To amend title XIX of the Social Security Act to count portions of income from annuities of a community spouse as income available to institutionalized spouses for purposes of eligibility for medical assistance, and for other purposes.

Medicare physician payment; new/alternative payment models; Medicare coverage, including coverage policies pertaining to implantable cardioverter-defibrillators and transcatheter aortic valve replacement; Medicare hospital payment; access to Medicare claims data; Ways & Means Committee hospital payment project; physician and hospital quality; electronic health record incentive program; clinical data registries; health care quality; medical imaging and prior authorization, including HR 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018; the Stark Law and the in-office ancillary services exception, including HR 4206/S 2051, the Medicare Care Coordination Improvement Act; Promoting Integrity in Medicare Act, HR 2066; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; HR 1155/S 1361, 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; S 46, the Strengthening Medicare Intensive Cardiac Rehabilitation Programs Act of 2017; HR 3325/S 428, The Advancing Care for Exceptional Kids Act of 2017 (or ACE Kids Act), a bill to allow a state, at its option, to elect to provide medical assistance for items and services furnished to eligible children with medically complex conditions enrolled in a Medicaid Children's Care Coordination (MCCC) program; Senate Finance Committee chronic care project; graduate medical education policy including HR 2267/S 1301, Resident Physician Shortage Reduction Act of 2017; end of life care, including HR 2797/S 1334, the Patient Choice and Quality Care Act of 2017; Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA) implementation; oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; physician-owned hospital policy, including HR 1156/S 1133, the Patient Access to High Quality Care Act of 2017; Medicaid coverage and eligibility, including HR 829, Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017, HR 181, Close Annuity Loopholes in Medicaid Act, and HR 705, Verify Eligibility Coverage Act; HR 3163, Medicare Part B Home Infusion Services Temporary Transitional Payment Act; Affordable Care Act repeal/replace/reform efforts; HR 3767 and S 989, the Ensuring Childrens Access to Specialty Care Act of 2017; HR 3635, the Local Coverage Determination Clarification Act of 2017; Ways and Means Committee Medicare extenders policy/legislation.

Client expense: $380,000 · 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), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, White House Office

H.R. 181, on Medicaid annuities; S.2227 / H.R. 5306 Empower Care Act; H.R. 1892 Bipartisan Budget Act of 2018; H.R. 1625 Consolidated Appropriations Act of 2018.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare physician payment; new/alternative payment models; Medicare coverage; Medicare hospital payment; access to Medicare claims data; Ways & Means Committee hospital payment project; physician and hospital quality; electronic health record incentive program; clinical data registries; health care quality; medical imaging and prior authorization, including HR 4841, Standardizing Electronic Prior Authorization for Safe Prescribing Act of 2018; the Stark Law and the in-office ancillary services exception, including HR 4206/S 2051, the Medicare Care Coordination Improvement Act; Promoting Integrity in Medicare Act, HR 2066; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; HR 1155/S 1361, 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; S 46, the Strengthening Medicare Intensive Cardiac Rehabilitation Programs Act of 2017; HR 3325/S 428, The Advancing Care for Exceptional Kids Act of 2017 (or ACE Kids Act), a bill to allow a state, at its option, to elect to provide medical assistance for items and services furnished to eligible children with medically complex conditions enrolled in a Medicaid Children's Care Coordination (MCCC) program; Senate Finance Committee chronic care project; graduate medical education policy including HR 2267/S 1301, Resident Physician Shortage Reduction Act of 2017; end of life care, including HR 2797/S 1334, the Patient Choice and Quality Care Act of 2017; Children's Health Insurance Program (CHIP) extension, including HR 3922, the CHAMPIONING HEALTHY KIDS Act; Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA) implementation; oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; repeal of the Independent Payment Advisory Board (IPAB), including S 251, the Protecting Medicare from Executive Action Act, S 260, the Protecting Seniors' Access to Medicare Act, SJ Res 16, SJ Res 17, and HR Res 51, joint resolutions approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Payment Advisory Board, and HR 849, a bill to repeal the IPAB; physician-owned hospital policy, including HR 1156/S 1133, the Patient Access to High Quality Care Act of 2017; Medicaid coverage and eligibility, including HR 829, Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017, HR 181, Close Annuity Loopholes in Medicaid Act, and HR 705, Verify Eligibility Coverage Act; HR 3163, Medicare Part B Home Infusion Services Temporary Transitional Payment Act; Affordable Care Act repeal/replace/reform efforts, including the American Health Care Act, the Better Care Reconciliation Act, S 1835, the Lower Premiums Through Reinsurance Act of 2017, and the Graham/Cassidy amendment to the American Health Care Act; HR 3120, a bill to amend title XVIII of the Social Security Act to reduce the volume of future electronic health record-related significant hardship requests; HR 3767 and S 989, the Ensuring Childrens Access to Specialty Care Act of 2017; HR 3635, the Local Coverage Determination Clarification Act of 2017; Ways and Means Committee Medicare extenders policy/legislation; above-mentioned issues included in HR 1892, the Bipartisan Budget Act of 2018.

H.R. 181, on Medicaid annuities; S.2227 / H.R. 5306 Empower Care Act; H.R. 1892 Bipartisan Budget Act of 2018; H.R. 1625 Consolidated Appropriations Act of 2018.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 181, on Medicaid annuities; Medicaid reform & proposals in H.R. 1628, the American Health Care Act, and the Senate discussion draft entitled, Better Care Reconciliation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare physician payment; new/alternative payment models; Medicare coverage; Medicare hospital payment; access to Medicare claims data; Ways & Means Committee hospital payment project; physician and hospital quality; electronic health record incentive program; clinical data registries; health care quality; medical imaging and prior authorization; the Stark Law and the in-office ancillary services exception including HR 4206/S 2051, the Medicare Care Coordination Improvement Act; Promoting Integrity in Medicare Act, HR 2066; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; HR 1155/S 1361, 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; S 46, the Strengthening Medicare Intensive Cardiac Rehabilitation Programs Act of 2017; S 428, The Advancing Care for Exceptional Kids Act of 2017, a bill to allow a state, at its option, to elect to provide medical assistance for items and services furnished to eligible children with medically complex conditions enrolled in a Medicaid Children's Care Coordination (MCCC) program; Senate Finance Committee chronic care project; graduate medical education policy including HR 2267/S 1301, Resident Physician Shortage Reduction Act of 2017; end of life care, including HR 2797/S 1334, the Patient Choice and Quality Care Act of 2017; Children's Health Insurance Program (CHIP) extension, including HR 3922, the CHAMPIONING HEALTHY KIDS Act; Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA) implementation; oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; repeal of the Independent Payment Advisory Board (IPAB), including S 251, the Protecting Medicare from Executive Action Act, S 260, the Protecting Seniors' Access to Medicare Act, SJ Res 16, SJ Res 17, and HR Res 51, joint resolutions approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Payment Advisory Board, and HR 849, a bill to repeal the IPAB; physician-owned hospital policy, including HR 1156/S 1133, the Patient Access to High Quality Care Act of 2017; Medicaid eligibility: HR 829, Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017, HR 181, Close Annuity Loopholes in Medicaid Act, and HR 705, Verify Eligibility Coverage Act; HR 3163, Medicare Part B Home Infusion Services Temporary Transitional Payment Act; Affordable Care Act repeal/replace/reform efforts, including the American Health Care Act, the Better Care Reconciliation Act, S 1835, the Lower Premiums Through Reinsurance Act of 2017, and the Graham/Cassidy amendment to the American Health Care Act; HR 3120, a bill to amend title XVIII of the Social Security Act to reduce the volume of future electronic health record-related significant hardship requests; HR 3767 and S 989, the Ensuring Childrens Access to Specialty Care Act of 2017; HR 3635, the Local Coverage Determination Clarification Act of 2017; Ways and Means Committee Medicare extenders policy/legislation.

H.R. 181, on Medicaid annuities; proposals related to Medicaid in H.R. 1628, the American Health Care Act; treatment of medical expense deductions in P.L. 115-97.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1115 Waivers- Iowa Repeal of Three Month Retroactive Coverage H.R. 181, CALM Act H.R. 1082, Medicaid Home Improvement Act H.R. 5626, To amend title XIX of the Social Security Act to eliminate the requirement for 3 months of retroactive coverage under the Medicaid program

Client expense: $64,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare physician payment; new/alternative payment models; Medicare coverage; Medicare hospital payment; access to Medicare claims data; Ways & Means Committee hospital payment project; physician and hospital quality; electronic health record incentive program; clinical data registries; health care quality; medical imaging and prior authorization; the Stark Law and the in-office ancillary services exception; Promoting Integrity in Medicare Act, HR 2066; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; HR 1155/S 1361, 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; S 46, the Strengthening Medicare Intensive Cardiac Rehabilitation Programs Act of 2017; S 428, The Advancing Care for Exceptional Kids Act of 2017, a bill to allow a state, at its option, to elect to provide medical assistance for items and services furnished to eligible children with medically complex conditions enrolled in a Medicaid Children's Care Coordination (MCCC) program; Senate Finance Committee chronic care project; graduate medical education policy including HR 2267/S 1301, Resident Physician Shortage Reduction Act of 2017; end of life care, including HR 2797/S 1334, the Patient Choice and Quality Care Act of 2017; Children's Health Insurance Program (CHIP) extension; Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA) implementation; oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; repeal of the Independent Payment Advisory Board (IPAB), including S 251, the Protecting Medicare from Executive Action Act, S 260, the Protecting Seniors' Access to Medicare Act, SJ Res 16, SJ Res 17, and HR Res 51, joint resolutions approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Payment Advisory Board, and HR 849, a bill to repeal the IPAB; physician-owned hospital policy, including HR 1156/S 1133, the Patient Access to High Quality Care Act of 2017; Medicaid eligibility: HR 829, Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017, HR 181, Close Annuity Loopholes in Medicaid Act, and HR 705, Verify Eligibility Coverage Act; HR 3163, Medicare Part B Home Infusion Services Temporary Transitional Payment Act; Affordable Care Act repeal/replace reform efforts, including the American Health Care Act, the Better Care Reconciliation Act and the Graham/Cassidy amendment to the American Health Care Act; HR 3120, a bill to amend title XVIII of the Social Security Act to reduce the volume of future electronic health record-related significant hardship requests; H.R. 3767 and S. 989, the Ensuring Childrens Access to Specialty Care Act of 2017; H.R. 3635, the Local Coverage Determination Clarification Act of 2017.

H.R. 181, on Medicaid annuities; proposals related to Medicaid in H.R. 1628, the American Health Care Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare physician payment; new/alternative payment models; Medicare coverage; Medicare hospital payment; access to Medicare claims data; Ways & Means Committee hospital payment project; physician and hospital quality; electronic health record incentive program; clinical data registries; health care quality; medical imaging and prior authorization; the Stark Law and the in-office ancillary services exception; Promoting Integrity in Medicare Act, HR 2066; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; HR 1155, 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; S 46, the Strengthening Medicare Intensive Cardiac Rehabilitation Programs Act of 2017; S 428, The Advancing Care for Exceptional Kids Act of 2017, a bill to allow a state, at its option, to elect to provide medical assistance for items and services furnished to eligible children with medically complex conditions enrolled in a Medicaid Children's Care Coordination (MCCC) program; Senate Finance Committee chronic care project; graduate medical education policy including HR 2267/S 1301, Resident Physician Shortage Reduction Act of 2017; end of life care, including HR 2797/S 1334, the Patient Choice and Quality Care Act of 2017; Children's Health Insurance Program (CHIP) extension; Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA) implementation; oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; repeal of the Independent Payment Advisory Board (IPAB), including S 251, the Protecting Medicare from Executive Action Act, S 260, the Protecting Seniors' Access to Medicare Act, SJ Res 16, SJ Res 17, and HR Res 51, joint resolutions approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Payment Advisory Board, and HR 849, a bill to repeal the IPAB; physician-owned hospital policy, including HR 1156/S 1133, the Patient Access to High Quality Care Act of 2017; Medicaid eligibility: HR 829, Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017, HR 181, Close Annuity Loopholes in Medicaid Act, and HR 705, Verify Eligibility Coverage Act; HR 3163, Medicare Part B Home Infusion Services Temporary Transitional Payment Act; Affordable Care Act repeal/replace reform efforts, including the American Health Care Act and the Better Care Reconciliation Act.

H.R. 181, on Medicaid annuities; Medicaid reform & proposals in H.R. 1628, the American Health Care Act, and the Senate discussion draft entitled, Better Care Reconciliation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 181, which would alter how income from annuities is counted towards Medicaid eligibility, policies that would eliminate the state option to increase the home equity threshold for purposes of Medicaid eligibility, and other policies related to Medicaid coverage; and H.R.1628, the American Health Care Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.181 on Medicaid annuities; Medicaid reform proposals in H.R.1628, the American Health Care Act, and the Senate discussion draft entitled, Better Care Reconciliation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2938 Removing Barriers to Medicaid and CHIP Addiction Treatment Act of 2017 H.R. 181 Close Annuity Loopholes in Medicaid Act H.R. 184 Protect Medical Innovation Act H.R. 244 Consolidated Appropriations Act, 2017 H.R. 284 Advancing Medical Resident Training in Community Hospitals Act H.R. 372 Competitive Health Insurance Reform Act H.R. 592 Pharmacy and Medically Underserved Areas Enhancement Act S. 109 Pharmacy and Medically Underserved Areas Enhancement Act H.R. 741 Rural Hospital Regulatory Relief Act S. 243 Rural Hospital Regulatory Relief Act H.R. 749 Lower Drug Costs through Competition Act H.R. 766 Amend Title XVII of the Social Security Act to Expand Telehealth in Medicare H.R. 829 Prioritizing the Most Vulnerable Over Lottery Winners Act H.R. 849 Protecting Seniors' Access to Medicare Act S. 260 Protecting Seniors' Access to Medicare Act H.R. 908 Medicare Advantage Quality Payment Relief Act H.R. 998 Searching for and Cutting Regulations that are Unnecessarily Burdensome (SCRUB) Act H.R. 1004 Regulatory Integrity Act H.R. 1038 Improving Transparency and Accuracy in Medicare Part D Spending H.R. 1072 Obamacare Replacement Act S. 222 Obamacare Replacement Act H.R. 1148 Furthering Access to Stroke Telemedicine (FAST) Act S. 431 Furthering Access to Stroke Telemedicine (FAST) Act H.R. 1245 Affordable and Safe Prescription Drug Importation Act S. 469 Affordable and Safe Prescription Drug Importation Act H.R. 1565 Saving Lives, Saving Costs Act H.R. 1628 American Health Care Act H.R. 1703 Medical Product Communications Act H.R. 1776 Improving Access to Affordable Prescription Drugs Act S. 771 Improving Access to Affordable Prescription Drugs Act H.R. 2550 Medicare Telehealth Parity Act H.R. 2556 CONNECT for Health Act S. 1016 CONNECT for Health Act S. 108 Medical Device Access and Innovation Protection Act S. 251 Protecting Medicare from Executive Action Act S. 309 Community-Based Independence for Seniors Act S. 413 Improving Transparency and Accuracy in Medicare Part D Spending S. 464 Independence at Home Act S. 469 Affordable and Safe Prescription Drug Importation Act S. 64 Safe and Affordable Drugs from Canada Act S. 761 Health Care Options Act S. 771 Improving Access to Affordable Prescription Drugs Act S. 787, Telehealth Innovation and Improvement Act S. 870 Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act

H.R. 2938 Removing Barriers to Medicaid and CHIP Addiction Treatment Act of 2017 H. Res. 142 Expressing support for "National Obesity Care Week" S. Res. 63 Expressing support for "National Obesity Care Week" H.R. 181 Close Annuity Loopholes in Medicaid Act H.R. 184 Protect Medical Innovation Act H.R. 244 Consolidated Appropriations Act, 2017 H.R. 284 Advancing Medical Resident Training in Community Hospitals Act H.R. 309 National Clinical Care Commission Act S. 920 National Clinical Care Commission Act H.R. 372 Competitive Health Insurance Reform Act H.R. 592 Pharmacy and Medically Underserved Areas Enhancement Act S. 109 Pharmacy and Medically Underserved Areas Enhancement Act H.R. 706 Plan Verification and Fairness Act H.R. 741 Rural Hospital Regulatory Relief Act S. 243 Rural Hospital Regulatory Relief Act H.R. 749 Lower Drug Costs through Competition Act H.R. 766 Amend Title XVII of the Social Security Act to Expand Telehealth in Medicare H.R. 829 Prioritizing the Most Vulnerable Over Lottery Winners Act H.R. 849 Protecting Seniors' Access to Medicare Act S. 260 Protecting Seniors' Access to Medicare Act H.R. 908 Medicare Advantage Quality Payment Relief Act H.R. 998 Searching for and Cutting Regulations that are Unnecessarily Burdensome (SCRUB) Act H.R. 1004 Regulatory Integrity Act H.R. 1009 OIRA Insight, Reform, and Accountability Act S. 676 OIRA Insight, Reform, and Accountability Act H.R. 1038 Improving Transparency and Accuracy in Medicare Part D Spending H.R. 1072 Obamacare Replacement Act S. 222 Obamacare Replacement Act H.R. 1101 Small Business Health Fairness Act H.R. 1121 Pre-Existing Conditions Protection Act H.R. 1148 Furthering Access to Stroke Telemedicine (FAST) Act S. 431 Furthering Access to Stroke Telemedicine (FAST) Act H.R. 1215 Protecting Access to Care Act H.R. 1245 Affordable and Safe Prescription Drug Importation Act S. 469 Affordable and Safe Prescription Drug Importation Act H.R. 1267 Personal Health Investment Today (PHIT) Act S. 482 Personal Health Investment Today (PHIT) Act H.R. 1304 Self-Insurance Protection Act H.R. 1313 Preserving Employee Wellness Programs Act H.R. 1554 Jessie's Law S. 581 Jessie's Law H.R. 1565 Saving Lives, Saving Costs Act H.R. 1628 American Health Care Act H.R. 1703 Medical Product Communications Act H.R. 1776 Improving Access to Affordable Prescription Drugs Act S. 771 Improving Access to Affordable Prescription Drugs Act H.R. 1922 Foreign Medical School Accountability Fairness Act S. 850 Foreign Medical School Accountability Fairness Act H.R. 1953 Treat and Reduce Obesity Act (TROA) S. 830 Treat and Reduce Obesity Act (TROA) H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 898 Conrad State 30 and Physician Access Reauthorization Act H.R. 2192 To Amend the Public Health Service Act to Eliminate the Non-Application of Certain State Waiver Provisions to Members of Congress and Congressional Staff H.R. 2212 Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act S. 974 Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act H.R. 2267 Resident Physician Reduction Shortage Act H.R. 246 Jobs and Premium Protection Act H.R. 2550 Medicare Telehealth Parity Act H.R. 2556 CONNECT for Health Act S. 1016 CONNECT for Health Act H.R. 2953 Amend the Congressional Budget Act of 1974 Respecting the Scoring of Preventive Health Savings S. 108 Medical Device Access and Innovation Protection Act S. 183 Jobs and Premium Protection Act S. 191 Patient Freedom Act S. 251 Protecting Medicare from Executive Action Act S. 309 Community-Based Independence for Seniors Act S. 413 Improving Transparency and Accuracy in Medicare Part D Spending S. 464 Independence at Home Act S. 469 Affordable and Safe Prescription Drug Importation Act S. 64 Safe and Affordable Drugs from Canada Act S. 761 Health Care Options Act S. 771 Improving Access to Affordable Prescription Drugs Act S. 787, Telehealth Innovation and Improvement Act S. 870 Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act

S.9, Over-the-Counter Hearing Aid Act of 2016 - Sent endorsement letter. Discussed potential repeal of the Affordable Care Act (P.L.111-148, P.L.111-152). Discussed MACRA implementation. Discussed changes to the Medicare benefit design, such as: copays, premiums, and deductibles. Discussed health care quality and measurement. Discussed AARP opposition to Medicaid block grants and per capita caps. H.R. 1017/S. 479, Removing Barriers to Colorectal Cancer Screening Act - Sent a letter of endorsement. Discussed concerns with/opposition to potential changes to Medicaid (includes letter to House Energy and Commerce Oversight and Investigations Subcommittee). Discussed Medicaid home and community-based services. Discussed Medicare code relating to family caregivers. H.R. 1421/S.568, Improving Access to Medicare Coverage Act - Discussed reintroduction of and our support for bill. Responded to question regarding H.R. 181 (regarding annuities for community spouse of an institutionalized spouse and Medicaid spousal impoverishment provisions) and Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017 (H.R. 829). Discussed possible repeal of final federal regulations regarding conditions of participation for long-term care facilities and our comments on the proposed rule. Responded to inquiry regarding nursing home abuses. Responded to inquiry regarding the Supplemental Security Income (SSI) Restoration Act (no bill number). H.R. 1628, American Health Care Act - Discussed health care reform and opposition to the bill including because of age tax and changes to Medicaid. Discussed priorities for older adults in health care reform legislation including Medicare, private health insurance/age tax, Medicaid, and prescription drugs. S. 191, Patient Freedom Act of 2017 - Discussed bill. Discussed health care reform generally. H.R. 2028 (Public Law 114-254) - Further Continuing and Security Assistance Appropriations Act, 2017 - Lobbied in support of increased funding for CMS' state survey and certification program and opposition to hostile policy riders re Patient Protection and Affordable Care Act. Discussed possible Medicaid hearing questions.

Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 (P.L. 114-10) including policies related to the Quality Payment Program 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 H.R. 181 - Close Annuity Loopholes in Medicaid Act H.R. 365 - Primary Care Enhancement Act of 2017 H.R. 829 - Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017 H.R. 1121 - Pre-Existing Conditions Protection Act H.R. 1160 - ACO Assignment Improvement Act of 2017 H.R. 1617 - Promoting Access to Diabetic Shoes Act H.R. 1628 - American Health Care Act of 2017 S. 191 - Patient Freedom Act S. 222/H.R. 1072 - Obamacare Replacement Act S. 251 - Protecting Medicare from Executive Action Act of 2017 S. 260/H.R. 849 - Protecting Seniors' Access to Medicare Act of 2017 S. 403/H.R. 1175 - Health Savings Act of 2017 S. 445/H.R. 1825 - Home Health Care Planning Improvement Act of 2017 S. 428 - Advancing Care for Exceptional Kids (ACE Kids) Act

Client expense: Not reported · Firm income: $23,450

Medicare physician payment; new/alternative payment models; Medicare coverage; Medicare hospital payment; Ways & Means Committee hospital payment project; physician and hospital quality; electronic health record incentive program; clinical data registries; health care quality; medical imaging and prior authorization; the Stark Law and the in-office ancillary services exception; Promoting Integrity in Medicare Act, HR 2066; Medicare Access and CHIP Reauthorization Act implementation and oversight; Bipartisan Budget Act of 2015 and Medicare site of service policy; HR 1155, 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; S 46, the Strengthening Medicare Intensive Cardiac Rehabilitation Programs Act of 2017; S 428, The Advancing Care for Exceptional Kids Act of 2017, a bill to allow a state, at its option, to elect to provide medical assistance for items and services furnished to eligible children with medically complex conditions enrolled in a Medicaid Children's Care Coordination (MCCC) program; Senate Finance Committee chronic care project; graduate medical education policy; end of life care; Children's Health Insurance Program (CHIP) extension; Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA) implementation; oversight and implementation of the Protecting Access to Medicare Act of 2014, including Appropriate Use Criteria; repeal of the Independent Payment Advisory Board (IPAB), including S 251, the Protecting Medicare from Executive Action Act, S 260, the Protecting Seniors' Access to Medicare Act, SJ Res 16, SJ Res 17, and HR Res 51, joint resolutions approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Payment Advisory Board, and HR 849, a bill to repeal the IPAB; physician-owned hospital policy, including HR 1156; Medicaid eligibility: HR 829, Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017, HR 181, Close Annuity Loopholes in Medicaid Act, and HR 705, Verify Eligibility Coverage Act.

S.9, Over-the-Counter Hearing Aid Act of 2016 - Sent endorsement letter. Discussed potential repeal of the Affordable Care Act (P.L.111-148, P.L.111-152). Discussed MACRA implementation. Discussed changes to the Medicare benefit design, such as: copays, premiums, and deductibles. Discussed health care quality and measurement. Discussed AARP opposition to Medicaid block grants and per capita caps. H.R. 1017/S. 479, Removing Barriers to Colorectal Cancer Screening Act - Sent a letter of endorsement. Discussed concerns with/opposition to potential changes to Medicaid (includes letter to House Energy and Commerce Oversight and Investigations Subcommittee). Discussed Medicaid home and community-based services. Discussed Medicare code relating to family caregivers. H.R. 1421/S.568, Improving Access to Medicare Coverage Act - Discussed reintroduction of and our support for bill. Responded to question regarding H.R. 181 (regarding annuities for community spouse of an institutionalized spouse and Medicaid spousal impoverishment provisions) and Prioritizing the Most Vulnerable Over Lottery Winners Act of 2017 (H.R. 829). Discussed possible repeal of final federal regulations regarding conditions of participation for long-term care facilities and our comments on the proposed rule. Responded to inquiry regarding nursing home abuses. Responded to inquiry regarding the Supplemental Security Income (SSI) Restoration Act (no bill number). H.R. 1628, American Health Care Act - Discussed health care reform and opposition to the bill including because of age tax and changes to Medicaid. Discussed priorities for older adults in health care reform legislation including Medicare, private health insurance/age tax, Medicaid, and prescription drugs. S. 191, Patient Freedom Act of 2017 - Discussed bill. Discussed health care reform generally. H.R. 2028 (Public Law 114-254) - Further Continuing and Security Assistance Appropriations Act, 2017 - Lobbied in support of increased funding for CMS' state survey and certification program and opposition to hostile policy riders re Patient Protection and Affordable Care Act. Discussed possible Medicaid hearing questions.

SConRes 3- Medicare and Medicaid cuts in reconciliation Nomination of Tom Price for Secretary of Health & Human Services Nomination of Seema Verma for CMS Administrator Improving Access to Mental Health and Substance Abuse Treatment HR 1628- American Health Care Act of 2017, repeal of the Affordable Care Act and cuts to Medicaid and Medicare HR 829- Changes to Medicaid coverage and eligibility HR 181- Medicaid eligibility changes that would impoverish spouses Safe nurse staffing levels Children's Health Insurance Program (CHIP) Reauthorization S 771, HR 1776- Improving Access to Affordable Prescription Drugs Act Medicaid payments to home care providers Medicaid funding, benefits, coverage Medicare funding, benefits, policy, eligibility age, means tests, spending equity across jurisdictions

Client expense: $630,000 · Firm income: Not reported

H.R. 181, which would alter how income from annuities is counted towards Medicaid eligibility, policies that would eliminate the state option to increase the home equity threshold for purposes of Medicaid eligibility, and other policies related to Medicaid coverage; and H.R.1628, the American Health Care Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 181 Close Annuity Loopholes in Medicaid Act H.R. 184 Protect Medical Innovation Act H.R. 284 Advancing Medical Resident Training in Community Hospitals Act H.R. 741 Rural Hospital Regulatory Relief Act S. 243 Rural Hospital Regulatory Relief Act H.R. 766 Amend Title XVII of the Social Security Act to expand telehealth in Medicare H.R. 849 Protecting Seniors' Access to Medicare Act S. 260 Protecting Seniors' Access to Medicare Act H.R. 1038 Improving Transparency and Accuracy in Medicare Part D Spending S. 413 Improving Transparency and Accuracy in Medicare Part D Spending H.R. 1148 Furthering Access to Stroke Telemedicine (FAST) Act S. 431 Furthering Access to Stroke Telemedicine (FAST) Act H.R. 1245 Affordable and Safe Prescription Drug Importation Act S. 469 Affordable and Safe Prescription Drug Importation Act H.R. 1628 American Health Care Act H.R. 1776 Improving Access to Affordable Prescription Drugs Act S. 771 Improving Access to Affordable Prescription Drugs Act Pub. L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) S. 64 Safe and Affordable Drugs from Canada Act S. 108 Medical Debvice Access and Innovation Protection Act S. 251 Protecting Medicare from Executive Action Act S. 464 Independence at Home Act

Client expense: $170,000 · Firm income: Not reported

H.R. 181 Close Annuity Loopholes in Medicaid Act H.R. 184 Protect Medical Innovation Act H.R. 246 Jobs and Premium Protection Act S. 183 Jobs and Premium Protection Act H.R. 284 Advancing Medical Resident Training in Community Hospitals Act H.R. 309 National Clinical Care Commission Act H.R. 372 Competitive Health Insurance Reform Act H.R. 592 Pharmacy and Medically Underserved Areas Enhancement Act S. 109 Pharmacy and Medically Underserved Areas Enhancement Act H.R. 741 Rural Hospital Regulatory Relief Act S. 243 Rural Hospital Regulatory Relief Act H.R. 766 Amend Title XVII of the Social Security Act to expand telehealth in Medicare H.R. 829 Prioritizing the Most Vulnerable Over Lottery Winners Act H.R. 849/ S. 260 Protecting Seniors' Access to Medicare Act H.R. 998 Searching for and Cutting Regulations that are Unnecessarily Burdensome (SCRUB) Act H.R. 1004 Regulatory Integrity Act H.R. 1009 OIRA Insight, Reform, and Accountability Act S. 676 OIRA Insight, Reform, and Accountability Act H.R. 1038 Improving Transparency and Accuracy in Medicare Part D Spending S. 413 Improving Transparency and Accuracy in Medicare Part D Spending H.R. 1072/ S. 222 Obamacare Replacement Act H.R. 1101 Small Business Health Fairness Act of 2017 H.R. 1121 Pre-Existing Conditions Protection Act of 2017 H.R. 1148/S. 431 Furthering Access to Stroke Telemedicine (FAST) Act H.R. 1215 Protecting Access to Care Act H.R. 1245/S. 469 Affordable and Safe Prescription Drug Importation Act H.R. 1267/S. 482 (PHIT Act) H.R. 1304 Self-Insurance Protection Act H.R. 1313 Preserving Employee Wellness Programs Act H.R. 1554/S. 581 Jessie's Law H.R. 1565 Saving Lives, Saving Costs Act H.R. 1628 American Health Care Act H.R. 1776/ S. 771 Improving Access to Affordable Prescription Drugs Act Pub. L. 102-143 Telephone Consumer Protection Act Pub. L. 111-5, The American Recovery and Reinvestment Act Pub. L. 111-148 Patient Protection and Affordable Care Act (PPACA) Pub. L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) P.L. 114-198 Comprehensive Addiction and Recovery Act Pub. L. 114-255, 21st Century Cures Act Pub. L. 114-270 Expanding Capacity for Health Outcomes Act (ECHO) Pub. L. 114-328, National Defense Authorization Act for Fiscal Year Pub. L. 114-329 American Innovation and Competitiveness Act S. 870 Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act S. 64 Safe and Affordable Drugs from Canada Act S. 108 Medical Debvice Access and Innovation Protection Act S. 191 Patient Freedom Act S. 251 Protecting Medicare from Executive Action Act S. 464 Independence at Home Act S. 761 Health Care Options Act of 2017 S. 787, Telehealth Innovation and Improvement Act

H.R. 181, the Close Annuity Loopholes in Medicaid Act H.R. 1628, the American Health Care Act

Client expense: $64,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 181, which would alter how income from annuities is counted towards Medicaid eligibility, policies that would eliminate the state option to increase the home equity threshold for purposes of Medicaid eligibility, and other policies related to Medicaid coverage; and the American Health Care Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE