Medicare Mental Health Inpatient Equity Act of 2017

H.R. 1173: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program S. 448: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program H.R. 2509: Medicare Mental Health Inpatient Equity Act of 2017. Legislation To amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program S.1169: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes H.R. 1953: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes S. 3797, H.R. 6781: Mental Health Telemedicine Expansion Act S. 830: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes H.R. 3331: To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology S. 1732: Improving Access to Behavioral Health Information Technology Act H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes S. 1905, HR 3931: Excellence in Mental Health and Addiction Treatment Expansion Act. To increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services S. 1169, H.R. 2687: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes S. 3383, H.R. 5477: Rural DOCS Act. To provide incentives for state Medicaid expenditures related to the expansion of substance-use treatment and recovery services targeting provider capacity S. 428, H.R. 3325: Advancing Care for Exceptional Kids Act

Client expense: $100,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1173/S. 448, the Medicare Mental Health Access Act H.R. 849, the Protecting Seniors Access to Medicare Act S. 1301/H.R. 2267, the Resident Physician Shortage Reduction Act H.R. 2276/S. 2575, the Audiology Patient Choice Act H.R. 5594, the Improving Access to Remote Behavioral Health Treatment Act of 2018 S. 2680, the Opioid Crisis Response Act of 2018 H.R. 6, the SUPPORT for Patients and Communities Act H.R. 1925, the At-Risk Youth Medicaid Protection Act H.R. 2509, the Medicare Mental Health Inpatient Equity Act S. 1169, the Medicaid Coverage for Addiction Recovery Expansion Act H.R. 2687, the Medicaid Coverage for Addiction Recovery Expansion Act H.R. 4005, the Medicaid Reentry Act H.R. 4097, the Medicare Beneficiary Opioid Addiction Treatment Act S. 2843/H.R. 5818, the Opioid Workforce Act of 2018 Comments re: the Centers for Medicare & Medicaid Services (CMS) decision to suspend the risk adjustment payments to insurers participating in the individual and small-group marketplaces, as mandated by the Affordable Care Act Support for S.J.Res.63, a joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to "Short-Term, Limited Duration Insurance. Comments re: CMSs proposed rule, Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2019. CMS-1693-P Comments re: CMSs proposed rule, Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations-Pathways to Success. Comments re: CMSs proposed rule, Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations-Pathways to Success Comment on the CY 2019 Proposed Rule for the Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction. Issue relating to suicide prevention; in general Issues relating to the enforcement of mental health parity; in general

Support H.R. 741/ S. 243 Rural Hospital Regulatory Relief Act of 2017, a bill that amends title XVIII (Medicare) of the Social Security Act to permanently extend the application by the Centers for Medicare & Medicaid Services of an instruction against the enforcement of certain physician supervision requirements with respect to outpatient therapeutic services in critical access hospitals and small rural hospitals; Support H.R. 807/ S. 253 Medicare Access to Rehabilitation Services Act of 2017, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; Discussion about the Electronic Clinical Quality Measure Reporting: advocating for an extension of the reporting deadline to increase hospitals ability to meet requirements in the Hospital Inpatient Quality Reporting program and the Medicare EHR Incentive Program;Requested clarification from CMS about providing care to justice-involved individuals and receiving Medicaid/Medicare reimbursement for such care to Made efforts in support of clarifying that hospitals may have designated units to care for patients in the custody of law enforcement/correctional institutions and may receive Medicaid reimbursement for care provided in such units; Support S. 872/ HR 1955Rural Hospital Access Act of 2017, a bill to amend title XVIII of the Social Security Act to make permanent the extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support S 1301/ HR 2267, Resident Physician Shortage Reduction Act of 2017, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose H.R. 1628 American Health Care Act / Better Care Reconciliation Act, a bill that would repeal and replace much of the Affordable Care Act, including repealing Medicaid expansion and the advanced premium tax credits for the purchase of coverage on the Health Insurance Marketplaces; Support S 1334/ HR 2797Patient Choices and Quality Care Act of 2017, a bill to provide for advanced illness care coordination services for Medicare beneficiaries; Urged the Administration to cancel Stage 3 of meaningful use by removing the 2018 start date from the regulation. The Administration also should institute a 90- day reporting period in every future year of the program, and gather input from stakeholders on ways to further reduce the burden of the meaningful use program from current requirements; Review S. 1169/ HR 2687, Medicaid Coverage for Addiction Recovery Expansion Act, a bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities; Review HR 2509 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Urged CMS to rescind the 25% Rule and instead rely on the site-neutral payment policy to bring transformative change to the LTCH field; Discussion with CMS about direct supervision of outpatient therapeutic services; Support 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; Discussed with Congress potential offsets to pay for CHIP and other Medicare extender legislation; Support straight extensions of the Medicare-dependent hospital and enhanced low-volume adjustment program; Support eliminating the reductions to Medicaid payments for DSH in fiscal years 2018 and 2019; Urged CMS to eliminate a duplicative budget-neutrality adjustment (BNA) being applied to Medicare payments for LTCH site-neutral cases, an unwarranted 5.1 percent cut. Urged CMS to permanently eliminate the LTCH 25% Rule policy; support The Limited Repeal of the IMD Exclusion for Adult Medicaid Beneficiaries with Substance Use Disorder Act, which would improve access to needed substance use disorder (SUD)treatment services for millions of Americans.

H.R. 1173/S. 448, the Medicare Mental Health Access Act H.R. 849, the Protecting Seniors Access to Medicare Act S. 1301/H.R. 2267, the Resident Physician Shortage Reduction Act H.R. 2276/S. 2575, the Audiology Patient Choice Act H.R. 5594, the Improving Access to Remote Behavioral Health Treatment Act of 2018 S. 2680, the Opioid Crisis Response Act of 2018 H.R. 6, the SUPPORT for Patients and Communities Act H.R. 1925, the At-Risk Youth Medicaid Protection Act H.R. 2509, the Medicare Mental Health Inpatient Equity Act S. 1169, the Medicaid Coverage for Addiction Recovery Expansion Act H.R. 2687, the Medicaid Coverage for Addiction Recovery Expansion Act H.R. 4005, the Medicaid Reentry Act H.R. 4097, the Medicare Beneficiary Opioid Addiction Treatment Act S. 2843/H.R. 5818, the Opioid Workforce Act of 2018 Comments re: the Centers for Medicare & Medicaid Services (CMS) decision to suspend the risk adjustment payments to insurers participating in the individual and small-group marketplaces, as mandated by the Affordable Care Act Support for S.J.Res.63, a joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to "Short-Term, Limited Duration Insurance. Comments re: CMSs proposed rule, Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2019. CMS-1693-P Comments re: CMSs proposed rule, Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations-Pathways to Success. Issue relating to suicide prevention; in general Issues relating to the enforcement of mental health parity; in general

Client expense: $260,000 · Firm income: Not reported

H.R. 1173: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. S. 448: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. H.R. 2509: Medicare Mental Health Inpatient Equity Act of 2017. Legislation To amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program. S.1169: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes. H.R. 1953: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. S. 830: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. H.R. 3331: To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology. S. 1732: Improving Access to Behavioral Health Information Technology Act H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes. S. 1905, HR 3931: Excellence in Mental Health and Addiction Treatment Expansion Act. To increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services. S. 1169, H.R. 2687: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes. S. 3383, H.R. 5477: Rural DOCS Act. To provide incentives for state Medicaid expenditures related to the expansion of substance-use treatment and recovery services targeting provider capacity.

S. 448/H.R. 1173 Medicare Mental Health Access Act S. 874 At-Risk Youth Medicaid Protection Act S. 1905/H.R. 3931 Excellence in Mental Health and Addiction Treatment Expansion Act S. 1169/H.R. 2687 Medicaid Coverage for Addiction Recovery Expansion Act S. 1732/H.R. 3331 To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 6 Support for Patients and Communities Act H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes H.R. 2509 Medicare Mental Health Inpatient Inequity Act

Client expense: $160,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Support H.R. 741/ S. 243 Rural Hospital Regulatory Relief Act of 2017, a bill that amends title XVIII (Medicare) of the Social Security Act to permanently extend the application by the Centers for Medicare & Medicaid Services of an instruction against the enforcement of certain physician supervision requirements with respect to outpatient therapeutic services in critical access hospitals and small rural hospitals; Support H.R. 807/ S. 253 Medicare Access to Rehabilitation Services Act of 2017, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; Discussion about the Electronic Clinical Quality Measure Reporting: advocating for an extension of the reporting deadline to increase hospitals ability to meet requirements in the Hospital Inpatient Quality Reporting program and the Medicare EHR Incentive Program;Requested clarification from CMS about providing care to justice-involved individuals and receiving Medicaid/Medicare reimbursement for such care to Made efforts in support of clarifying that hospitals may have designated units to care for patients in the custody of law enforcement/correctional institutions and may receive Medicaid reimbursement for care provided in such units; Support S. 872/ HR 1955Rural Hospital Access Act of 2017, a bill to amend title XVIII of the Social Security Act to make permanent the extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support S 1301/ HR 2267, Resident Physician Shortage Reduction Act of 2017, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose H.R. 1628 American Health Care Act / Better Care Reconciliation Act, a bill that would repeal and replace much of the Affordable Care Act, including repealing Medicaid expansion and the advanced premium tax credits for the purchase of coverage on the Health Insurance Marketplaces; Support S 1334/ HR 2797Patient Choices and Quality Care Act of 2017, a bill to provide for advanced illness care coordination services for Medicare beneficiaries; Urged the Administration to cancel Stage 3 of meaningful use by removing the 2018 start date from the regulation. The Administration also should institute a 90- day reporting period in every future year of the program, and gather input from stakeholders on ways to further reduce the burden of the meaningful use program from current requirements; Review S. 1169/ HR 2687, Medicaid Coverage for Addiction Recovery Expansion Act, a bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities; Review HR 2509 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Urged CMS to rescind the 25% Rule and instead rely on the site-neutral payment policy to bring transformative change to the LTCH field; Discussion with CMS about direct supervision of outpatient therapeutic services; Support 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; Discussed with Congress potential offsets to pay for CHIP and other Medicare extender legislation; Support straight extensions of the Medicare-dependent hospital and enhanced low-volume adjustment program; Support eliminating the reductions to Medicaid payments for DSH in fiscal years 2018 and 2019; Urged CMS to eliminate a duplicative budget-neutrality adjustment (BNA) being applied to Medicare payments for LTCH site-neutral cases, an unwarranted 5.1 percent cut. Urged CMS to permanently eliminate the LTCH 25% Rule policy; support The Limited Repeal of the IMD Exclusion for Adult Medicaid Beneficiaries with Substance Use Disorder Act, which would improve access to needed substance use disorder (SUD)treatment services for millions of Americans.

H.R. 1173/S. 448, the Medicare Mental Health Access Act H.R. 849, the Protecting Seniors Access to Medicare Act S. 1301/H.R. 2267, the Resident Physician Shortage Reduction Act H.R. 2276/S. 2575, the Audiology Patient Choice Act H.R. 5594, the Improving Access to Remote Behavioral Health Treatment Act of 2018 S. 2680, the Opioid Crisis Response Act of 2018 H.R. 6, the SUPPORT for Patients and Communities Act H.R. 1925, the At-Risk Youth Medicaid Protection Act H.R. 2509, the Medicare Mental Health Inpatient Equity Act S. 1169, the Medicaid Coverage for Addiction Recovery Expansion Act H.R. 2687, the Medicaid Coverage for Addiction Recovery Expansion Act H.R. 4005, the Medicaid Reentry Act H.R. 4097, the Medicare Beneficiary Opioid Addiction Treatment Act

Client expense: $260,000 · Firm income: Not reported

Imputed Floor (FY 19 IPPS rule) 340B Drug Pricing Program Opioids SUD patient record sharing (H.R. 3545/S. 1850) 190-day limit on inpatient psychiatric care under Medicare (HR 2509) IMD exclusion (H.R. 2938/S. 1169) Veterans mental health and SUD at non-VA facilities (no specific bill) Observation status (H.R. 1421/S. 568) MISSION ZERO (H.R. 880/S. 1022) ALTO (H.R. 5197/S. 2516)

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

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

H.R. 1173: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. S. 448: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. H.R. 2509: Medicare Mental Health Inpatient Equity Act of 2017. Legislation To amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program. S.1169: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes. H.R. 1953: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. S. 830: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. H.R. 3331: To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology. S. 1732: Improving Access to Behavioral Health Information Technology Act H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes. S. 1905, HR 3931: Excellence in Mental Health and Addiction Treatment Expansion Act. To increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services. S. 1169, H.R. 2687: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes. H.R. 5477: Rural DOCS Act. To provide incentives for state Medicaid expenditures related to the expansion of substance-use treatment and recovery services targeting provider capacity.

S. 448/H.R. 1173 Medicare Mental Health Access Act S. 874 At-Risk Youth Medicaid Protection Act S. 1905/H.R. 3931 Excellence in Mental Health and Addiction Treatment Expansion Act S. 1169/H.R. 2687 Medicaid Coverage for Addiction Recovery Expansion Act S. 1732/H.R. 3331 To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes H.R. 2509 Medicare Mental Health Inpatient Inequity Act

Client expense: $260,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Imputed Floor (FY 19 IPPS rule), 340B Drug Pricing Program, Opioids: SUD patient record sharing (H.R. 3545/S. 1850), 190-day limit on inpatient psychiatric care under Medicare (HR 2509), IMD exclusion (H.R. 2938/S. 1169), Veterans mental health and SUD at non-VA facilities (no specific bill), Observation status (H.R. 1421/S. 568), MISSION ZERO (H.R. 880/S. 1022), ALTO (H.R. 5197/S. 2516)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 448/H.R. 1173 Medicare Mental Health Access Act S. 1905/H.R. 3931 Excellence in Mental Health and Addiction Treatment Expansion Act S. 1169/H.R. 2687 Medicaid Coverage for Addiction Recovery Expansion Act S. 1732/H.R. 3331 To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes H.R. 2509 Medicare Mental Health Inpatient Inequity Act

Client expense: $140,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Support H.R. 741/ S. 243 Rural Hospital Regulatory Relief Act of 2017, a bill that amends title XVIII (Medicare) of the Social Security Act to permanently extend the application by the Centers for Medicare & Medicaid Services of an instruction against the enforcement of certain physician supervision requirements with respect to outpatient therapeutic services in critical access hospitals and small rural hospitals; Support H.R. 807/ S. 253 Medicare Access to Rehabilitation Services Act of 2017, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; Discussion about the Electronic Clinical Quality Measure Reporting: advocating for an extension of the reporting deadline to increase hospitals ability to meet requirements in the Hospital Inpatient Quality Reporting program and the Medicare EHR Incentive Program;Requested clarification from CMS about providing care to justice-involved individuals and receiving Medicaid/Medicare reimbursement for such care to Made efforts in support of clarifying that hospitals may have designated units to care for patients in the custody of law enforcement/correctional institutions and may receive Medicaid reimbursement for care provided in such units; Support S. 872/ HR 1955Rural Hospital Access Act of 2017, a bill to amend title XVIII of the Social Security Act to make permanent the extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support S 1301/ HR 2267, Resident Physician Shortage Reduction Act of 2017, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose H.R. 1628 American Health Care Act / Better Care Reconciliation Act, a bill that would repeal and replace much of the Affordable Care Act, including repealing Medicaid expansion and the advanced premium tax credits for the purchase of coverage on the Health Insurance Marketplaces; Support S 1334/ HR 2797Patient Choices and Quality Care Act of 2017, a bill to provide for advanced illness care coordination services for Medicare beneficiaries; Urged the Administration to cancel Stage 3 of meaningful use by removing the 2018 start date from the regulation. The Administration also should institute a 90- day reporting period in every future year of the program, and gather input from stakeholders on ways to further reduce the burden of the meaningful use program from current requirements; Review S. 1169/ HR 2687, Medicaid Coverage for Addiction Recovery Expansion Act, a bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities; Review HR 2509 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Urged CMS to rescind the 25% Rule and instead rely on the site-neutral payment policy to bring transformative change to the LTCH field; Discussion with CMS about direct supervision of outpatient therapeutic services; Support 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; Discussed with Congress potential offsets to pay for CHIP and other Medicare extender legislation; Support straight extensions of the Medicare-dependent hospital and enhanced low-volume adjustment program; Support eliminating the reductions to Medicaid payments for DSH in fiscal years 2018 and 2019; Urged CMS to eliminate a duplicative budget-neutrality adjustment (BNA) being applied to Medicare payments for LTCH site-neutral cases, an unwarranted 5.1 percent cut. Urged CMS to permanently eliminate the LTCH 25% Rule policy.

S. 448/H.R. 1173 Medicare Mental Health Access Act S. 1905/H.R. 3931 Excellence in Mental Health and Addiction Treatment Expansion Act S. 1169/H.R. 2687 Medicaid Coverage for Addiction Recovery Expansion Act S. 1732/H.R. 3331 To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes H.R. 2509 Medicare Mental Health Inpatient Inequity Act

Client expense: $140,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

H.R. 1173: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. S. 448: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. H.R. 2509: Medicare Mental Health Inpatient Equity Act of 2017. Legislation To amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program. S.1169: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes. H.R. 1953: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. S. 830: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. H.R. 3331: To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology. S. 1732: Improving Access to Behavioral Health Information Technology Act H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes. S. 1905, HR 3931: Excellence in Mental Health and Addiction Treatment Expansion Act. To increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services. S. 1169, H.R. 2687: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes.

Imputed Floor (FY 19 IPPS rule) 340B Drug Pricing Program (H.R. 4392) Opioids SUD patient record sharing (H.R. 3545/S. 1850) 190-day limit on inpatient psychiatric care under Medicare (HR 2509) IMD exclusion (H.R. 2938/S. 1169) Veterans mental health and SUD at non-VA facilities (no specific bill) Observation status (H.R. 1421/S. 568) MISSION ZERO (H.R. 880/S. 1022) ALTO (H.R. 5197/S. 2516) ACA Stabilization (Standalone as well as part of the Bipartisan Budget Act of 2018 [H.R. 1892] and the Consolidated Appropriations Act of 2018 [H.R. 1625])

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

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

Support H.R. 741/ S. 243 Rural Hospital Regulatory Relief Act of 2017, a bill that amends title XVIII (Medicare) of the Social Security Act to permanently extend the application by the Centers for Medicare & Medicaid Services of an instruction against the enforcement of certain physician supervision requirements with respect to outpatient therapeutic services in critical access hospitals and small rural hospitals; Support H.R. 807/ S. 253 Medicare Access to Rehabilitation Services Act of 2017, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; Discussion about the Electronic Clinical Quality Measure Reporting: advocating for an extension of the reporting deadline to increase hospitals ability to meet requirements in the Hospital Inpatient Quality Reporting program and the Medicare EHR Incentive Program;Requested clarification from CMS about providing care to justice-involved individuals and receiving Medicaid/Medicare reimbursement for such care to Made efforts in support of clarifying that hospitals may have designated units to care for patients in the custody of law enforcement/correctional institutions and may receive Medicaid reimbursement for care provided in such units; Support S. 872/ HR 1955Rural Hospital Access Act of 2017A bill to amend title XVIII of the Social Security Act to make permanent the extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Submit Statement for Medicare Advantage Hearing on Promoting Integrated and Coordinated Care for Medicare Beneficiaries on the importance of promoting integrated and coordinated care for Medicare beneficiaries served through the Medicare Advantage (MA) program; Support S 1301/ HR 2267, Resident Physician Shortage Reduction Act of 2017, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose H.R. 1628/ S. xxx,American Health Care Act / Better Care Reconciliation Act, a bill that would repeal and replace much of the Affordable Care Act, including repealing Medicaid expansion and the advanced premium tax credits for the purchase of coverage on the Health Insurance Marketplaces; Support S 1334/ HR 2797Patient Choices and Quality Care Act of 2017, a bill to provide for advanced illness care coordination services for Medicare beneficiaries; Urged the Administration to cancel Stage 3 of meaningful use by removing the 2018 start date from the regulation. The Administration also should institute a 90- day reporting period in every future year of the program, and gather input from stakeholders on ways to further reduce the burden of the meaningful use program from current requirements; Review S. 1169/ HR 2687, Medicaid Coverage for Addiction Recovery Expansion Act, a bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities; Review HR 2509 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; Urged CMS to rescind the 25% Rule and instead rely on the site-neutral payment policy to bring transformative change to the LTCH field; Discussion with CMS about direct supervision of outpatient therapeutic services; Support 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; Discussed with Congress potential offsets to pay for CHIP and other Medicare extender legislation; Support straight extensions of the Medicare-dependent hospital and enhanced low-volume adjustment program; Support eliminating the reductions to Medicaid payments for DSH in fiscal years 2018 and 2019.

S. 448/H.R. 1173 Medicare Mental Health Access Act S. 1905/H.R. 3931 Excellence in Mental Health and Addiction Treatment Expansion Act S. 1169/H.R. 2687 Medicaid Coverage for Addiction Recovery Expansion Act S. 1732/H.R. 3331 To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes H.R. 2509 Medicare Mental Health Inpatient Inequity Act

Client expense: $150,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

H.R. 1173: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. S. 448: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. H.R. 2509: Medicare Mental Health Inpatient Equity Act of 2017. Legislation To amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program. S.1169: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes. H.R. 1953: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. S. 830: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. H.R. 3331: To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology. S. 1732: Improving Access to Behavioral Health Information Technology Act H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes. S. 1905, HR 3931: Excellence in Mental Health and Addiction Treatment Expansion Act. To increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services. S. 1169, H.R. 2687: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes.

Support H.R. 741/ S. 243 Rural Hospital Regulatory Relief Act of 2017, a bill that amends title XVIII (Medicare) of the Social Security Act to permanently extend the application by the Centers for Medicare & Medicaid Services of an instruction against the enforcement of certain physician supervision requirements with respect to outpatient therapeutic services in critical access hospitals and small rural hospitals; Support H.R. 807/ S. 253 Medicare Access to Rehabilitation Services Act of 2017, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; Discussion about the Electronic Clinical Quality Measure Reporting: advocating for an extension of the reporting deadline to increase hospitals ability to meet requirements in the Hospital Inpatient Quality Reporting program and the Medicare EHR Incentive Program;Requested clarification from CMS about providing care to justice-involved individuals and receiving Medicaid/Medicare reimbursement for such care to Made efforts in support of clarifying that hospitals may have designated units to care for patients in the custody of law enforcement/correctional institutions and may receive Medicaid reimbursement for care provided in such units; Support S. 872/ HR 1955Rural Hospital Access Act of 2017A bill to amend title XVIII of the Social Security Act to make permanent the extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Submit StatementMedicare Advantage Hearing on Promoting Integrated and Coordinated Care for Medicare Beneficiaries the importance of promoting integrated and coordinated care for Medicare eneficiaries served through the Medicare Advantage (MA) program; Support S 1301/ HR 2267, Resident Physician Shortage Reduction Act of 2017, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose H.R. 1628/ S. xxx,American Health Care Act / Better Care Reconciliation Act, a bill that would repeal and replace much of the Affordable Care Act, including repealing Medicaid expansion and the advanced premium tax credits for the purchase of coverage on the Health Insurance Marketplaces; Support S 1334/ HR 2797Patient Choices and Quality Care Act of 2017, a bill to provide for advanced illness care coordination services for Medicare beneficiaries; Urges the Administration to cancel Stage 3 of meaningful use by removing the 2018 start date from the regulation. The Administration also should institute a 90- day reporting period in every future year of the program, and gather input from stakeholders on ways to further reduce the burden of the meaningful use program from current requirements; Review S. 1169/ HR 2687, Medicaid Coverage for Addiction Recovery Expansion Act, a bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities; Review HR 2509 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; CMS should rescind the 25% Rule and instead rely on the site-neutral payment policy to bring transformative change to the LTCH field; Discussion with CMS about direct supervision of outpatient therapeutic services; Support 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; Discussed with Congress potential offsets to pay for CHIP and other Medicare extender legislation.

S. 448/H.R. 1173 Medicare Mental Health Access Act S. 1169 Medicaid Coverage for Addiction Recovery Expansion Act S. 1732 To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes H.R. 2509 Medicare Mental Health Inpatient Inequity Act H.R. 3331 To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

H.R. 1173: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. S. 448: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. H.R. 2509: Medicare Mental Health Inpatient Equity Act of 2017. Legislation To amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program. S.1169: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes. H.R. 1953: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. S. 830: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. H.R. 3331: To amend title XI of the Social Security Act to promote testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology. S. 1732: Improving Access to Behavioral Health Information Technology Act H.R. 2337: To amend title XIX of the Social Security Act to provide for a State Medicaid option to enhance administrative matching funds to support statewide behavioral health access program activities for children under 21 years of age, and for other purposes.

Support H.R. 741/ S. 243 Rural Hospital Regulatory Relief Act of 2017, a bill that amends title XVIII (Medicare) of the Social Security Act to permanently extend the application by the Centers for Medicare & Medicaid Services of an instruction against the enforcement of certain physician supervision requirements with respect to outpatient therapeutic services in critical access hospitals and small rural hospitals; Support H.R. 807/ S. 253 Medicare Access to Rehabilitation Services Act of 2017, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; Discussion about the Electronic Clinical Quality Measure Reporting: advocating for an extension of the reporting deadline to increase hospitals ability to meet requirements in the Hospital Inpatient Quality Reporting program and the Medicare EHR Incentive Program;Requested clarification from CMS about providing care to justice-involved individuals and receiving Medicaid/Medicare reimbursement for such care to Made efforts in support of clarifying that hospitals may have designated units to care for patients in the custody of law enforcement/correctional institutions and may receive Medicaid reimbursement for care provided in such units; Support S. 872/ HR 1955Rural Hospital Access Act of 2017A bill to amend title XVIII of the Social Security Act to make permanent the extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Submit StatementMedicare Advantage Hearing on Promoting Integrated and Coordinated Care for Medicare Beneficiaries the importance of promoting integrated and coordinated care for Medicare eneficiaries served through the Medicare Advantage (MA) program; Support S 1301/ HR 2267, Resident Physician Shortage Reduction Act of 2017, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose H.R. 1628/ S. xxx,American Health Care Act / Better Care Reconciliation Act, a bill that would repeal and replace much of the Affordable Care Act, including repealing Medicaid expansion and the advanced premium tax credits for the purchase of coverage on the Health Insurance Marketplaces; Support S 1334/ HR 2797Patient Choices and Quality Care Act of 2017, a bill to provide for advanced illness care coordination services for Medicare beneficiaries; Urges the Administration to cancel Stage 3 of meaningful use by removing the 2018 start date from the regulation. The Administration also should institute a 90- day reporting period in every future year of the program, and gather input from stakeholders on ways to further reduce the burden of the meaningful use program from current requirements; Review S. 1169/ HR 2687, Medicaid Coverage for Addiction Recovery Expansion Act, a bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities; Review HR 2509 Medicare Mental Health Inpatient Equity Act, a bill to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program; CMS should rescind the 25% Rule and instead rely on the site-neutral payment policy to bring transformative change to the LTCH field; Discussion with CMS about direct supervision of outpatient therapeutic services.

S. 448/H.R. 1173 Medicare Mental Health Access Act S. 1169 Medicaid Coverage for Addiction Recovery Expansion Act H.R. 2509 Medicare Mental Health Inpatient Inequity Act

Client expense: $220,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

H.R. 1173: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. S. 448: Medicare Mental Health Access Act. Legislation to amend Medicares Physician Definition, to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program. H.R. 2509: Medicare Mental Health Inpatient Equity Act of 2017. Legislation To amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program. S.1169: Medicaid Coverage for Addiction Recovery Expansion Act. A bill to amend title XIX of the Social Security Act to provide States with an option to provide medical assistance to individuals between the ages of 22 and 64 for inpatient services to treat substance use disorders at certain facilities, and for other purposes. H.R. 1953: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. S. 830: Treat and Reduce Obesity Act of 2017. To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes.

Client expense: $140,000 · Firm income: Not reported