To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication.

Monitor legislative and federal activity related to tax reform. Monitor legislative and federal activity related to Treasury Regulations proposed under section 385 of the Internal Revenue Code. Monitor legislative and administrative action related to implementation of H.R. 1, Tax Cuts and Jobs Act. S. 85, Restoring Access to Medication Act of 2017. S. 108, Medical Device Access and Innovation Protection Act. H.R. 184, Protect Medical Innovation Act of 2017. H.R. 394, Restoring Access to Medication Act of 2017. H.R. 1268, Veterinary Medicine Loan Repayment Program Enhancement Act. H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication.

Client expense: $1,320,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Natl Security Council (NSC), SENATE, Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

Issues related to the eligibility of over the counter drugs to be purchased using HSA and FSA accounts, including H.R.394 and S.85, both entitled Restoring Access to Medication Act of 2017, H. R. 4618, and H. R. 6199.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6, Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act H.R. 35, Health Savings Act of 2017 H.R. 143, Health Insurance Industry Antitrust Enforcement Act of 2017 H.R. 173/S. 40/S. 58, Middle Class Health Benefits Tax Repeal Act of 2017 H.R. 184, Protect Medical Innovation Act of 2017 H.R. 195, Making further continuing appropriations for the fiscal year ending September 30, 2018, and for other purposes H.R. 246, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 394/S. 85, Restoring Access to Medication Act of 2017 H.R. 620, ADA Education and Reform Act of 2017 H.R. 849/S. 260, Protecting Seniors Access to Medicare Act H.R. 1101, Small Business Health Fairness Act of 2017 H.R. 1175/S. 403, Health Savings Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 1313, Preserving Employee Wellness Programs Act H.R. 1625, Consolidated Appropriations Act, 2018 H.R. 1892, Bipartisan Budget Act of 2018 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. 3798, Save American Workers Act of 2017 H.R. 4284, Indexing Narcotics, Fentanyl, and Opioids (INFO) Act of 2018 H.R. 4616, To amend the Patient Protection and Affordable Care Act to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on the medical device excise tax H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619, To amend the Patient Protection and Affordable Care Act to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620, Protecting Families and Small Businesses Act of 2017 H.R. 4978/S. 2410, Chronic Disease Management Act of 2018 H.R. 5009, Jessies Law H.R. 5041, Safe Disposal of Unused Medication Act H.R. 5138, Bipartisan HSA Improvement Act of 2018 H.R. 5272, To provide additional guidance to grantees seeking funding to treat or prevent mental health or substance use disorders H.R. 5582, Abuse Deterrent Access Act of 2018 H.R. 5788, Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018 H.R. 5892, To establish an Advisory Committee on Opioids and the Workplace to advise the Secretary of Labor on actions the Department of Labor can take to address the impact of opioid abuse on the workplace H.R. 6199, Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018 H.R. 6311, Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018 S. 108, Medical Device Access and Innovation Protection Act S. 191, Patient Freedom Act of 2017 S. 222, Obamacare Replacement Act S. 251, Protecting Medicare from Executive Action Act of 2017 S. 974, Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act of 2017 S. 1835, Lower Premiums Through Reinsurance Act of 2017 S. 1850, Protecting Jessica Grubb's Legacy Act S. 1859, Healthcare Tax Relief Act S. 1978, Small Business and Family Health Tax Relief Act of 2017 S. 2004, Combating the Opioid Epidemic Act S. 2164, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings S. 3057, Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018 Draft legislation to stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility (Alexander-Murray) Proposed regulation on health reimbursement arrangements and other account-based group health plans (83 Fed. Reg. 54,420-54,477, October 29, 2018) Final Regulation, definition of employer under Section 3(5) of ERISA - association health plans (83 Fed. Reg. 28912-28964, June 21, 2018) Various issues relating to Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including the employer-sponsored health care system, implementation of regulatory process, provider network adequacy, delivery system reform, health savings account (HSAs), health reimbursement account (HRAs), and flexible spending account (FSAs) changes, IPAB, employer mandate, reporting requirements for issuers and applicable large employers, premium stabilization programs, medical loss ratio, medical malpractice reform, exchanges, the impact on small business, the Small Business Tax Credit, section 1332 waivers, section 1557 on nondiscrimination, caps on compensation deductibility required under section 9014, incompleteness or inaccuracy of cost impact analysis, lack of quantified benefit analysis, and need for empirical data sources on which to base costs and benefits, the Cost Sharing Reduction (CSR) program, the section 9010 Health Insurance Providers Fee or Health Insurance Tax (HIT), 40% excise tax on high-cost employer-sponsored health coverage (Cadillac tax); medical device tax; protect Medicare Part D's Non-Interference Clause from repeal Public Health Services Act (P.L.78-410), Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) (P.L. 93-406), regarding regulatory process and legislative corrections to ERISA preemption, changes to Medicare Advantage and Parts B, C, and D, including rebates and non-interference with prescription drug prices, entitlement reform, health information technology, telemedicine services in Medicare, and coordination and disease management programs; House Republican Taskforce on Health Care report; A Better Way to Fix Health Care; association health plans; importation of foreign pharmaceuticals into the United States and preemptive authority of federal food and drug regulations; Executive Order 13813, Promoting Healthcare Choice and Competition; addressing the opioids crisis, including end-stage renal disease; balance or surprise billing; single-payer health care options; aligning 42 CFR Part 2 with the Health Insurance Portability and Accountability Act (P.L. 104-191) for the purposes of treatment, payment, and health car operation (TPO); inclusion of prescription drug pricing on 2019 congressional agenda; general advocacy for Congress to reach a working quorum for the board of the Export-Import Bank; section 301 of the Trade Act of 1974; U.N. Convention on the Assignment of Receivables in Int'l Trade

Flexible spending arrangements (FSA) and health savings accounts (HSA) Graham-Cassidy Bill, no bill number. Graham-Cassidy contained a provision (section 108) to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescriptions prior to using an FSA or HSA to purchase OTC medicine. Better Care Reconciliation Act (H.R. 1628). BCRA contained a provision(section 209)to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescription prior to using an FSA or HSA to purchase OTC Medicines. American Healthcare Act (AHCA), no bill number. AHCA contained a provision(section 208)to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescription prior to using an FSA or HSA to purchase OTC Medicines. H.R. 394/S. 85 - Restoring Access to Medication Act of 2017. Repeals prohibition in Patient Protection and Affordable Care Act (P.L. 111-148, P.L. 111-152) against use of flexible spending arrangement (FSA) and health savings account (HSA) funds on over-the-counter (OTC) medications; all sections. H.R. 1175/S.403 - Health Savings Act of 2017 - Codifies OTC medications as qualified medical expenses; Section 301 H.R.4618 - To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication. Temporarily repeals prohibition in Patient Protection and Affordable Care Act (P.L. 111-148, P.L. 111-152) against use of flexible spending arrangement (FSA) and health savings account (HSA) funds on over-the-counter (OTC) medications. H.R.1625 - Consolidated Appropriations Act, 2018. Omnibus appropriations package. H.R. 6199 -- To amend the Internal Revenue Code of 1986 to include certain over-the-counter medical products as qualified medical expenses. Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, health flexible spending arrangements, and health reimbursement arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). The bill also allows the accounts to be used for menstrual care products.

Issues related to Short-Term, Limited-Duration Insurance Proposed Rule H.J. Res. 125 Continuing Appropriations Act H.R. 2212/S. 974 Creating and Restoring Equal Access to Equivalent Samples(CREATES) Act H.R. 4618 To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R.4894 Harmful Tax Prevention Act Issues related to Medicare Part D Issues related to Drug Pricing Issues related to Short: Term, Limited: Duration Insurance Proposed Rule

Client expense: $80,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of

S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax S. 2410, Chronic Disease Management Act (Thune) - flexibility for high-deductible health plans S. 3063, Health Insurance Tax Relief Act (Barrasso) - suspension of ACA health insurance tax H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 3798, Save American Workers Act (Walorski) - delay in Cadillac tax H.R. 4616 (Nunes) - delay in ACA excise tax on employer-provided health coverage H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4620, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax H.R. 4894, Harmful Tax Prevention Act (Noem) - relief from ACA health insurance tax H.R. 4978, Chronic Disease Management Act (Black) - flexibility for high-deductible health plans H.R. 5138, Bipartisan HSA Improvement Act (Kelly) - HSA changes H.R. 5963, Health Insurance Premium Reduction Act (Noem) - suspension of ACA health insurance tax H.R. 6199, Restoring Access to Medication Act (Jenkins) - OTC medical products as qualified medical expense, HSA improvements H.R. 6301, Promoting High-Value Health Care Through Flexibility for High Deductible Health Plans Act (Roskam) - flexibility on first dollar coverage for HSA plans H.R. 6305, Bipartisan HSA Improvement Act (Kelly) - HSA flexibility; treatment of certain employment-related services; FSA and HRA conversions H.R. 6306, Health Care Security Act (Paulsen) - HSA contribution limits, spousal catch-up contributions, grace period for medical expenses H.R. 6309, Allowing Working Seniors to Keep Their Health Savings Accounts Act (Paulsen) - HSA contributions by Medicare-eligible individuals H.R. 6311, Increasing Access to Lower Premium Plans and Expanding HSAs Act (Roskam) - suspension of health insurance tax, HSA improvements H.R. 6312, Personal Health Investment Today Act (Smith) - medical care tax deduction for qualified sports and fitness expenses H.R. 6313, RAISE Health Benefits Act (Stivers) - Health FSA rollovers H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan H.R. 6317, Primary Care Enhancement Act (Paulsen) - participation by HSA-eligible individuals in direct primary care (DPC) arrangements Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to enhancing tax treatment of long-term care insurance; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.

S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax S. 2410, Chronic Disease Management Act (Thune) - flexibility for high-deductible health plans S. 3063, Health Insurance Tax Relief Act (Barrasso) - suspension of ACA health insurance tax H.R. 195, Extension of Continuing Appropriations Act - one-year suspension of ACA health insurance tax, two-year delay in ACA excise tax on employer-sponsored health plans H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 4616 (Nunes) - delay in ACA excise tax on employer-provided health coverage H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4620, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax H.R. 4894, Harmful Tax Prevention Act (Noem) - relief from ACA health insurance tax H.R. 4978, Chronic Disease Management Act (Black) - flexibility for high-deductible health plans H.R. 5138, Bipartisan HSA Improvement Act (Kelly) - HSA changes H.R. 5963, Health Insurance Premium Reduction Act (Noem) - suspension of ACA health insurance tax H.R. 6199, Restoring Access to Medication Act (Jenkins) -- OTC medical products as qualified medical expense H.R. 6301, Promoting High-Value Health Care Through Flexibility for High Deductible Health Plans Act (Roskam) - flexibility on first dollar coverage for HSA plans H.R. 6305, Bipartisan HSA Improvement Act (Kelly) - HSA flexibility H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.

H.R. 6, Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act H.R. 35, Health Savings Act of 2017 H.R. 143, Health Insurance Industry Antitrust Enforcement Act of 2017 H.R. 173/S. 40/S. 58, Middle Class Health Benefits Tax Repeal Act of 2017 H.R. 184, Protect Medical Innovation Act of 2017 H.R. 195, Making further continuing appropriations for the fiscal year ending September 30, 2018, and for other purposes H.R. 246, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 394/S. 85, Restoring Access to Medication Act of 2017 H.R. 620, ADA Education and Reform Act of 2017 H.R. 849/S. 260, Protecting Seniors Access to Medicare Act H.R. 1101, Small Business Health Fairness Act of 2017 H.R. 1175/S. 403, Health Savings Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 1313, Preserving Employee Wellness Programs Act H.R. 1625, Consolidated Appropriations Act, 2018 H.R. 1892, Bipartisan Budget Act of 2018 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. 3798, Save American Workers Act of 2017 H.R. 4284, Indexing Narcotics, Fentanyl, and Opioids (INFO) Act of 2018 H.R. 4616, To amend the Patient Protection and Affordable Care Act to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on the medical device excise tax H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619, To amend the Patient Protection and Affordable Care Act to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620, Protecting Families and Small Businesses Act of 2017 H.R. 4978/S. 2410, Chronic Disease Management Act of 2018 H.R. 5009, Jessies Law H.R. 5041, Safe Disposal of Unused Medication Act H.R. 5138, Bipartisan HSA Improvement Act of 2018 H.R. 5272, To provide additional guidance to grantees seeking funding to treat or prevent mental health or substance use disorders H.R. 5582, Abuse Deterrent Access Act of 2018 H.R. 5788, Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018 H.R. 5892, To establish an Advisory Committee on Opioids and the Workplace to advise the Secretary of Labor on actions the Department of Labor can take to address the impact of opioid abuse on the workplace H.R. 6199, Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018 H.R. 6311, Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018 S. 108, Medical Device Access and Innovation Protection Act S. 191, Patient Freedom Act of 2017 S. 222, Obamacare Replacement Act S. 251, Protecting Medicare from Executive Action Act of 2017 S. 974, Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act of 2017 S. 1835, Lower Premiums Through Reinsurance Act of 2017 S. 1850, Protecting Jessica Grubb's Legacy Act S. 1859, Healthcare Tax Relief Act S. 1978, Small Business and Family Health Tax Relief Act of 2017 S. 2004, Combating the Opioid Epidemic Act S. 2164, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings S. 3057, Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018 Draft legislation to stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility (Alexander-Murray) Proposed regulations on definition of employer under section 3(5) of ERISA-association health plans (83 Fed. Reg. 614-636, January 5, 2018) Various issues relating to Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including the employer-sponsored health care system, implementation of regulatory process, provider network adequacy, delivery system reform, health savings account (HSAs), health reimbursement account (HRAs), and flexible spending account (FSAs) changes, IPAB, employer mandate, reporting requirements for issuers and applicable large employers, premium stabilization programs, medical loss ratio, medical malpractice reform, exchanges, the impact on small business, the Small Business Tax Credit, section 1332 waivers, section 1557 on nondiscrimination, caps on compensation deductibility required under section 9014, incompleteness or inaccuracy of cost impact analysis, lack of quantified benefit analysis, and need for empirical data sources on which to base costs and benefits, the Cost Sharing Reduction (CSR) program, the section 9010 Health Insurance Providers Fee or Health Insurance Tax (HIT), 40% excise tax on high-cost employer-sponsored health coverage (Cadillac tax); Public Health Services Act (P.L.78-410), Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) (P.L. 93-406), regarding regulatory process and legislative corrections to ERISA preemption, changes to Medicare Advantage and Parts B, C, and D, including rebates and non-interference with prescription drug prices, entitlement reform, health information technology, telemedicine services in Medicare, and coordination and disease management programs; House Republican Taskforce on Health Care report, A Better Way to Fix Health Care; association health plans; importation of foreign pharmaceuticals into the United States and preemptive authority of federal food and drug regulations; Executive Order 13813, Promoting Healthcare Choice and Competition; addressing the opioids crisis, including end-stage renal disease; balance or surprise billing; single-payer health care options

Monitor legislative and federal activity related to tax reform. Monitor legislative and federal activity related to Treasury Regulations proposed under section 385 of the Internal Revenue Code. Monitor legislative and administrative action related to implementation of H.R. 1, Tax Cuts and Jobs Act. S. 85, Restoring Access to Medication Act of 2017. S. 108, Medical Device Access and Innovation Protection Act. H.R. 184, Protect Medical Innovation Act of 2017. H.R. 394, Restoring Access to Medication Act of 2017. H.R. 1268, Veterinary Medicine Loan Repayment Program Enhancement Act. H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication.

Client expense: $1,700,000 · Firm income: Not reported

Monitor legislative and federal activity related to tax reform. Monitor legislative and federal activity related to Treasury Regulations proposed under section 385 of the Internal Revenue Code. Monitor legislative and administrative action related to implementation of H.R. 1, Tax Cuts and Jobs Act. S. 85, Restoring Access to Medication Act of 2017. S. 108, Medical Device Access and Innovation Protection Act. H.R. 184, Protect Medical Innovation Act of 2017. H.R. 394, Restoring Access to Medication Act of 2017. H.R. 1268, Veterinary Medicine Loan Repayment Program Enhancement Act. H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication.

Client expense: $1,600,000 · Firm income: Not reported

Issues related to the eligibility of over the counter drugs to be purchased using HSA and FSA accounts, including H.R.394 and S.85, both entitled Restoring Access to Medication Act of 2017, H. R. 4618, and H. R. 6199.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Flexible spending arrangements (FSA) and health savings accounts (HSA) Graham-Cassidy Bill, no bill number. Graham-Cassidy contained a provision (section 108) to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescriptions prior to using an FSA or HSA to purchase OTC medicine. Better Care Reconciliation Act (H.R. 1628). BCRA contained a provision(section 209)to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescription prior to using an FSA or HSA to purchase OTC Medicines. American Healthcare Act (AHCA), no bill number. AHCA contained a provision(section 208)to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescription prior to using an FSA or HSA to purchase OTC Medicines. H.R. 394/S. 85 - Restoring Access to Medication Act of 2017. Repeals prohibition in Patient Protection and Affordable Care Act (P.L. 111-148, P.L. 111-152) against use of flexible spending arrangement (FSA) and health savings account (HSA) funds on over-the-counter (OTC) medications; all sections. H.R. 1175/S.403 - Health Savings Act of 2017 - Codifies OTC medications as qualified medical expenses; Section 301 H.R.4618 - To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication. Temporarily repeals prohibition in Patient Protection and Affordable Care Act (P.L. 111-148, P.L. 111-152) against use of flexible spending arrangement (FSA) and health savings account (HSA) funds on over-the-counter (OTC) medications. H.R.1625 - Consolidated Appropriations Act, 2018. Omnibus appropriations package. H.R. 6199 -- To amend the Internal Revenue Code of 1986 to include certain over-the-counter medical products as qualified medical expenses. Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, health flexible spending arrangements, and health reimbursement arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). The bill also allows the accounts to be used for menstrual care products.

H. Res. 142/S. Res. 63 National Obesity Care Week Resolution S. Res. 325 National Obesity Care Week Resolution S. J. Res. 16 a joint resolution approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the independent payment Medicare advisory board H.J. Res 51/S. J. Res 17 Independent Payment Advisory Board Repeal H.R 1995 Value Based Insurance Design for Better Care Act H.R. 1004 Regulatory Integrity Act H.R. 1009/S. 676 OIRA Insight, Reform, and Accountability Act H.R. 1038/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 H.R. 1121 Pre-Existing Conditions Protection Act H.R. 1148/S. 431 Furthering Access to Stroke Telemedicine (FAST) Act H.R. 1215 Protecting Access to Care Act H.R. 1267/S. 482 Personal Health Investment Today Act H.R. 1304 Self-Insurance Protection Act H.R. 1313 Preserving Employee Wellness Programs Act H.R. 1554 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. 184 Protect Medical Innovation Act H.R. 1953/S. 830 Treat and Reduce Obesity Act H.R. 2267/S. 1301 Resident Physician Shortage Reduction Act H.R. 246/S. 183 Jobs and Premium Protection Act H.R. 2550 Medicare Telehealth Parity Act H.R. 2556/S. 1016 CONNECT for Health Act H.R. 2797/S. 1334 Patient Choice and Quality Care Act H.R. 2824 Increasing Opportunity and Success for Children and Parents Through Evidence-Based Home Visiting Act H.R. 284 Advancing Medical Resident Training in Community Hospitals Act H.R. 2953/S. 2164 Preventive Health Savings Act H.R. 3044 to expand supplemental benefits to meet the needs of chronically ill Medicare Advantage enrollees H.R. 3059/S. 1441 Community Health Center and Primary Care Workforce Expansion Act H.R. 3120 to reduce the volume of future electronic health record-related significant hardship requests H.R. 3124/S. 1299 Preventing Diabetes in Medicare Act H.R. 3168 to provide continued access to Medicare Advantage plans for special needs H.R. 3224 Critical Access and Rural Equity Act H.R. 3245 Medicare Civil and Criminal Penalties Act H.R. 3263 to extend the Medicare independence at home medical demonstration program H.R. 3358/S. 1771 Fiscal Year 2018 Labor-Health and Human Services-Education Appropriations Bill H.R. 3394 Teaching Health Centers Graduate Medical Education Extension Act H.R. 3447 Furthering Access to Coordinated Treatment for Seniors Act H.R. 3545 Overdoes Prevention and Patient Safety Act H.R. 3726 Stark Administrative Simplification Act of 2017 H.R. 3728 Empowering Medical Professionals and Optimizing Workforce Efficiency and Readiness Act H.R. 3820/S. 977 Medicare Home Health Flexibility Act H.R. 3862 National Health Service Corps Strengthening Act H.R. 3921 Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 3922 Continuing Community Health and Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 4541 Continuing Community Health and Medical Professional Programs to Improve Our Nation and Keep Insurance Delivery Stable H.R. 4613 Ensuring Patient Access to Healthcare Records Act H.R. 4616 to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617 to provide for a temporary moratorium on the medical device excise tax H.R. 4618 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619 to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620 Protecting Families and Small Businesses Act H.R. 4006 Community-Based Independence for Seniors Act of 2017 H.R. 4200/S. 2052 Healthcare Market Certainty and Mandate Relief Act H.R. 4520 to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2017 H.R. 4552/S. 1291 Advancing Medical Training in Community Hospitals Act H.R. 4105 to extend the health professions workforce demonstration project H.R. 592/S. 109 Pharmacy and Medically Underserved Areas Enhancement Act H.R. 706 Plan Verification and Fairness Act H.R. 741/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. 849/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.3545 Overdose Prevention and Patient Safety Act H.R.3727 To amend title XVIII of the Social Security Act to include additional telehealth services for purposes of MA organization bids, and for other purposes H.R. 4206/S. 2051 Medicare Care Coordination Improvement Act Introduction of the Healthcare Cybersecurity Improvement Act Introduction of the Stark Law Modernization Act of 2017 Pub L. 114-198 Comprehensive Addiction and Recovery Act Pub L. 115-31 Fiscal Year 2017 Consolidated Appropriations Act Pub L. 115-80 National Clinical Care Commission Act Pub. L. 102-143 Telephone Consumer Protection Act Pub. L. 111-148 Patient Protection and Affordable Care Act (PPACA) Pub. L. 111-5 The American Recovery and Reinvestment Act Pub. L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) 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 Pub L. 115-63 Disaster Relief and Airway Extension Act Pub. L. 115-96 2018 Continuing Resolution Pub. L. 115-97 Tax Cuts and Jobs Act Reintroduction of TELE-MED Act of 2015 S. 108 Medical Device Access and Innovation Protection Act S. 297 Increasing Competition in Pharmaceuticals Act S. 1754 Training the Next Generation of Primary Care Doctors Act S. 1827 Keep Kids' Insurance Dependable and Secure Act S. 1829 Strong Families Act S. 1850 Protecting Jessica Grubbs Legacy Act (The Legacy Act) S. 1859 Healthcare Tax Relief Act S. 1899 to reauthorize and extend funding for community health centers and the National Health Service Corps S. 1967 Mandate Relief Act S. 191 Patient Freedom Act S. 251 Protecting Medicare from Executive Action Act S. 309 Community Based Independence for Seniors Act S. 464 Independence at Home Act H .R. 1933/S. 761 Health Care Options Act of 2017 S. 787 Telehealth Innovation and Improvement Act S. 870 Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act S. 1978 Small Business and Family Health Tax Relief Act S. Con. Res. 3 Budget Resolution

Monitor legislative and federal activity related to tax reform. Monitor legislative and federal activity related to Treasury Regulations proposed under section 385 of the Internal Revenue Code. Monitor legislative and administrative action related to implementation of H.R. 1, Tax Cuts and Jobs Act. S. 85, Restoring Access to Medication Act of 2017. S. 108, Medical Device Access and Innovation Protection Act. H.R. 184, Protect Medical Innovation Act of 2017. H.R. 394, Restoring Access to Medication Act of 2017. H.R. 1268, Veterinary Medicine Loan Repayment Program Enhancement Act. H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication.

Client expense: $1,670,000 · Firm income: Not reported

Monitor legislative and federal activity related to tax reform. Monitor legislative and federal activity related to Treasury Regulations proposed under section 385 of the Internal Revenue Code. Monitor legislative and administrative action related to implementation of H.R. 1, Tax Cuts and Jobs Act. S. 85, Restoring Access to Medication Act of 2017. S. 108, Medical Device Access and Innovation Protection Act. H.R. 184, Protect Medical Innovation Act of 2017. H.R. 394, Restoring Access to Medication Act of 2017. H.R. 1268, Veterinary Medicine Loan Repayment Program Enhancement Act. H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication.

Client expense: $3,420,000 · Firm income: Not reported

Issues related to federal income taxes Issues related to the definition of cost in the computation of the federal Capital Gains Tax Issues related to remote sales taxes H. R. 2193 Remote Transactions Parity Act H.J. Res. 125 Continuing Appropriations Act H.R. 1625 Consolidated Appropriations Act H.R. 3500 Ensuring Integrity Within the IRS Workforce Act H.R. 4618 To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4916 Preventing IRS Abuse and Protecting Free Speech Act H.R. 5012 Creating Real and Useful Middle-Class Benefits and Savings Act H.R.4894 Harmful Tax Prevention Act HR 2887 No Regulation without Representation S.976 Marketplace Fairness Act H.R. 4886 Permanent Tax Cuts for Americans Act H.R. 4916: Preventing IRS Abuse and Protecting Free Speech Act S. 2689: The Small Business Taxpayer Bill of Rights Act H.R. 5444: the Taxpayer First Act H.R.5514: Tax Fairness Act S.2687: To amend the Internal Revenue Code of 1986 to make permanent the individual tax provisions of the tax reform law, and for other purposes. S.2688: The Capital Gains Inflation Relief Act Issues related to indexing capital gains taxes to inflation H.Con.Res.119: Expressing the sense of Congress that a carbon tax would be detrimental to the United States economy

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

Issues related to Short-Term, Limited-Duration Insurance Proposed Rule H.J. Res. 125 Continuing Appropriations Act H.R. 2212/S. 974 Creating and Restoring Equal Access to Equivalent Samples(CREATES) Act H.R. 4618 To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R.4894 Harmful Tax Prevention Act Issues related to Medicare Part D Issues related to Drug Pricing Issues related to Short: Term, Limited: Duration Insurance Proposed Rule

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of

H.R. 6, Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act H.R. 35, Health Savings Act of 2017 H.R. 143, Health Insurance Industry Antitrust Enforcement Act of 2017 H.R. 173/S. 40/S. 58, Middle Class Health Benefits Tax Repeal Act of 2017 H.R. 184, Protect Medical Innovation Act of 2017 H.R. 195, Making further continuing appropriations for the fiscal year ending September 30, 2018, and for other purposes H.R. 246, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 394/S. 85, Restoring Access to Medication Act of 2017 H.R. 849/S. 260, Protecting Seniors Access to Medicare Act H.R. 1101, Small Business Health Fairness Act of 2017 H.R. 1175/S. 403, Health Savings Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 1313, Preserving Employee Wellness Programs Act H.R. 1625, Consolidated Appropriations Act, 2018 H.R. 1628, American Health Care Act of 2017 H.R. 1892, Bipartisan Budget Act of 2018 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. 4284, Indexing Narcotics, Fentanyl, and Opioids (INFO) Act of 2018 H.R. 4616, To amend the Patient Protection and Affordable Care Act to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on the medical device excise tax H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619, To amend the Patient Protection and Affordable Care Act to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620, Protecting Families and Small Businesses Act of 2017 H.R. 4978/S. 2410, Chronic Disease Management Act of 2018 H.R. 5009, Jessies Law H.R. 5041, Safe Disposal of Unused Medication Act H.R. 5138, Bipartisan HSA Improvement Act of 2018 H.R. 5272, To provide additional guidance to grantees seeking funding to treat or prevent mental health or substance use disorders H.R. 5582, Abuse Deterrent Access Act of 2018 H.R. 5788, Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018 S. 108, Medical Device Access and Innovation Protection Act S. 191, Patient Freedom Act of 2017 S. 222, Obamacare Replacement Act S. 251, Protecting Medicare from Executive Action Act of 2017 S. 974, Creating and Restoring Equal Access To Equivalent Samples (CREATES) Act of 2017 S. 1835, Lower Premiums Through Reinsurance Act of 2017 S. 1850, Protecting Jessica Grubb's Legacy Act S. 1859, Healthcare Tax Relief Act S. 1978, Small Business and Family Health Tax Relief Act of 2017 S. 2164, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings Draft legislation titled To stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility (Alexander-Murray) Proposed regulations on definition of employer under section 3(5) of ERISA-association health plans (83 Fed. Reg. 614-636, January 5, 2018) Various issues relating to Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including the employer-sponsored health care system, implementation of regulatory process, provider network adequacy, delivery system reform, health savings account (HSAs), health reimbursement account (HRAs), and flexible spending account (FSAs) changes, IPAB, employer mandate, reporting requirements for issuers and applicable large employers, premium stabilization programs, medical loss ratio, medical malpractice reform, exchanges, the impact on small business, the Small Business Tax Credit, section 1332 waivers, section 1557 on nondiscrimination, caps on compensation deductibility required under section 9014, incompleteness or inaccuracy of cost impact analysis, lack of quantified benefit analysis, and need for empirical data sources on which to base costs and benefits, the Cost Sharing Reduction (CSR) program, the section 9010 Health Insurance Providers Fee or Health Insurance Tax (HIT), 40% excise tax on high-cost employer-sponsored health coverage (Cadillac tax); Public Health Services Act (P.L.78-410), Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) (P.L. 93-406), regarding regulatory process and legislative corrections to ERISA preemption, changes to Medicare Advantage and Parts B, C, and D, including rebates and non-interference with prescription drug prices, entitlement reform, health information technology, telemedicine services in Medicare, and coordination and disease management programs; House Republican Taskforce on Health Care report, A Better Way to Fix Health Care; association health plans; importation of foreign pharmaceuticals into the United States and preemptive authority of federal food and drug regulations; Executive Order 13813, Promoting Healthcare Choice and Competition; addressing the opioid crisis

S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax S. 2410, Chronic Disease Management Act (Thune) - flexibility for high-deductible health plans S. 3063, Health Insurance Tax Relief Act (Barrasso) - suspension of ACA health insurance tax H.R. 195, Extension of Continuing Appropriations Act - one-year suspension of ACA health insurance tax, two-year delay in ACA excise tax on employer-sponsored health plans H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 4616 (Nunes) - delay in ACA excise tax on employer-provided health coverage H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4620, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax H.R. 4894, Harmful Tax Prevention Act (Noem) - relief from ACA health insurance tax H.R. 4978, Chronic Disease Management Act (Black) - flexibility for high-deductible health plans H.R. 5138, Bipartisan HSA Improvement Act (Kelly) - HSA changes H.R. 5963, Health Insurance Premium Reduction Act (Noem) - suspension of ACA health insurance tax H.R. 6199, Restoring Access to Medication Act (Jenkins) -- OTC medical products as qualified medical expense H.R. 6301, Promoting High-Value Health Care Through Flexibility for High Deductible Health Plans Act (Roskam) - flexibility on first dollar coverage for HSA plans H.R. 6305, Bipartisan HSA Improvement Act (Kelly) - HSA flexibility H.R. 6314, Health Savings Act (Burgess) - definition of high-deductible health plan Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.

Flexible spending arrangements (FSA) and health savings accounts (HSA) Graham-Cassidy Bill, no bill number. Graham-Cassidy contained a provision (section 108) to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescriptions prior to using an FSA or HSA to purchase OTC medicine. Better Care Reconciliation Act (H.R. 1628). BCRA contained a provision(section 209)to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescription prior to using an FSA or HSA to purchase OTC Medicines. American Healthcare Act (AHCA), no bill number. AHCA contained a provision(section 208)to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescription prior to using an FSA or HSA to purchase OTC Medicines. H.R. 394/S. 85 - Restoring Access to Medication Act of 2017. Repeals prohibition in Patient Protection and Affordable Care Act (P.L. 111-148, P.L. 111-152) against use of flexible spending arrangement (FSA) and health savings account (HSA) funds on over-the-counter (OTC) medications; all sections. H.R. 1175/S.403 - Health Savings Act of 2017 - Codifies OTC medications as qualified medical expenses; Section 301 H.R.4618 - To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication. Temporarily repeals prohibition in Patient Protection and Affordable Care Act (P.L. 111-148, P.L. 111-152) against use of flexible spending arrangement (FSA) and health savings account (HSA) funds on over-the-counter (OTC) medications. H.R.1625 - Consolidated Appropriations Act, 2018. Omnibus appropriations package. H.R. 6199 -- To amend the Internal Revenue Code of 1986 to include certain over-the-counter medical products as qualified medical expenses. Repeals provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, health flexible spending arrangements, and health reimbursement arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs). The bill also allows the accounts to be used for menstrual care products.

Issues related to the eligibility of over the counter drugs to be purchased using HSA and FSA accounts, including H.R.394 and S.85, both entitled Restoring Access to Medication Act of 2017, H. R. 4618, and H. R. 6199.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to federal income taxes Issues related to the definition of cost in the computation of the federal Capital Gains Tax Issues related to remote sales taxes H. R. 2193 Remote Transactions Parity Act H.J. Res. 125 Continuing Appropriations Act H.R. 1625 Consolidated Appropriations Act H.R. 3500 Ensuring Integrity Within the IRS Workforce Act H.R. 4618 To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4916 Preventing IRS Abuse and Protecting Free Speech Act H.R. 5012 Creating Real and Useful Middle-Class Benefits and Savings Act H.R.4894 Harmful Tax Prevention Act HR 2887 No Regulation without Representation S.976 Marketplace Fairness Act H.R. 4886 Permanent Tax Cuts for Americans Act

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of

Issues related to Short-Term, Limited-Duration Insurance Proposed Rule H.J. Res. 125 Continuing Appropriations Act H.R. 2212/S. 974 Creating and Restoring Equal Access to Equivalent Samples(CREATES) Act H.R. 4618 To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R.4894 Harmful Tax Prevention Act

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of

Monitor legislative and federal activity related to tax reform. Monitor legislative and federal activity related to Treasury Regulations proposed under section 385 of the Internal Revenue Code. Monitor legislative and administrative action related to implementation of H.R. 1, Tax Cuts and Jobs Act. S. 85, Restoring Access to Medication Act of 2017. S. 108, Medical Device Access and Innovation Protection Act. H.R. 184, Protect Medical Innovation Act of 2017. H.R. 394, Restoring Access to Medication Act of 2017. H.R. 1268, Veterinary Medicine Loan Repayment Program Enhancement Act. H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication.

Client expense: $3,450,000 · Firm income: Not reported

H.R. 35, Health Savings Act of 2017 H.R. 143, Health Insurance Industry Antitrust Enforcement Act of 2017 H.R. 173/S. 40/S. 58, Middle Class Health Benefits Tax Repeal Act of 2017 H.R. 184, Protect Medical Innovation Act of 2017 H.R. 195, Making further continuing appropriations for the fiscal year ending September 30, 2018, and for other purposes H.R. 246, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 394/S. 85, Restoring Access to Medication Act of 2017 H.R. 849/S. 260, Protecting Seniors Access to Medicare Act H.R. 1101, Small Business Health Fairness Act of 2017 H.R. 1175/S. 403, Health Savings Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 1313, Preserving Employee Wellness Programs Act H.R. 1625, Consolidated Appropriations Act, 2018 H.R. 1628, American Health Care Act of 2017 H.R. 1892, Bipartisan Budget Act of 2018 H.R. 4616, To amend the Patient Protection and Affordable Care Act to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on the medical device excise tax H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619, To amend the Patient Protection and Affordable Care Act to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620, Protecting Families and Small Businesses Act of 2017 H.R. 4978/S. 2410, Chronic Disease Management Act of 2018 H.R. 5138, Bipartisan HSA Improvement Act of 2018 S. 108, Medical Device Access and Innovation Protection Act S. 191, Patient Freedom Act of 2017 S. 222, Obamacare Replacement Act S. 251, Protecting Medicare from Executive Action Act of 2017 S. 1835, Lower Premiums Through Reinsurance Act of 2017 S. 1859, Healthcare Tax Relief Act S. 1978, Small Business and Family Health Tax Relief Act of 2017 S. 2164, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings Draft legislation titled To stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility (Alexander-Murray) Proposed regulations on definition of employer under section 3(5) of ERISA-association health plans (83 Fed. Reg. 614-636, January 5, 2018) Various issues relating to Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including changes to the employer-sponsored health care system, implementation of regulatory process, provider network adequacy, delivery system reform, health savings account (HSAs), health reimbursement account (HRAs), and flexible spending account (FSAs) changes, IPAB, employer mandate, reporting requirements for issuers and applicable large employers, premium stabilization programs, medical loss ratio, medical malpractice reform, exchanges, the impact on small business, the Small Business Tax Credit, section 1332 waivers, section 1557 on nondiscrimination, caps on compensation deductibility required under section 9014, incompleteness or inaccuracy of cost impact analysis, lack of quantified benefit analysis, and need for empirical data sources on which to base costs and benefits, the Cost Sharing Reduction (CSR) program, the section 9010 Health Insurance Providers Fee or Health Insurance Tax (HIT), 40% excise tax on high-cost employer-sponsored health coverage (Cadillac tax); Public Health Services Act (P.L.78-410), Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) (P.L. 93-406), regarding regulatory process and legislative corrections to ERISA preemption, changes to Medicare Advantage and Parts B, C, and D, including rebates and non-interference with prescription drug prices, entitlement reform, health information technology, telemedicine services in Medicare, and coordination and disease management programs; House Republican Taskforce on Health Care report, A Better Way to Fix Health Care; association health plans; importation of foreign pharmaceuticals into the United States and preemptive authority of federal food and drug regulations; Executive Order 13813, Promoting Healthcare Choice and Competition

S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax H.R. 195, Extension of Continuing Appropriations Act - one-year suspension of ACA health insurance tax, two-year delay in ACA excise tax on employer-sponsored health plans H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 4616 (Nunes) - delay in ACA Cadillac tax H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4620, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax H.R. 4894, Harmful Tax Prevention Act (Noem) - relief from ACA health insurance tax H.R. 5138, Bipartisan HSA Improvement Act (Kelly) - HSA changes Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to health savings accounts; issues related to the deductibility of employer-sponsored health coverage; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.

Issues related to the eligibility of over the counter drugs to be purchased using HSA and FSA accounts, including H.R.394 and S.85, both entitled Restoring Access to Medication Act of 2017, and H. R. 4618.

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

S. J. Res. 16 a joint resolution approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the independent payment Medicare advisory board H.J. Res 51/S. J. Res 17 Independent Payment Advisory Board Repeal H.R 1995 Value Based Insurance Design for Better Care Act H.R. 1004 Regulatory Integrity Act H.R. 1009/S. 676 OIRA Insight, Reform, and Accountability Act H.R. 1038/S. 413 Improving Transparency and Accuracy in Medicare Part D Spending H.R. 1148/S. 431 Furthering Access to Stroke Telemedicine (FAST) Act H.R. 1215 Protecting Access to Care Act H.R. 1554 Jessie's Law H.R. 1565 Saving Lives, Saving Costs Act H.R. 1628 American Health Care Act H.R. 1953/S. 830 Treat and Reduce Obesity Act H.R. 2267/S. 1301 Resident Physician Shortage Reduction Act H.R. 246/S. 183 Jobs and Premium Protection Act H.R. 2550 Medicare Telehealth Parity Act H.R. 2556/S. 1016 CONNECT for Health Act H.R. 2797/S. 1334 Patient Choice and Quality Care Act H.R. 284 Advancing Medical Resident Training in Community Hospitals Act H.R. 2953/S. 2164 Preventive Health Savings Act H.R. 3044 to expand supplemental benefits to meet the needs of chronically ill Medicare Advantage enrollees H.R. 3059/S. 1441 Community Health Center and Primary Care Workforce Expansion Act H.R. 3120 to reduce the volume of future electronic health record-related significant hardship requests H.R. 3124/S. 1299 Preventing Diabetes in Medicare Act H.R. 3168 to provide continued access to Medicare Advantage plans for special needs H.R. 3224 Critical Access and Rural Equity Act H.R. 3245 Medicare Civil and Criminal Penalties Act H.R. 3263 to extend the Medicare independence at home medical demonstration program H.R. 3394 Teaching Health Centers Graduate Medical Education Extension Act H.R. 3447 Furthering Access to Coordinated Treatment for Seniors Act H.R. 3726 Stark Administrative Simplification Act of 2017 H.R. 3728 Empowering Medical Professionals and Optimizing Workforce Efficiency and Readiness Act H.R. 3820/S. 977 Medicare Home Health Flexibility Act H.R. 3862 National Health Service Corps Strengthening Act H.R. 3921 Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 3922 Continuing Community Health and Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 4541 Continuing Community Health and Medical Professional Programs to Improve Our Nation and Keep Insurance Delivery Stable H.R. 4613 Ensuring Patient Access to Healthcare Records Act H.R. 4618 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619 to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620 Protecting Families and Small Businesses Act H.R. 4006 Community-Based Independence for Seniors Act of 2017 H.R. 4520 to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2017 H.R. 4552/S. 1291 Advancing Medical Training in Community Hospitals Act H.R. 4105 to extend the health professions workforce demonstration project H.R. 4841 Standardizing Electronic Prior Authorization for Safe Prescribing Act H.R. 592/S. 109 Pharmacy and Medically Underserved Areas Enhancement Act H.R. 741/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/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. 2687/S. 1169 Medicaid Coverage for Addiction Recovery Expansion Act H.R.3727 To amend title XVIII of the Social Security Act to include additional telehealth services for purposes of MA organization bids, and for other purposes H.R. 4206/S. 2051 Medicare Care Coordination Improvement Act Pub L. 114-198 Comprehensive Addiction and Recovery Act Pub. L. 115-120 Fiscal Year 2018 Continuing Resolution Pub L. 115-123 Bipartisan Budget Act Pub L. 115-141 Fiscal Year 2018 Omnibus Appropriations Act Pub. L. 111-148 Patient Protection and Affordable Care Act (PPACA) Pub. L. 111-5 The American Recovery and Reinvestment Act Pub. L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) Pub. L. 114-255 21st Century Cures Act Pub. L. 114-270 Expanding Capacity for Health Outcomes Act (ECHO) Pub L. 115-63 Disaster Relief and Airway Extension Act Reintroduction of TELE-MED Act of 2015 S. 1754 Training the Next Generation of Primary Care Doctors Act S. 1827 Keep Kids' Insurance Dependable and Secure Act S. 1859 Healthcare Tax Relief Act S. 1899 to reauthorize and extend funding for community health centers and the National Health Service Corps S. 251 Protecting Medicare from Executive Action Act S. 309 Community Based Independence for Seniors Act S. 464 Independence at Home Act S. 787 Telehealth Innovation and Improvement Act S. 870 Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act S. 1978 Small Business and Family Health Tax Relief Act S. Con. Res. 3 Budget Resolution H.R. 3545 Overdose Prevention and Patient Safety Act H.R. 4613 Ensuring Patient Access to Healthcare Records Act S.1850 Jessie's Law H.R. 4206/S.2501 Medicare Care Coordination Improvement Act

S. J. Res. 16 a joint resolution approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the independent payment Medicare advisory board H.J. Res 51/S. J. Res 17 Independent Payment Advisory Board Repeal H.R 1995 Value Based Insurance Design for Better Care Act H.R. 1004 Regulatory Integrity Act H.R. 1009/S. 676 OIRA Insight, Reform, and Accountability Act H.R. 1038/S. 413 Improving Transparency and Accuracy in Medicare Part D Spending H.R. 1101 Small Business Health Fairness Act H.R. 1121 Pre-Existing Conditions Protection Act H.R. 1148/S. 431 Furthering Access to Stroke Telemedicine (FAST) Act H.R. 1215 Protecting Access to Care Act H.R. 1267/S. 482 Personal Health Investment Today Act H.R. 1304 Self-Insurance Protection Act H.R. 1313 Preserving Employee Wellness Programs Act H.R. 1554 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. 184 Protect Medical Innovation Act H.R. 1876 Good Samaritan Health Professionals Act H.R. 1953/S. 830 Treat and Reduce Obesity Act H.R. 2267/S. 1301 Resident Physician Shortage Reduction Act H.R. 246/S. 183 Jobs and Premium Protection Act H.R. 2550 Medicare Telehealth Parity Act H.R. 2556/S. 1016 CONNECT for Health Act H.R. 2797/S. 1334 Patient Choice and Quality Care Act H.R. 284 Advancing Medical Resident Training in Community Hospitals Act H.R. 2953/S. 2164 Preventive Health Savings Act H.R. 3044 to expand supplemental benefits to meet the needs of chronically ill Medicare Advantage enrollees H.R. 3059/S. 1441 Community Health Center and Primary Care Workforce Expansion Act H.R. 3120 to reduce the volume of future electronic health record-related significant hardship requests H.R. 3124/S. 1299 Preventing Diabetes in Medicare Act H.R. 3168 to provide continued access to Medicare Advantage plans for special needs H.R. 3224 Critical Access and Rural Equity Act H.R. 3245 Medicare Civil and Criminal Penalties Act H.R. 3263 to extend the Medicare independence at home medical demonstration program H.R. 3394 Teaching Health Centers Graduate Medical Education Extension Act H.R. 3447 Furthering Access to Coordinated Treatment for Seniors Act H.R. 3726 Stark Administrative Simplification Act of 2017 H.R. 3728 Empowering Medical Professionals and Optimizing Workforce Efficiency and Readiness Act H.R. 3820/S. 977 Medicare Home Health Flexibility Act H.R. 3862 National Health Service Corps Strengthening Act H.R. 3921 Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 3922 Continuing Community Health and Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 4541 Continuing Community Health and Medical Professional Programs to Improve Our Nation and Keep Insurance Delivery Stable H.R. 4613 Ensuring Patient Access to Healthcare Records Act H.R. 4616 to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617 to provide for a temporary moratorium on the medical device excise tax H.R. 4618 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619 to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620 Protecting Families and Small Businesses Act H.R. 4006 Community-Based Independence for Seniors Act of 2017 H.R. 4200/S. 2052 Healthcare Market Certainty and Mandate Relief Act H.R. 4520 to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2017 H.R. 4552/S. 1291 Advancing Medical Training in Community Hospitals Act H.R. 4105 to extend the health professions workforce demonstration project H.R. 4841 Standardizing Electronic Prior Authorization for Safe Prescribing Act H.R. 592/S. 109 Pharmacy and Medically Underserved Areas Enhancement Act H.R. 706 Plan Verification and Fairness Act H.R. 741/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. 849/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. 2687/S. 1169 Medicaid Coverage for Addiction Recovery Expansion Act H.R.3727 To amend title XVIII of the Social Security Act to include additional telehealth services for purposes of MA organization bids, and for other purposes H.R. 4206/S. 2051 Medicare Care Coordination Improvement Act H.R. 5138 Bipartisan Health Savings Accounts Improvement Act Introduction of the Healthcare Cybersecurity Improvement Act Introduction of the Stark Law Modernization Act Pub L. 114-198 Comprehensive Addiction and Recovery Act Pub. L. 115-120 Fiscal Year 2018 Continuing Resolution Pub L. 115-80 National Clinical Care Commission Act Pub L. 115-123 Bipartisan Budget Act Pub L. 115-141 Fiscal Year 2018 Omnibus Appropriations Act Pub. L. 102-143 Telephone Consumer Protection Act Pub. L. 111-148 Patient Protection and Affordable Care Act (PPACA) Pub. L. 111-5 The American Recovery and Reinvestment Act Pub. L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) Pub. L. 114-255 21st Century Cures Act Pub. L. 114-270 Expanding Capacity for Health Outcomes Act (ECHO) Pub. L. 114-329 American Innovation and Competitiveness Act Pub L. 115-63 Disaster Relief and Airway Extension Act Pub. L. 115-97 Tax Cuts and Jobs Act Reintroduction of TELE-MED Act of 2015 S. 108 Medical Device Access and Innovation Protection Act S. 297 Increasing Competition in Pharmaceuticals Act S. 1754 Training the Next Generation of Primary Care Doctors Act S. 1827 Keep Kids' Insurance Dependable and Secure Act S. 1829 Strong Families Act S. 1859 Healthcare Tax Relief Act S. 1899 to reauthorize and extend funding for community health centers and the National Health Service Corps S. 1967 Mandate Relief Act S. 251 Protecting Medicare from Executive Action Act S. 2278 State Offices of Rural Health Reauthorization Act S. 309 Community Based Independence for Seniors Act S. 464 Independence at Home Act H .R. 1933/S. 761 Health Care Options Act S. 787 Telehealth Innovation and Improvement Act S. 870 Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act S. 1978 Small Business and Family Health Tax Relief Act S. Con. Res. 3 Budget Resolution H.R. 3545 Overdose Prevention and Patient Safety Act H.R. 4613 Ensuring Patient Access to Healthcare Records Act S.1850 Jessie's Law H.R. 4206/S.2501 Medicare Care Coordination Improvement Act

Flexible spending arrangements (FSA) and health savings accounts (HSA) Graham-Cassidy Bill, no bill number. Graham-Cassidy contained a provision (section 108) to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescriptions prior to using an FSA or HSA to purchase OTC medicine. Better Care Reconciliation Act (H.R. 1628). BCRA contained a provision(section 209)to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescription prior to using an FSA or HSA to purchase OTC Medicines. American Healthcare Act (AHCA), no bill number. AHCA contained a provision(section 208)to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescription prior to using an FSA or HSA to purchase OTC Medicines. H.R. 394/S. 85 - Restoring Access to Medication Act of 2017. Repeals prohibition in Patient Protection and Affordable Care Act (P.L. 111-148, P.L. 111-152) against use of flexible spending arrangement (FSA) and health savings account (HSA) funds on over-the-counter (OTC) medications; all sections. H.R. 1175/S.403 - Health Savings Act of 2017 - Codifies OTC medications as qualified medical expenses; Section 301 H.R.4618 - To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication. Temporarily repeals prohibition in Patient Protection and Affordable Care Act (P.L. 111-148, P.L. 111-152) against use of flexible spending arrangement (FSA) and health savings account (HSA) funds on over-the-counter (OTC) medications. H.R.1625 - Consolidated Appropriations Act, 2018. Omnibus appropriations package.

Client expense: $192,000 · Firm income: Not reported

Affordable Care Act, all provisions; HR1628 - American Health Care Act, all provisions; HR1101 - Small Business Health Fairness Act, all provisions; HR173/S58 - Middle Class Health Benefits Tax Repeal Act, all provisions; Better Care Reconciliation Act, all provisions. H.R. 246 Jobs and Premium Protection Act; S.1859 - Healthcare Tax Relief Act; S.1978 - Small Business and Family Health Tax Relief Act; H.R. 3956: STARS Act; S.1818 - Small Business Health Plans Act; HR 4616 - Cadillac Tax; Employer Mandate Delay; H.R.4620 - Protecting Families and Small Businesses Act; HR4618 - Over the Counter Drugs; HR4200/S.2052 - H.R. 4200: Healthcare Market Certainty and Mandate Relief Act; S. 1996/HR 2919 Commonsense Reporting Act; Cadillac Tax; ERISA; Alexander - Murray - Individual Market Stabilization; Sen. Pauls Association Health Plan Draft

Client expense: $2,390,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Consumer Financial Protection Bureau (CFPB), Consumer Product Safety Commission (CPSC), Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Federal Maritime Commission, Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, White House Office

H.R.1370: Continuing Resolution through January 19, 2018 H.R. 2810: National Defense Authorization Act for Fiscal Year 2018 - Provisions related to Department of Defense, Tricare, and medical research issues H.J.Res 123: Continuing Resolution through December 22, 2017 H.R.2998: Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2018 S. 1519: National Defense Authorization Act for Fiscal Year 2018 - Provisions related to Department of Defense, Tricare, and medical research issues S.0000: Department of Defense (Chairmans Mark) - Making appropriations for the Department of Defense for the fiscal year ending September 30, 2018 S.0000: Department of Homeland Security (Chairmans Mark) - Making appropriations for the Department of Homeland Security for the fiscal year ending September 30, 2018, and for other purposes. HR4618 ACA Tax Legislation-OTC Tax

Client expense: $1,110,000 · Firm income: Not reported

Monitor legislative and federal activity related to tax reform. Monitor legislative and federal activity related to Treasury Regulations proposed under section 385 of the Internal Revenue Code. S. 85, Restoring Access to Medication Act of 2017. S. 108, Medical Device Access and Innovation Protection Act. H.R. 1, Tax Cuts and Jobs Act. H.R. 184, Protect Medical Innovation Act of 2017. H.R. 394, Restoring Access to Medication Act of 2017. H.R. 1268, Veterinary Medicine Loan Repayment Program Enhancement Act. H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication.

Client expense: $2,140,000 · Firm income: Not reported

Affordable Care Act, all provisions; HR1628 - American Health Care Act, all provisions; HR1101 - Small Business Health Fairness Act, all provisions; HR173/S58 - Middle Class Health Benefits Tax Repeal Act, all provisions; Better Care Reconciliation Act, all provisions. H.R. 246 Jobs and Premium Protection Act; S.1859 - Healthcare Tax Relief Act; S.1978 - Small Business and Family Health Tax Relief Act; H.R. 3956: STARS Act; S.1818 - Small Business Health Plans Act; HR 4616 - Cadillac Tax; Employer Mandate Delay; H.R.4620 - Protecting Families and Small Businesses Act; HR4618 - Over the Counter Drugs; HR4200/S.2052 - H.R. 4200: Healthcare Market Certainty and Mandate Relief Act; S. 1996/HR 2919 Commonsense Reporting Act; Cadillac Tax; ERISA; Alexander - Murray - Individual Market Stabilization; Sen. Pauls Association Health Plan Draft

Client expense: $2,390,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Consumer Financial Protection Bureau (CFPB), Consumer Product Safety Commission (CPSC), Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Federal Maritime Commission, Federal Reserve System, Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Customs & Border Protection, White House Office

Better Care Reconciliation Act (Enzi) - ACA repeal and replace issues; tax provisions; Heller amendment on Cadillac tax S. 1, Tax Cuts and Jobs Act (Enzi) - ACA individual mandate S. 28, Health Savings Account Expansion Act (Flake) - HSA improvements S. 85, Restoring Access to Medications Act (Roberts) - paying for OTC products with HSA funds S. 403, Health Savings Act (Hatch) - HSA and FSA improvements S. 761, Health Care Options Act (Alexander) - using premiums for off-Exchange plans S. 1859, Healthcare Tax Relief Act (Gardner) - suspension of ACA health insurance tax S. 1978, Small Business and Family Health Tax Relief Act (Heitkamp) - suspension of ACA health insurance tax H.R. 1, Tax Cuts and Jobs Act (Brady) - ACA individual mandate H.R. 246, Jobs and Premium Protection Act (Noem-Sinema) - repeal of ACA health insurance tax H.R. 247, Health Savings Account Expansion Act (Brat) - HSA improvements H.R. 394, Restoring Access to Medications Act (Jenkins) - paying for OTC products with HSA funds H.R. 1175, Health Savings Act (Paulsen) - HSA and FSA improvements H.R. 1628, American Health Care Act (Black) - ACA repeal and replace issues; tax provisions H.R. 4616 (Nunes) - delay in ACA Cadillac tax H.R. 4618 (Jenkins) - use of HSA funds for OTC medications H.R. 4260, Protecting Families and Small Businesses Act (Noem) - relief from ACA health insurance tax Regulatory Issues: Annual insurer provider fees; issues concerning the patient-centered outcomes research fee; employer and individual coverage mandate; W-2 reporting requirements; health reimbursement accounts; deductibility limits for insurer compensation; health insurer and employer reporting of health coverage; issues related to implementation of health insurance tax; issues related to the refundable credit for coverage under a qualified health plan; issues related to coverage of chronic conditions in high deductible health plans; issues related to the deductibility of employer-sponsored health coverage; issues related to qualified small employer health reimbursement accounts (QSEHRAs); issues related to implementation of the excise tax on high cost employer-sponsored health coverage; and other issues relating to health care reform implementation.

H.R. 1, An Act to provide for reconciliation pursuant to titles II and V of the concurrent resolution on the budget for fiscal year 2018, including provisions relating to Senate Amendment 1687 H.R. 35, Health Savings Act of 2017 H.R. 143, Health Insurance Industry Antitrust Enforcement Act of 2017 H.R. 173/S. 40/S. 58, Middle Class Health Benefits Tax Repeal Act of 2017 H.R. 184, Protect Medical Innovation Act of 2017 H.R. 246, To repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act H.R. 247/S. 28, Health Savings Account Expansion Act of 2017 H.R. 394/S. 85, Restoring Access to Medication Act of 2017 H.R. 849/S. 260, Protecting Seniors Access to Medicare Act H.R. 1101/S. 1818, Small Business Health Fairness Act of 2017 H.R. 1175/S. 403, Health Savings Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 1280, Health Savings Account Act H.R. 1313, Preserving Employee Wellness Programs Act H.R. 1628, American Health Care Act of 2017 H.R. 2430/S. 934, FDA Reauthorization Act of 2017 H.R. 4616, To amend the Patient Protection and Affordable Care Act to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on the medical device excise tax H.R. 4618, To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619, To amend the Patient Protection and Affordable Care Act to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620, Protecting Families and Small Businesses Act of 2017 S. 108, Medical Device Access and Innovation Protection Act S. 191, Patient Freedom Act of 2017 S. 222, Obamacare Replacement Act S. 251, Protecting Medicare from Executive Action Act of 2017 S. 934, FDA Reauthorization Act of 2017 S. 1835, Lower Premiums Through Reinsurance Act of 2017 S. 1852, Solution for Undocumented Children through Careers, Employment, Education, and Defending our Nation (SUCCEED) Act S. 1859, Healthcare Tax Relief Act S. 1978, Small Business and Family Health Tax Relief Act of 2017 S. 2164, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings H.Con.Res.71 - Establishing the congressional budget for the United States Government for fiscal year 2018 and setting forth the appropriate budgetary levels for fiscal years 2019 through 2027, including provisions relating to Senate Amendment 1227 Draft legislation titled To stabilize individual market premiums for the 2018 and 2019 plan years and provide meaningful State flexibility (Alexander-Murray) Proposed regulations on benefit and payment parameters for 2019 (82 Fed. Reg. 51,052-51,148, November 2, 2017) Request for Information reducing regulatory burdens imposed by the Patient Protection and Affordable Care Act & Improving Health Care Choices to Employer Patients (82 Fed. Reg. 26,885-26,887, June 12, 2017) Request for Information Treasury proposed review of regulations & recommendations to further compliance with Executive Orders 13771 and 13777 (82 Fed. Reg. 27,217-27,218, June 14, 2017) Various issues relating to Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Affordability Reconciliation Act of 2010 (P.L. 111-152), including the employer-sponsored health care system, implementation of regulatory process, provider network adequacy, delivery system reform, health savings account (HSAs), health reimbursement account (HRAs), and flexible spending account (FSAs) changes, IPAB, employer mandate, reporting requirements for issuers and applicable large employers, premium stabilization programs, medical loss ratio, medical malpractice reform, exchanges, the impact on small business, the Small Business Tax Credit, section 1332 waivers, section 1557 on nondiscrimination, caps on compensation deductibility required under section 9014, incompleteness or inaccuracy of cost impact analysis, lack of quantified benefit analysis, and need for empirical data sources on which to base costs and benefits, the Cost Sharing Reduction (CSR) program, the section 9010 Health Insurance Providers Fee or Health Insurance Tax (HIT), 40% excise tax on high-cost employer-sponsored health coverage (Cadillac tax); Public Health Services Act (P.L.78-410), Internal Revenue Code and the Employee Retirement Income Security Act (ERISA) (P.L. 93-406), regarding regulatory process and legislative corrections to ERISA preemption, changes to Medicare Advantage and Parts B, C, and D, including rebates and non-interference with prescription drug prices, entitlement reform, health information technology, telemedicine services in Medicare, and coordination and disease management programs; IRS Notice application of market reform and other provisions of the Affordable Care Act to HRAs, Health FSAs, and certain other employer healthcare arrangements HRAs (Notice 2013-54, September 13, 2013); IRS Notice on Section 4980I - Excise Tax on High Cost Employer-Sponsored Health Coverage (Notice 2015-16, February 23, 2015); IRS Notice on qualified small employer health reimbursement arrangements (Notice 2017-67, October 31, 2017); House Republican Taskforce on Health Care report, A Better Way to Fix Health Care; association health plans; importation of foreign pharmaceuticals into the United States and preemptive authority of federal food and drug regulations; Executive Order 13813, Promoting Healthcare Choice and Competition

Flexible spending arrangements (FSA) and health savings accounts (HSA) Graham-Cassidy Bill, no bill number. Graham-Cassidy contained a provision (section 108) to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescriptions prior to using an FSA or HSA to purchase OTC medicine. Better Care Reconciliation Act (H.R. 1628). BCRA contained a provision(section 209)to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescription prior to using an FSA or HSA to purchase OTC Medicines. American Healthcare Act (AHCA), no bill number. AHCA contained a provision(section 208)to repeal the Affordable Care Act (ACA) requirement that patients obtain a prescription prior to using an FSA or HSA to purchase OTC Medicines. H.R. 394/S. 85 - Restoring Access to Medication Act of 2017. Repeals prohibition in Patient Protection and Affordable Care Act (P.L. 111-148, P.L. 111-152) against use of flexible spending arrangement (FSA) and health savings account (HSA) funds on over-the-counter (OTC) medications; all sections. H.R. 1175/S.403 - Health Savings Act of 2017 - Codifies OTC medications as qualified medical expenses; Section 301 H.R.4618 - To amend the Internal Revenue Code of 1986 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication. Temporarily repeals prohibition in Patient Protection and Affordable Care Act (P.L. 111-148, P.L. 111-152) against use of flexible spending arrangement (FSA) and health savings account (HSA) funds on over-the-counter (OTC) medications.

Client expense: $228,000 · Firm income: Not reported

Issues related to the eligibility of over the counter drugs to be purchased using HSA and FSA accounts, including H.R.394 and S.85, both entitled Restoring Access to Medication Act of 2017, and H. R. 4618.

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

H. Res. 142/S. Res. 63 National Obesity Care Week Resolution S. Res. 325 National Obesity Care Week Resolution S. J. Res. 16 a joint resolution approving the discontinuation of the process for consideration and automatic implementation of the annual proposal of the independent payment Medicare advisory board H.J. Res 51/S. J. Res 17 Independent Payment Advisory Board Repeal H.R 1995 Value Based Insurance Design for Better Care Act H.R. 1004 Regulatory Integrity Act H.R. 1009/S. 676 OIRA Insight, Reform, and Accountability Act H.R. 1038/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 H.R. 1121 Pre-Existing Conditions Protection Act H.R. 1148/S. 431 Furthering Access to Stroke Telemedicine (FAST) Act H.R. 1215 Protecting Access to Care Act H.R. 1267/S. 482 Personal Health Investment Today Act H.R. 1304 Self-Insurance Protection Act H.R. 1313 Preserving Employee Wellness Programs Act H.R. 1554 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. 184 Protect Medical Innovation Act H.R. 1953/S. 830 Treat and Reduce Obesity Act H.R. 2267/S. 1301 Resident Physician Shortage Reduction Act H.R. 246/S. 183 Jobs and Premium Protection Act H.R. 2550 Medicare Telehealth Parity Act H.R. 2556/S. 1016 CONNECT for Health Act H.R. 2797/S. 1334 Patient Choice and Quality Care Act H.R. 2824 Increasing Opportunity and Success for Children and Parents Through Evidence-Based Home Visiting Act H.R. 284 Advancing Medical Resident Training in Community Hospitals Act H.R. 2953/S. 2164 Preventive Health Savings Act H.R. 3044 to expand supplemental benefits to meet the needs of chronically ill Medicare Advantage enrollees H.R. 3059/S. 1441 Community Health Center and Primary Care Workforce Expansion Act H.R. 3120 to reduce the volume of future electronic health record-related significant hardship requests H.R. 3124/S. 1299 Preventing Diabetes in Medicare Act H.R. 3168 to provide continued access to Medicare Advantage plans for special needs H.R. 3224 Critical Access and Rural Equity Act H.R. 3245 Medicare Civil and Criminal Penalties Act H.R. 3263 to extend the Medicare independence at home medical demonstration program H.R. 3358/S. 1771 Fiscal Year 2018 Labor-Health and Human Services-Education Appropriations Bill H.R. 3394 Teaching Health Centers Graduate Medical Education Extension Act H.R. 3447 Furthering Access to Coordinated Treatment for Seniors Act H.R. 3545 Overdoes Prevention and Patient Safety Act H.R. 3726 Stark Administrative Simplification Act of 2017 H.R. 3728 Empowering Medical Professionals and Optimizing Workforce Efficiency and Readiness Act H.R. 3820/S. 977 Medicare Home Health Flexibility Act H.R. 3862 National Health Service Corps Strengthening Act H.R. 3921 Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 3922 Continuing Community Health and Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act H.R. 4541 Continuing Community Health and Medical Professional Programs to Improve Our Nation and Keep Insurance Delivery Stable H.R. 4613 Ensuring Patient Access to Healthcare Records Act H.R. 4616 to provide for a temporary moratorium on the employer mandate and to provide for a delay in the implementation of the excise tax on high cost employer-sponsored health coverage H.R. 4617 to provide for a temporary moratorium on the medical device excise tax H.R. 4618 to provide for a temporary moratorium on certain taxes affecting purchases of prescription medication H.R. 4619 to provide temporary relief from the annual fee imposed on health insurance providers, to the extent that such fee is due to Puerto Rican health insurance H.R. 4620 Protecting Families and Small Businesses Act H.R. 4006 Community-Based Independence for Seniors Act of 2017 H.R. 4200/S. 2052 Healthcare Market Certainty and Mandate Relief Act H.R. 4520 to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2017 H.R. 4552/S. 1291 Advancing Medical Training in Community Hospitals Act H.R. 4105 to extend the health professions workforce demonstration project H.R. 592/S. 109 Pharmacy and Medically Underserved Areas Enhancement Act H.R. 706 Plan Verification and Fairness Act H.R. 741/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. 849/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.3545 Overdose Prevention and Patient Safety Act H.R.3727 To amend title XVIII of the Social Security Act to include additional telehealth services for purposes of MA organization bids, and for other purposes H.R. 4206/S. 2051 Medicare Care Coordination Improvement Act Introduction of the Healthcare Cybersecurity Improvement Act Introduction of the Stark Law Modernization Act of 2017 Pub L. 114-198 Comprehensive Addiction and Recovery Act Pub L. 115-31 Fiscal Year 2017 Consolidated Appropriations Act Pub L. 115-80 National Clinical Care Commission Act Pub. L. 102-143 Telephone Consumer Protection Act Pub. L. 111-148 Patient Protection and Affordable Care Act (PPACA) Pub. L. 111-5 The American Recovery and Reinvestment Act Pub. L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) 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 Pub L. 115-63 Disaster Relief and Airway Extension Act Pub. L. 115-96 2018 Continuing Resolution Pub. L. 115-97 Tax Cuts and Jobs Act Reintroduction of TELE-MED Act of 2015 S. 108 Medical Device Access and Innovation Protection Act S. 297 Increasing Competition in Pharmaceuticals Act S. 1754 Training the Next Generation of Primary Care Doctors Act S. 1827 Keep Kids' Insurance Dependable and Secure Act S. 1829 Strong Families Act S. 1850 Protecting Jessica Grubbs Legacy Act (The Legacy Act) S. 1859 Healthcare Tax Relief Act S. 1899 to reauthorize and extend funding for community health centers and the National Health Service Corps S. 1967 Mandate Relief Act S. 191 Patient Freedom Act S. 251 Protecting Medicare from Executive Action Act S. 309 Community Based Independence for Seniors Act S. 464 Independence at Home Act H .R. 1933/S. 761 Health Care Options Act of 2017 S. 787 Telehealth Innovation and Improvement Act S. 870 Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act S. 1978 Small Business and Family Health Tax Relief Act S. Con. Res. 3 Budget Resolution