions involving White House Cancer research task force initiative Discussions involving potential reform of health care delivery and payment systems implemented by The Affordable Care Act Monitored P.L. 114-255 To accelerate the discovery, development, and delivery of 21st century cures, and for other purposes (all sections of full text) Monitored H.R. 4784 Lower Drug Costs through Competition Act Monitored S. 2615 Increasing Competition in Pharmaceuticals Act; discussions regarding price escalation of certain orphan or generic drugs Monitored H.R. 776 Stark Administrative Simplification Act of 2015 Monitored Hatch white paper examining potential reforms to the Stark Law Monitored H.R. 2300 Empowering Patients First Act of 2015 Monitored P.L. 114-198 Comprehensive Addiction and Recovery Act of 2016 Monitored H.R. 6018 Ensuring Health Care Opportunities Act Monitored S. 3320 Ensuring Health Care Opportunities Act Monitored S. 3326 State Flexibility to Provide Affordable Health Options Act

Client expense: Not reported · Firm income: $130,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of the Vice President of the United States, SENATE

HR 976 HR 2513

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,050,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

General issues relating to physicians, ownership at hospitals; H.R.976 Patient Access Higher Quality Health Care Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688, H.R. 5273) Medicare audit contractor program reforms (H.R. 2156, S. 2368) Rural hospital policies (H.R. 663 / S. 332, H.R. 169/S. 258, H.R. 1611/S. 257, S. 1461/H.R. 2878, H.R. 5164, H.R. 5613, CAH cost-based reimbursement) Telehealth, interoperability, health information technology (H.R. 6, S. 2511, S. 2484/H.R. 4442) Post-Acute Care policies (H.R. 3298), home health prior authorization S. 2108, H.R. 5713 Graduate Medical Education policy (H.R. 2124, S. 1148, H.R 3292) HR 976, HR 2513 DSH payment Bundled payment programs Clinical lab payment policy MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies (H.R. 5273) Stark Law reforms H.R. 4428 Star Ratings Medicare Part B drug payment model Medicare Advantage

Client expense: $70,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR976, Patient Access to Higher Quality Health Care Act of 2015 (All sections of full text) HR2513:Promoting Access, Competition and Equity Act of 2015 or the PACE Act of 2015 (All sections of full text) S.2511 Improving Health Information Technology Act - Discussions involving new HHS/OCR HIPAA guidance to providers for release of information(ROI) Discussions involving nominations to federally authorized commissions Monitored S.2615 Increasing Competition in Pharmaceuticals Act; discussions regarding price escalation of certain orphan or generic drugs Monitored discussions that would result in additional federal regulation of Group Purchasing Organizations Monitored HR776 Stark Administrative Simplification Act of 2015 Monitored Hatch white paper examining potential reforms to the Stark Law Monitored HR2300 Empowering Patients First Act of 2015 Monitored P.L. 114-198 Comprehensive Addiction and Recovery Act of 2016 Monitored HR 4784 Lower Drug Costs through Competition Act Monitored H.R.6 21st Century Cures Act; discussions pertaining to hospital reimbursement reductions

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.976, Patient Access to Higher Quality Health Care Act of 2015 Issues Related to SGR Reform Issues Related to the 340B Program Issues Related to Medicare Inpatient and Outpatient Hospital Payment Rates Issues Related to Signatures for CMS regarding implementation of Section 603 of The Bipartisan Budget Act of 2015

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 3130, Independence at Home Act of 2016, all provisions S. 3220, Medicare Common Access Card Act of 2015, all provisions H.R. 3355, To amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs, all provisions S. 488, A bill to amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs, all provisions S. 1913, Stopping Medication Abuse and Protecting Seniors Act of 2015, all provisions H.R. 4442, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions S. 2484, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions S. 2141, Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015, all provisions S. 1131, Medicare Diabetes Prevention Act of 2015, all provisions H.R. 976, Patient Access to Higher Quality Health Care Act of 2015, all provisions H.R. 2568, Fair Medical Audits Act of 2015, all provisions H.R. 4499, Promoting Responsible Opioid Prescribing (PROP) Act of 2016, all provisions S. 2758, Promoting Responsible Opioid Prescribing (PROP) Act of 2016, all provisions Medicare program: ACO Improvement Act of 2016 Medicare program: Medicare Access and CHIP Reauthorization Act (MACRA) implementation Medicare program: Merit-Based Incentive Payment System (MIPS) Medicare program: Part B Drug Demonstration Medicare program: Outpatient Prospective Payment - site of service, pain measures Medicare program: Advancing Care Information (ACI) Medicare program: Clinical Practice Improvement Activities (CPIA) Medicare program: Resource use Medicare program: Physician Fee Schedule Medicare program: Independent Payment Advisory Board (IPAB) Medicare program: Center for Medicare and Medicaid Innovation (CMMI) Medicare program: Global surgical codes Medicare program: Mobility payment add-on Medicare program: Episode groups Medicare program: Patient relationship codes Medicare program: Composite scoring and performance adjustments Medicare program: Feedback reports Medicare program: Alternative payment models (APMs) Medicare program: Relative Value Scale Update Committee (RUC) Medicare program: Health Insurance Portability and Accountability Act (HIPAA) Medicare program: Electronic health record (EHR) interoperability Medicare program: EHR/Meaningful Use Medicare program: EHR Certification Medicare program: ICD-10 Medicare program: Medicare appeals Medicare program: Medicare Pre-Diabetes Program Medicare program: Unique Device Identifier Medicare program: CPT Medicare program: Social Security Number Removal Initiative Medicare program: Telehealth Medicare program: In-office Ancillary Services Exception Medicare program: Value-based Payment Modifier Medicare program: Graduate Medical Education Medicare program: Physician Quality Reporting System (PQRS) Medicare program: Prescription drug diversion Medicare program: Physician data Medicare program: Physician-owned hospital moratorium Medicare program: Smart Card technology Medicare program: PECOS/Medicare Enrollment Medicare program: Diabetes Prevention Program fees

Client expense: $3,870,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, Veterans Affairs, Dept of (VA), White House Office

Policies affecting hospitals in the Affordable Care Act (P.L. 111-148 and P.L. 111-152; H.R. 2513, The Promoting Access, Competition, and Equity Act of 2015; H.R. 976, the Patient Access to Higher Quality Health Care Act; H.R. 5273, Helping Hospitals Improve Patient Care Act; and issues related to hospital outpatient departments (HOPD).

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 976 HR 2513

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 976 HR 2513

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.976, Patient Access to Higher Quality Health Care Act of 2015 (all sections of full text) H.R. 2513: Promoting Access, Competition, and Equity Act of 2015 or the PACE Act of 2015 (All sections of full text) S. 2511 Improving Health Information Technology Act; discussions involving new HHS/OCR HIPAA guidance to providers for release of information(ROI) Discussions involving nominations to federally authorized commissions Monitored H.R. 6 21st Century Cures Act; discussions pertaining to hospital reimbursement reductions Monitored H.R. 4784 Lower Drug Costs through Competition Act Monitored S. 2615 Increasing Competition in Pharmaceuticals Act; discussions regarding price escalation of certain orphan or generic drugs Monitored discussions that would result in additional federal regulation of Group Purchasing Organizations Monitored H.R. 776 Stark Administrative Simplification Act of 2015 Monitored Hatch white paper examining potential reforms to the Stark Law Monitored H.R. 2300 Empowering Patients First Act of 2015 Monitored P.L. 114-198 Comprehensive Addiction and Recovery Act of 2016

Client expense: Not reported · Firm income: $130,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General issues relating to physicians, ownership at hospitals; H.R.976 Patient Access Higher Quality Health Care Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,690,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Policies affecting hospitals in the Affordable Care Act (P.L. 111-148 and P.L. 111-152; H.R. 2513, The Promoting Access, Competition, and Equity Act of 2015; H.R. 976, the Patient Access to Higher Quality Health Care Act; and H.R. 5273, Helping Hospitals Improve Patient Care Act.

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR976, Patient Access to Higher Quality Health Care Act of 2015 (All sections of full text) HR2513:Promoting Access, Competition and Equity Act of 2015 or the PACE Act of 2015 (All sections of full text) S.2511 Improving Health Information Technology Act - discussions pertaining to improvement, effectiveness and efficiency of electronic health records and health information technology for doctors, patients, and hospitals Discussions involving new HHS/OCR HIPAA guidance to providers for release of information(ROI) on patient records requests Monitored S.2615 Increasing Competition in Pharmaceuticals Act; discussions regarding price escalation of certain orphan or generic drugs Monitored discussions that would result in additional federal regulation of Group Purchasing Organizations Monitored HR776 Stark Administrative Simplification Act of 2015 Monitored Hatch white paper examining potential reforms to the Stark Law Monitored HR2300 Empowering Patients First Act of 2015 Monitored S.524 Comprehensive Addiction and Recovery Act of 2016 Monitored HR953 Comprehensive Addiction and Recovery Act of 2015 Monitored HR 4784 Lower Drug Costs through Competition Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.976, Patient Access to Higher Quality Health Care Act of 2015 Issues Related to SGR Reform Issues Related to the 340B Program Issues Related to Medicare Inpatient and Outpatient Hospital Payment Rates

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4499, Promoting Responsible Opioid Prescribing (PROP) Act of 2016, all provisions S. 2758, Promoting Responsible Opioid Prescribing (PROP) Act of 2016, all provisions H.R. 976, Patient Access to Higher Quality Health Care Act of 2015, all provisions H.R. 5273, Helping Hospitals Improve Patient Care Act of 2016, all provisions H.R. 2977, Furthering Access to Stroke Telemedicine (FAST) Act, all provisions H.R. 21102, Medicare Diabetes Prevention Act of 2015, all provisions S. 1131, Medicare Diabetes Prevention Act of 2015, all provisions H.R. 1470, SGR Repeal and Medicare Provider Payment Modernization Act of 2015, provisions relating to delivery and payment reform S. 810, SGR Repeal and Medicare Provider Payment Modernization Act of 2015, provisions relating to delivery and payment reform H.R. 1190, Protecting Seniors' Access to Medicare Act of 2015, all provisions H.R. 4442, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions S. 2484, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions S. 1913, Stopping Medication Abuse and Protecting Seniors Act of 2015, all provisions H.R. 1608, Lymphedema Treatment Act, all provisions S. 2373, Lymphedema Treatment Act, all provisions S. 2943, National Defense Authorization Act for Fiscal Year 2017, provisions relating to Telemedicine and licensure Medicare program: Diabetes prevention Medicare program: IPAB Repeal Medicare program: Medicare Access and CHIP Reauthorization Act (MACRA) Implementation Medicare program: MACRA physician compliance flexibility Medicare program: Quality Payment Program (QPP) Medicare program: Protecting Access to Medicare Act (PAMA) implementation Medicare program: Merit-Based Incentive Payment System (MIPS) Medicare program: Value-Based Modifier (VBM) Medicare program: Advancing Care Information (ACI) score Medicare program: Clinical Practice Improvement Activities (CPIAs) Medicare program: Resource Use Medicare program: Alternative Payment Models (APMs) Medicare program: Physician Quality Reporting System (PQRS) Medicare program: Graduate Medical Education (GME) Medicare program: Prescription Drug Diversion/Opioid abuse Medicare program: Physician data Medicare program: Adding unique device identifier to billing form Medicare program: Physician-owned hospital moratorium Medicare program: Physician Office-based Labs (POLS) Medicare program: EHR/Meaningful Use Medicare program: Sunshine Act Medicare program: Part B Drug Demonstration/Reimbursement Medicare program: In-Office Ancillary Services Exception Medicare program: Provider networks adequacy and balance billing Medicare program: AHIP-CMS Core Measure activity Medicare program: Comprehensive joint replacement Medicare program: Chronic care Medicare program: Home health prior authorization Medicare program: Telehealth Medicare program: Clinical Trials - insurance coverage improvements Medicare program: Coverage policy Medicare program: Program Integrity/Provider Enrollment Medicare and Medicaid programs: EHR interoperability/digital health Medicaid program: State Medicaid cuts

Client expense: $4,310,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Indian Health Service, Internal Revenue Service (IRS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R.976, Patient Access to Higher Quality Health Care Act of 2015 (all sections of full text) H.R. 2513: Promoting Access, Competition, and Equity Act of 2015 or the PACE Act of 2015 (All sections of full text) S. 2511 Improving Health Information Technology Act - discussions pertaining to the improvement, effectiveness and efficiency of electronic health records and health information technology for doctors, patients and hospitals. Discussions involving new HHS/OCR HIPAA guidance to providers for release of information(ROI)on patient records requests Monitored S. 2615 Increasing Competition in Pharmaceuticals Act; discussions regarding price escalation of certain orphan or generic drugs Monitored discussions that would result in additional federal regulation of Group Purchasing Organizations Monitored H.R. 776 Stark Administrative Simplification Act of 2015 Monitored Hatch white paper examining potential reforms to the Stark Law Monitored H.R. 2300 Empowering Patients First Act of 2015 Monitored S. 524 Comprehensive Addiction and Recovery Act of 2016 Monitored H.R. 953 Comprehensive Addiction and Recovery Act of 2015 Monitored H.R. 4784 Lower Drug Costs through Competition Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.976, Patient Access to Higher Quality Health Care Act of 2015 Issues Related to SGR Reform Issues Related to the 340B Program Issues Related to Medicare Inpatient and Outpatient Hospital Payment Rates

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program and that Stage 3 not begin until 75 percent of EHs, CAHs and EPs attain Stage 2.; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Support ICD-10 delay and advocate to maintain the Oct. 1, 2015 transition date for ICD-10; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records.

Client expense: $5,120,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Policies affecting hospitals in the Affordable Care Act (P.L. 111-148 and P.L. 111-152; H.R. 2513, The Promoting Access, Competition, and Equity Act of 2015; HR. 976, the Patient Access to Higher Quality Health Care Act; H.R. 4273/S.2409, Medicare and Medicaid Improvement and Adjustments Act 2015.

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Two Midnight Rule Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688) Medicare audit contractor program reforms (H.R. 2156, S. 2368) 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, health information technology (H.R. 6, S. 2511, S. 2484/H.R. 4442) 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) H.R. 4428 Clinical lab payment policy Discharge planning MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies Stark Law reforms

Client expense: $83,731 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR976, Patient Access to Higher Quality Health Care Act of 2015 (All sections of full text) HR2513:Promoting Access, Competition and Equity Act of 2015 or the PACE Act of 2015 (All sections of full text) Monitored potential legislation on the improvement, effectiveness and efficiency of electronic health records and health information technology for doctors, patients and hospitals. Monitored HR776 Stark Administrative Simplification Act of 2015 Monitored S.2615 Increasing Competition in Pharmaceuticals Act; discussions regarding price escalation of certain orphan or generic drugs Monitored discussions that would result in additional federal regulation of Group Purchasing Organizations Monitored HR2300 Empowering Patients First Act of 2015 Monitored S.524 Comprehensive Addiction and Recovery Act of 2016 Monitored HR953 Comprehensive Addiction and Recovery Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.976, Patient Access to Higher Quality Health Care Act of 2015 (all sections of full text) H.R. 2513: Promoting Access, Competition, and Equity Act of 2015 or the PACE Act of 2015 (All sections of full text) Monitored potential legislation on the improvement, effectiveness and efficiency of electronic health records and health information technology for doctors, patients and hospitals. Monitored S. 2615 Increasing Competition in Pharmaceuticals Act; discussions regarding price escalation of certain orphan or generic drugs Monitored discussions that would result in additional federal regulation of Group Purchasing Organizations Monitored H.R. 776 Stark Administrative Simplification Act of 2015 Monitored H.R. 2300 Empowering Patients First Act of 2015 Monitored S. 524 Comprehensive Addiction and Recovery Act of 2016 Monitored H.R. 953 Comprehensive Addiction and Recovery Act of 2015

Client expense: Not reported · Firm income: $130,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General issues relating to physicians, ownership at hospitals; H.R.976 Patient Access Higher Quality Health Care Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

H.R. 1190, Protecting Seniors' Access to Medicare Act of 2015, all provisions S. 141, Protecting Seniors' Access to Medicare Act of 2015, all provisions H.R. 2102, Medicare Diabetes Prevention Act of 2015, all provisions S. 1131, Medicare Diabetes Prevention Act of 2015, all provisions H.R. 169, Critical Access Hospital Relief Act of 2015, all provisions S. 258, Critical Access Hospital Relief Act of 2015, all provisions H.R. 2513, Promoting Access, Competition, and Equity (PACE) Act of 2015, all provisions S. 2153, Provider Payment Sunshine Act, all provisions S. 2425, Patient Access and Medicare Protection Act, all provisions H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015, all provisions H.R. 3309, Flex-IT 2 Act, all provisions H.R. 976, Patient Access to Higher Quality Health Care Act of 2015, all provisions H.R. 1018, Patient Access to Disposable Medical Technology Act of 2015, all provisions H.R. 2568, Fair Medical Audits Act of 2015, all provisions H.R. 169, Critical Access Hospital Relief Act of 2015, all provisions H.R. 3940, Meaningful Use Hardship Relief Act of 2015, all provisions S. 2141, Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015, all provisions S. 2368, Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015, all provisions H.R. 1470, SGR Repeal and Medicare Provider Payment Modernization Act of 2015, all provisions S. 810, SGR Repeal and Medicare Provider Payment Modernization Act of 2015, all provisions H. R.2 - Medicare Access and CHIP Reauthorization Act of 2015, all provisions S. 843, Improving Access to Medicare Coverage Act of 2015, all provisions H.R. 3770, End Surprise Billing Act of 2015, all provisions Medicare program: Protecting Access to Medicare Act (PAMA) implementation Medicare program: MACRA Implementation/Alternate payment models Medicare program: ACA implementation/Marketplace open enrollment Medicare program: Independent Payment Advisory Board Repeal (IPAB) Medicare program: Misvalued Codes Medicare program: Meaningful Use Regulations/Electronic Health Records Medicare program: Electronic Health Records (EHR) interoperability and certification Medicare program: Telehealth and Medicare coverage Medicare program: Sequestration Medicare program: Comprehensive Joint Replacement Initiative Medicare program: In-Office Ancillary Services Exception (IOASE) Medicare program: Merit-Based Incentive Payment System (MIPS) Medicare program: Value-Based Payment Modifier (VPM) Medicare program: Graduate Medical Education (GME) Medicare program: Meaningful Use/hardship exemptions and Stage 3 regulations Medicare program: Prescription Drug Diversion Medicare program: Physician data Medicare program: Clinical Diagnostic Laboratory Tests Payment System Medicare program: Physician Quality Reporting System (PQRS) Medicare program: Drugs of Abuse Testing Medicare program: Program Integrity Medicare program: Recovery Audit Contracting (RAC) Medicare program: Mental health and HIPAA privacy law Medicare program: Chronic care Medicare program: Medicare Advantage/narrow networks Medicare program: Pre-diabetes Medicare program: Hypertension Medicare program: Drug pricing Medicare program: Relative Value Scale Update Committee (RUC) Medicaid program: Medicaid expansion Medicaid program: CPT Medicare and Medicaid programs: ICD-10

Client expense: $4,530,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE, Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

HR976, Patient Access to Higher Quality Health Care Act of 2015 (All sections of full text) HR2513:Promoting Access, Competition and Equity Act of 2015 or the PACE Act of 2015 (All sections of full text) Monitored potential legislation on the improvement, effectiveness and efficiency of electronic health records and health information technology for doctors, patients and hospitals. Monitored discussions regarding price escalation of certain orphan or generic drugs. Monitored policy proposals that would result in additional federal regulations of Group Purchasing Organizations Monitored HR776 Stark Administrative Simplification Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HALO letter sent to Congress about the Medicare Sustainable Growth Rate (SGR) for physician payment; Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program and that Stage 3 not begin until 75 percent of EHs, CAHs and EPs attain Stage 2.; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support HR 2, Medicare Access and CHIP Reauthorization Act of 2015, a bill to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and strengthen Medicare access by improving physician payments and making other improvements, to reauthorize the Childrens Health Insurance Program; Support HR 1470, SGR Repeal and Medicare Provider Payment Modernization Act of 2015, a bill to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and improve Medicare payments for physicians and other professionals; Support S 629, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Oppose Recovery Audit Contracts (RACs)Section 3 that imposes financial penalties on RACs; Support ICD-10 delay and advocate to maintain the Oct. 1, 2015 transition date for ICD-10; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 1295, Trade Preferences Extension Act of 2015because the inclusion of the Medicare sequestration offset; Oppose HR 976 and HR 2513Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records.

Client expense: $4,800,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

General issues relating to physicians, ownership at hospitals; H.R.976 Patient Access Higher Quality Health Care Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

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.976, Patient Access to Higher Quality Health Care Act of 2015 Issues Related to SGR Reform Issues Related to the 340B Program Issues Related to Medicare Inpatient and Outpatient Hospital Payment Rates

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1190, Protecting Seniors' Access to Medicare Act of 2015, all provisions S. 141, Protecting Seniors' Access to Medicare Act of 2015, all provisions H.R. 2102, Medicare Diabetes Prevention Act of 2015, all provisions S. 1131, Medicare Diabetes Prevention Act of 2015, all provisions H.R. 169, Critical Access Hospital Relief Act of 2015, all provisions S. 258, Critical Access Hospital Relief Act of 2015, all provisions H.R. 2513, Promoting Access, Competition, and Equity (PACE) Act of 2015, all provisions S. 2153, Provider Payment Sunshine Act, all provisions S. 2425, Patient Access and Medicare Protection Act, all provisions H.R. 270, Flexibility in Health IT Reporting (Flex-IT) Act of 2015, all provisions H.R. 3309, Flex-IT 2 Act, all provisions H.R. 976, Patient Access to Higher Quality Health Care Act of 2015, all provisions H.R. 1018, Patient Access to Disposable Medical Technology Act of 2015, all provisions H.R. 2568, Fair Medical Audits Act of 2015, all provisions H.R. 169, Critical Access Hospital Relief Act of 2015, all provisions H.R. 3940, Meaningful Use Hardship Relief Act of 2015, all provisions S. 2141, Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015, all provisions S. 2368, Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015, all provisions H.R. 1470, SGR Repeal and Medicare Provider Payment Modernization Act of 2015, all provisions S. 810, SGR Repeal and Medicare Provider Payment Modernization Act of 2015, all provisions H. R.2 - Medicare Access and CHIP Reauthorization Act of 2015, all provisions S. 843, Improving Access to Medicare Coverage Act of 2015, all provisions H.R. 3770, End Surprise Billing Act of 2015, all provisions Medicare program: Protecting Access to Medicare Act (PAMA) implementation Medicare program: MACRA Implementation/Alternate payment models Medicare program: ACA implementation/Marketplace open enrollment Medicare program: Independent Payment Advisory Board Repeal (IPAB) Medicare program: Misvalued Codes Medicare program: Meaningful Use Regulations/Electronic Health Records Medicare program: Electronic Health Records (EHR) interoperability and certification Medicare program: Telehealth and Medicare coverage Medicare program: Sequestration Medicare program: Comprehensive Joint Replacement Initiative Medicare program: In-Office Ancillary Services Exception (IOASE) Medicare program: Merit-Based Incentive Payment System (MIPS) Medicare program: Value-Based Payment Modifier (VPM) Medicare program: Graduate Medical Education (GME) Medicare program: Meaningful Use/hardship exemptions and Stage 3 regulations Medicare program: Prescription Drug Diversion Medicare program: Physician data Medicare program: Clinical Diagnostic Laboratory Tests Payment System Medicare program: Physician Quality Reporting System (PQRS) Medicare program: Drugs of Abuse Testing Medicare program: Program Integrity Medicare program: Recovery Audit Contracting (RAC) Medicare program: Mental health and HIPAA privacy law Medicare program: Chronic care Medicare program: Medicare Advantage/narrow networks Medicare program: Pre-diabetes Medicare program: Hypertension Medicare program: Drug pricing Medicare program: Relative Value Scale Update Committee (RUC) Medicaid program: Medicaid expansion Medicaid program: CPT Medicare and Medicaid programs: ICD-10

Client expense: $4,490,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE, Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

Policies affecting hospitals in the Affordable Care Act (P.L. 111-148 and P.L. 111-152) and H.R.2029, Consolidated Appropriations Act; H.R. 2513, The Promoting Access, Competition, and Equity Act of 2015; HR. 976, the Patient Access to Higher Quality Health Care Act; H.R. 4273/S.2409, Medicare and Medicaid Improvement and Adjustments Act 2015.

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 976 HR 2513

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 976 HR 2513

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.976, Patient Access to Higher Quality Health Care Act of 2015 (all sections of full text) H.R. 2513: Promoting Access, Competition, and Equity Act of 2015 or the PACE Act of 2015 (All sections of full text) Monitored potential legislation on the improvement, effectiveness and efficiency of electronic health records and health information technology for doctors, patients and hospitals. Monitored discussions regarding price escalation of certain orphan or generic drugs Monitored policy proposals that would result in additional federal regulation of Group Purchasing Organizations Monitored H.R. 776 Stark Administrative Simplification Act of 2015

Client expense: Not reported · Firm income: $130,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HALO letter sent to Congress about the Medicare Sustainable Growth Rate (SGR) for physician payment; Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, which provide incentives and penalties to encourage meaningful use of EHRs by hospitals and physicians and to extend non-enforcement instruction for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibilityadvocate for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support HR 2, Medicare Access and CHIP Reauthorization Act of 2015, a bill to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and strengthen Medicare access by improving physician payments and making other improvements, to reauthorize the Childrens Health Insurance Program; Support HR 1470, SGR Repeal and Medicare Provider Payment Modernization Act of 2015, a bill to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and improve Medicare payments for physicians and other professionals; Support S 629, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Oppose Recovery Audit Contracts (RACs)Section 3 that imposes financial penalties on RACs; Support ICD-10 delay and advocate to maintain the Oct. 1, 2015 transition date for ICD-10; Discussions to oppose site neutral payments. Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 1295, Trade Preferences Extension Act of 2015because the inclusion of the Medicare sequestration offset; Oppose HR 976 and HR 2513Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process.

Client expense: $4,020,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R.976 - Patient Access to Higher Quality Health Care Act of 2015 Issues Related to 340B Program Changes Issues Related to Telehealth

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

H.R.976, Patient Access to Higher Quality Health Care Act of 2015 Issues Related to SGR Reform Issues Related to the 340B Program Issues Related to Medicare Inpatient and Outpatient Hospital Payment Rates

Client expense: Not reported · Firm income: $110,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE