Protecting Married Seniors from Impoverishment Act

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. Expansion of Medicare benefits to include hearing, vision, and dental benefits 8. Administration of the Medicare State Health Insurance Assistance Programs 9. Medicare Observation Status Regulations 10. Nursing Home Arbitration Regulations 11. Medicare 340(B) drug reimbursement policy 12. Home care workers and Medicare Reassignment Policy 13. Medicare equitable relief policy 14. S. 340, CREATES Act of 2019, entire bill 15. H.R. 965, CREATES Act of 2019, entire bill 16. H.R. 1046, Medicare Negotiation and Competitive Licensing Act of 2019, entire bill 17. CMS Proposals on Part D Drug Pricing 18. S. 691, Medicare Extra Rx HELP Act of 2019, entire bill 19. H.R. 1342, EMPOWER Care Act, entire bill 20. S. 548, EMPOWER Care Act, entire bill 21. H.R. 1343, Protecting Married Seniors from Impoverishment Act, entire bill 22. S. 97, Affordable and Safe Prescription Drug Importation Act, entire bill 23. S. 99, Medicare Drug Price Negotiation Act, entire bill 24. H.R. 3, Lower Drug Costs Now Act of 2019, entire bill 25. H.R. 1393, Medicare Dental, Vision and Hearing Benefit Act of 2019, entire bill 26. H.R. 1394, Medigap Consumer Protection Act of 2019, entire bill 27. H.R. 1682, Improving Access to Medicare Coverage Act of 2019, entire bill 28. H.R. 4386, Stop the Wait Act, entire bill 29. Proposals regarding the tiering generic drugs under Medicare Part D 30. Proposals regarding the use of Medicaid waivers during the COVID-19 pandemic 31. S. 3544, Coronavirus Relief for Seniors and People with Disabilities Act of 2020, entire bill 32. H.R. 6305, Coronavirus Relief for Seniors and People with Disabilities Act of 2020, entire bill 33. Oklahoma Medicaid waiver application 34. Proposals to streamline Medicare enrollment during the COVID-19 pandemic

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Pension & Welfare Benefits Administration, Pension Benefit Guaranty Corporation (PBGC), SENATE, Social Security Administration (SSA)

Support H.R.1265 &H.R.4468 - Nursing Home Workforce Quality Act- to end the mandatory certified nursing assistant training lock out. Support H.R.1343 Protecting Married Seniors from Impoverishment Act, to extend the Money Follows the Person Act and protection against impoverishment for spouses of Medicaid beneficiaries receiving long term services and supports at home. Support H.R.1342 - EMPOWER Care Act, to reauthorize Money Follows the Person for 5 years. Support H.R 1682/S. 753- Improving Access to Medicare Coverage Act of 2019, to solve the Medicare "observation days" issue by counting all time a beneficiary spends in a hospital toward the 3-day stay requirement for coverage of post-acute care. Support H.R 6698- Quality Care for Nursing Home Residents and Workers During COVID-19 Act Support H.R.2594/ S.1190 - Rural Access to Hospice Act of 2019 Support H.R 2150, Home Health Care Planning Improvement Act Support H.R.4063 - Medicare Adult Day Services Act of 2019 Support- H.R.748 - CARES Act Support H.R.5821 - HOSPICE Act Support S. 3544 Coronavirus Relief for Seniors and People with Disabilities Act of 2020 Support H.R. 6305 Coronavirus Relief for Seniors and People with Disabilities Act of 2020

Client expense: $65,513 · Firm income: Not reported

P.L. 111-375 National Alzheimer's Project Act, All Sections P.L. 115-119 Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act P.L. 115-406 Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act S.591 Guardianship Accountability Act S.299 Geriatrics Workforce Improvement Act S.548/H.R.1342 EMPOWER Care Act H.R.1343 Protecting Married Seniors from Impoverishment Act S.740 Alzheimer's Caregiver Support Act H.R. 1955 Understanding Appropriate Alzheimer's Care Act of 2019 S.880/H.R.1873 Improving HOPE for Alzheimer's Act H.R.1903/S.901 Younger-Onset Alzheimer's Disease Act of 2019 S.2080/H.R.647 Palliative Care and Hospice Education and Training Act S.1250/H.R.2401 American Cures Act S.1017 Supporting America's Caregivers and Families Act S.995/H.R.2035 Lifespan Respite Care Reauthorization Act of 2019 S.1126/H.R.2283 Concentrating on High-Value Alzheimer's Needs to Get to an End (CHANGE) Act of 2019 S.1361/H.R.2584 Preventive Health Savings Act of 2019 S.1628 Paid Family Leave Pilot Extension Act S.1618 Expanding Capacity for Health Outcomes (ECHO) Act of 2019 S.1202 Independence at Home Act of 2019 H.R.3644 Independence at Home Demonstration Act of 2019 H.R.3436 Improving Chronic Care Management Act H.R.3107 Improving Seniors' Timely Access to Care Act H.R.4334 Dignity in Aging Act of 2019 S.2469/H.R.4386 Stop the Wait Act H.R.2781 Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) for Health Act of 2019 S.2521/H.R.4397 Direct CARE Opportunity Act S.3057 Modernization of the Older Americans Act Amendments S.2677 Older Americans and Social Isolation and Loneliness Act H.R.4859 Protecting Older Americans from Social Isolation Act of 2019 H.Res.821 to establish a permanent select Committee in Aging in the House of Representatives H.R.6379 Families First Coronavirus Response Act S.3548/H.R.748 Coronavirus Aid, Relief, and Economic Security (CARES) Act; including provisions that would impact individuals living with Alzheimer's and other dementia and their caregivers. H.R.4334 Supporting Older Americans Act of 2020 S.3544/H.R.6305 Coronavirus Relief for Seniors and People with Disabilities Act S.3768 /H.R.6972 Nursing Home COVID-19 Protection and Prevention Act of 2020 H.R.7048 Nursing Home Pandemic Protection Act S.3644/H.R.6698 Quality Care for Nursing Home Residents and Workers During COVID-19 Act H.R.6638 Reducing COVID-19 Disparities by Investing in Public Health H.R.7158 Health Enterprise Zones Act H.R.6800 Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act S.3517/H.R.6487 ACCESS Act S.3740/H.R.6951 COVID-19 Recovery for Seniors and People with Disabilities Act In forthcoming COVID-19 relief packages, the Alzheimer's Association is advocating for inclusion of policies that would impact those in the Alzheimer's and dementia community including: - Improving HOPE for Alzheimer's Act (S.880/H.R.1873) - Extension of the Independence at Home demonstration model - Promoting Alzheimer's Awareness to Prevent Elder Abuse Act, including Elder Justice Initiative training for professionals through the Department of Justice - Emergency Preparedness in long-term and community-based care settings - Expanding Capacity for Health Outcomes (Project ECHO) - Project VITAL: Virtual Inclusive Technology for ALL

Support H.R.1265 &H.R.4468 - Nursing Home Workforce Quality Act- to end the mandatory certified nursing assistant training lock out. Support H.R.1343 Protecting Married Seniors from Impoverishment Act, to extend the Money Follows the Person Act and protection against impoverishment for spouses of Medicaid beneficiaries receiving long term services and supports at home. Support H.R.1342 - EMPOWER Care Act, to reauthorize Money Follows the Person for 5 years. Support H.R 1682/S. 753- Improving Access to Medicare Coverage Act of 2019, to solve the Medicare "observation days" issue by counting all time a beneficiary spends in a hospital toward the 3-day stay requirement for coverage of post-acute care. Support H.R 6698- Quality Care for Nursing Home Residents and Workers During COVID-19 Act Support H.R.2594/ S.1190 - Rural Access to Hospice Act of 2019 Support H.R 2150, Home Health Care Planning Improvement Act Support H.R.4063 - Medicare Adult Day Services Act of 2019 Support- H.R.748 - CARES Act Support H.R.5821 - HOSPICE Act Support S. 3544 Coronavirus Relief for Seniors and People with Disabilities Act of 2020 Support H.R. 6305 Coronavirus Relief for Seniors and People with Disabilities Act of 2020

Client expense: $97,055 · Firm income: Not reported

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. Expansion of Medicare benefits to include hearing, vision, and dental benefits 8. Administration of the Medicare State Health Insurance Assistance Programs 9. Medicare Observation Status Regulations 10. Nursing Home Arbitration Regulations 11. Medicare 340(B) drug reimbursement policy 12. Home care workers and Medicare Reassignment Policy 13. Medicare equitable relief policy 14. S. 340, CREATES Act of 2019, entire bill 15. H.R. 965, CREATES Act of 2019, entire bill 16. H.R. 1046, Medicare Negotiation and Competitive Licensing Act of 2019, entire bill 17. CMS Proposals on Part D Drug Pricing 18. S. 691, Medicare Extra Rx HELP Act of 2019, entire bill 19. H.R. 1342, EMPOWER Care Act, entire bill 20. S. 548, EMPOWER Care Act, entire bill 21. H.R. 1343, Protecting Married Seniors from Impoverishment Act, entire bill 22. S. 97, Affordable and Safe Prescription Drug Importation Act, entire bill 23. S. 99, Medicare Drug Price Negotiation Act, entire bill 24. H.R. 3, Lower Drug Costs Now Act of 2019, entire bill 25. H.R. 1393, Medicare Dental, Vision and Hearing Benefit Act of 2019, entire bill 26. H.R. 1394, Medigap Consumer Protection Act of 2019, entire bill 27. H.R. 1682, Improving Access to Medicare Coverage Act of 2019, entire bill 28. H.R. 4386, Stop the Wait Act, entire bill 29. Proposals regarding the tiering generic drugs under Medicare Part D 30. Proposals regarding the use of Medicaid waivers during the COVID-19 pandemic 31. S. 3544, Coronavirus Relief for Seniors and People with Disabilities Act of 2020, entire bill 32. H.R. 6305, Coronavirus Relief for Seniors and People with Disabilities Act of 2020, entire bill 33. Oklahoma Medicaid waiver application 34. Proposals to streamline Medicare enrollment during the COVID-19 pandemic

P.L. 111-375 National Alzheimer's Project Act, All Sections P.L. 115-119 Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act P.L. 115-406 Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act S.591 Guardianship Accountability Act S.299 Geriatrics Workforce Improvement Act S.548/H.R.1342 EMPOWER Care Act H.R.1343 Protecting Married Seniors from Impoverishment Act S.740 Alzheimer's Caregiver Support Act H.R. 1955 Understanding Appropriate Alzheimer's Care Act of 2019 S.880/H.R.1873 Improving HOPE for Alzheimer's Act H.R.1903/S.901 Younger-Onset Alzheimer's Disease Act of 2019 S.2080/H.R.647 Palliative Care and Hospice Education and Training Act S.1250/H.R.2401 American Cures Act S.1017 Supporting America's Caregivers and Families Act S.995/H.R.2035 Lifespan Respite Care Reauthorization Act of 2019 S.1126/H.R.2283 Concentrating on High-Value Alzheimer's Needs to Get to an End (CHANGE) Act of 2019 S.1361/H.R.2584 Preventive Health Savings Act of 2019 S.1628 Paid Family Leave Pilot Extension Act S.1618 Expanding Capacity for Health Outcomes (ECHO) Act of 2019 S.1202 Independence at Home Act of 2019 H.R.3644 Independence at Home Demonstration Act of 2019 H.R.3436 Improving Chronic Care Management Act H.R.3107 Improving Seniors' Timely Access to Care Act H.R.4334 Dignity in Aging Act of 2019 S.2469/H.R.4386 Stop the Wait Act H.R.2781 Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) for Health Act of 2019 S.2521/H.R.4397 Direct CARE Opportunity Act S.3057 Modernization of the Older Americans Act Amendments S.2677 Older Americans and Social Isolation and Loneliness Act H.R.4859 Protecting Older Americans from Social Isolation Act of 2019 H.Res.821 to establish a permanent select Committee in Aging in the House of Representatives H.R.6379 Families First Coronavirus Response Act S.3548/H.R.748 Coronavirus Aid, Relief, and Economic Security (CARES) Act; including provisions that would impact individuals living with Alzheimer's and other dementia and their caregivers. H.R.4334 Supporting Older Americans Act of 2020 S.3544/H.R.6305 Coronavirus Relief for Seniors and People with Disabilities Act In forthcoming COVID-19 relief packages, the Alzheimer's Association is advocating for inclusion of policies that would impact those in the Alzheimer's and dementia community including: - Improving HOPE for Alzheimer's Act (S.880/H.R.1873) - Extension of the Independence at Home demonstration model - Promoting Alzheimer's Awareness to Prevent Elder Abuse Act, including Elder Justice Initiative training for professionals through the Department of Justice - Emergency Preparedness in long-term and community-based care settings - Expanding Capacity for Health Outcomes (Project ECHO) - Project VITAL: Virtual Inclusive Technology for ALL

S. 3277, HCBS Infrastructure Improvement Act S.2000/H.R. 1343, Protecting Married Seniors from Impoverishment Act H.R. 1342, the Empower Care Act H.R. 748, CARES Act, Secs. 2201, 3811, and 3812 S. 3544, H.R. 6305, Coronavirus Relief for Seniors and People with Disabilities Act of 2020

Client expense: $66,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support H.R.1265 &H.R.4468 - Nursing Home Workforce Quality Act- to end the mandatory certified nursing assistant training lock out. Support H.R.1343 Protecting Married Seniors from Impoverishment Act, to extend the Money Follows the Person Act and protection against impoverishment for spouses of Medicaid beneficiaries receiving long term services and supports at home. Support H.R.1342 - EMPOWER Care Act, to reauthorize Money Follows the Person for 5 years. Support H.R 1682/S. 753- Improving Access to Medicare Coverage Act of 2019, to solve the Medicare "observation days" issue by counting all time a beneficiary spends in a hospital toward the 3-day stay requirement for coverage of post-acute care. Support H.R.2594/ S.1190 - Rural Access to Hospice Act of 2019 Support H.R 2150, Home Health Care Planning Improvement Act Support H.R.4063 - Medicare Adult Day Services Act of 2019 Support- H.R.748 - CARES Act Support H.R.5821 - HOSPICE Act

Client expense: $49,764 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. Expansion of Medicare benefits to include hearing, vision, and dental benefits 8. Administration of the Medicare State Health Insurance Assistance Programs 9. Medicare Observation Status Regulations 10. Nursing Home Arbitration Regulations 11. Medicare 340(B) drug reimbursement policy 12. Home care workers and Medicare Reassignment Policy 13. Medicare equitable relief policy 14. S. 340, CREATES Act of 2019, entire bill 15. H.R. 965, CREATES Act of 2019, entire bill 16. H.R. 1046, Medicare Negotiation and Competitive Licensing Act of 2019, entire bill 17. CMS Proposals on Part D Drug Pricing 18. S. 691, Medicare Extra Rx HELP Act of 2019, entire bill 19. H.R. 1342, EMPOWER Care Act, entire bill 20. S. 548, EMPOWER Care Act, entire bill 21. H.R. 1343, Protecting Married Seniors from Impoverishment Act, entire bill 22. S. 97, Affordable and Safe Prescription Drug Importation Act, entire bill 23. S. 99, Medicare Drug Price Negotiation Act, entire bill 24. H.R. 3, Lower Drug Costs Now Act of 2019, entire bill 25. H.R. 1393, Medicare Dental, Vision and Hearing Benefit Act of 2019, entire bill 26. H.R. 1394, Medigap Consumer Protection Act of 2019, entire bill 27. H.R. 1682, Improving Access to Medicare Coverage Act of 2019, entire bill 28. H.R. 4386, Stop the Wait Act, entire bill 29. Proposals regarding the tiering generic drugs under Medicare Part D 30. Proposals regarding the use of Medicaid waivers during the COVID-19 pandemic 31. S. 3544, Coronavirus Relief for Seniors and People with Disabilities Act of 2020, entire bill 32. H.R. 6305, Coronavirus Relief for Seniors and People with Disabilities Act of 2020, entire bill

H.R. 3 Lower Drug Costs Now Act of 2019 -allowing Medicare to negotiate prescription drug prices, limiting the ability of drug companies to spike their prices overnight, ensuring that actions to address egregious prices apply to coverage beyond Medicare S. 2543 Prescription Drug Pricing Reduction Act of 2019 - comprehensive legislation to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers HR 6159 Kids' Access to Primary Care Act of 2020 - To amend title XIX of the Social Security Act to renew the application of the Medicare payment rate floor to primary care services furnished under the Medicaid program, and for other purposes. H.R.1393 Medicare Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare program. H.R.576 Seniors Have Eyes, Ears, and Teeth Act - expands Medicare coverage to include eyeglasses, hearing aids, and dental care. S.22/H.R.2951 Medicare Dental Benefit Act of 2019 - coverage of dental services under Medicare Part B H.R.1342 EMPOWER Care Act - reauthorize the Money Follows the Person Demonstration Program H.R. 1343 - Protecting Married Seniors Act - provisions regarding Medicaid eligibility that protect against spousal impoverishment for recipients of home and community-based services. H.R. 4996 Helping Medicaid Offer Maternity Services Act of 2019 - MOMs Act - provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individual S.1423Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare and Medicaid programs

H.R. 6074, Coronavirus Preparedness and Response Supplemental Appropriations Act. H.R. 6201, Families First Coronavirus Response Act; H.R. 748, Coronavirus Aid, Relief, and Economic Security (CARES) Act - Discussed Medicare enrollment national open enrollment period, medical expense deduction, cost-sharing protections for commercial/private health insurance holders, telehealth access, nursing homes, virtual visitation, home and community-based services, Older Americans Act programs, Medicare home health care, and family caregiving, no-cost COVID-19 testing, equitable relief payments, retirement savings tax relief, suspensions of foreclosures and evictions, expanded unemployment benefits, paid sick and family leave, affordable broadband, and government operations, among other issues. S. 3517, Discussed Advancing Connectivity during the Coronavirus to Ensure Support for Seniors Act (ACCESS Act). S. 753/H.R. 1682, Improving Access to Medicare Coverage Act. H.R. 6305, To assist older Americans and people with disabilities affected by COVID-19.; S. 3544, Coronavirus Relief for Seniors and People with Disabilities Act. H.R. 6379, Take Responsibility for Workers and Families Act. Discussed Medicaid HCBS grants and virtual visitation provisions. No bill number, discussed Nursing Home Modernization Reform Act of 2019. No bill number, discussed Elder Justice Act Reauthorization and nursing home bill. S. 2807, discussed Hospice Care Improvement Act of 2019. H.R. 1343, Protecting Married Seniors from Impoverishment Act. Discussed Medicaid home and community-based services and family financial impacts. No bill number. Discussed nursing homes, criminal background checks, inappropriate use of anti-psychotropic drugs, guardianship, and Elder Justice Act Reauthorization. H.R. 5821, Helping Our Senior Population in Comfort Environments (HOSPICE) Act. Discussed HOSPICE Act and live discharges of long-term terminally ill individuals from hospice. S. 3277; Discussed feedback on HCBS Infrastructure Improvement Act and the bill. No bill number. Discussed long-term services and supports financing legislation, Social Security, Administrations Medicaid guidance, and Ways and Means Caring for Aging Americans hearing statement from November 2019. No bill number. Discussed family caregiving supports, Medicare Advantage (MA) Value-Based Insurance Design (VBID) Demonstration, and the MA VBID hospice demonstration component. H.R. 5821, Helping Our Senior Population in Comfort Environments Act. No bill number. Discussed issues impacting dual-eligibles. S. 296/H.R.2150, Home Health Care Planning Improvement Act. No bill number. CMS nursing home Coronavirus guidance. No bill number. Discussed nursing home virtual visitation. S. 3548/H.R. 748, P.L. 116-136, CARES Act Lobbied regarding nursing homes, virtual visitation, home and community-based services, Older Americans Act programs, Medicare home health care, and family caregiving. S.1999 - Improving Low Income Access to Prescription Drugs Act. H.R. 3, the Lower Drug Costs Now Act. S. 2543, the Prescription Drug Pricing Reduction Act. No bill number - Discussed surprise medical billing. H.R. 5800 - Ban Surprise Billing Act. H.R. 5826 - Consumer Protections Against Surprise Medical Bills Act. No bill number - Discussed Alaska-specific nursing home legislation.

P.L. 115-119, RAISE Family Caregivers Act. Discussed the law and the Family Caregiving Advisory Councils work, including additional funding. Lifespan Respite Care Reauthorization Act (S. 995/H.R. 2035). No bill - Assisting family caregivers in addressing the financial challenges of family caregiving S. 110, the Medical Expense Savings Act,; H.R. 2073, to extend the 7.5 percent adjusted gross income floor for the medical expense deduction. S. 3057, Modernization of the Older Americans Act Amendments. S. 299, Geriatrics Workforce Improvement Act. No bill number, drug pricing. S. 591, the Guardianship Accountability Act/guardianship, retirement security, elder justice, scams, fraud, biomedical research. H.R. 4334, Supporting Older Americans Act of 2020 and OAA reauthorization No bill number. Discussed Assisting Caregivers Today (ACT) and potential event with ACT Caucus. H.R. 1342, EMPOWER Care Act.; H.R. 1343, Protecting Married Seniors from Impoverishment Act. H.R. 2035, Lifespan Respite Care Reauthorization Act.; No bill number. Discussed Senior Guardianship Attack Force legislative proposal. S. 3517, Discussed Advancing Connectivity during the Coronavirus to Ensure Support for Seniors Act (ACCESS Act). No bill number. CMS nursing home Coronavirus guidance. No bill number. Discussed nursing home virtual visitation. S. 3548/H.R. 748, Lobbied regarding nursing homes, virtual visitation, home and community-based services, Older Americans Act programs, Medicare home health care, and family caregiving. H.R. 6379, Take Responsibility for Workers and Families Act. Discussed virtual visitation provisions and Medicaid HCBS grants. H.R. 6305, To assist older Americans and people with disabilities affected by COVID-19; S. 3544, Coronavirus Relief for Seniors and People with Disabilities Act. P.L. 115-182, VA MISSION Act. Discussed VA Caregiver Support Program and proposed rule.

Support H.R.1265 &H.R.4468 - Nursing Home Workforce Quality Act- to end the mandatory certified nursing assistant training lock out. Support H.R.1343 Protecting Married Seniors from Impoverishment Act, to extend the Money Follows the Person Act and protection against impoverishment for spouses of Medicaid beneficiaries receiving long term services and supports at home. Support H.R.1342 - EMPOWER Care Act, to reauthorize Money Follows the Person for 5 years. Support H.R 1682/S. 753- Improving Access to Medicare Coverage Act of 2019, to solve the Medicare "observation days" issue by counting all time a beneficiary spends in a hospital toward the 3-day stay requirement for coverage of post-acute care. Support H.R.2594/ S.1190 - Rural Access to Hospice Act of 2019 Support H.R 2150, Home Health Care Planning Improvement Act Support H.R.4063 - Medicare Adult Day Services Act of 2019

Client expense: $42,017 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

P.L. 111-375 National Alzheimer's Project Act, All Sections P.L. 115-119 Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act P.L. 115-406 Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act S.591 Guardianship Accountability Act S.299 Geriatrics Workforce Improvement Act S.548/H.R.1342 EMPOWER Care Act H.R.1343 Protecting Married Seniors from Impoverishment Act S.740 Alzheimer's Caregiver Support Act H.R. 1955 Understanding Appropriate Alzheimer's Care Act of 2019 S.880/H.R.1873 Improving HOPE for Alzheimer's Act H.R.1903/S.901 Younger-Onset Alzheimer's Disease Act of 2019 S.2080/H.R.647 Palliative Care and Hospice Education and Training Act S.1250/H.R.2401 American Cures Act S.1017 Supporting America's Caregivers and Families Act S.995/H.R.2035 Lifespan Respite Care Reauthorization Act of 2019 S.1126/H.R.2283 Concentrating on High-Value Alzheimer's Needs to Get to an End (CHANGE) Act of 2019 S.1361/H.R.2584 Preventive Health Savings Act of 2019 S.1628 Paid Family Leave Pilot Extension Act S.1618 Expanding Capacity for Health Outcomes (ECHO) Act of 2019 S.1202 Independence at Home Act of 2019 H.R.3644 Independence at Home Demonstration Act of 2019 H.R.3436 Improving Chronic Care Management Act H.R.3107 Improving Seniors' Timely Access to Care Act H.R.4334 Dignity in Aging Act of 2019 S.2469/H.R.4386 Stop the Wait Act H.R.2781 Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) for Health Act of 2019 S.2521/H.R.4397 Direct CARE Opportunity Act S.3057 Modernization of the Older Americans Act Amendments S.2677 Older Americans and Social Isolation and Loneliness Act H.R.4859 Protecting Older Americans from Social Isolation Act of 2019

Client expense: $400,000 · Firm income: Not reported

S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims S. 1114, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap S. 2081, Stop Drug Companies from Overcharging Seniors in Medicare Part B Act of 2019 (Peters)- drugs in Part B S. 2252, Empowering States to Address Drug Costs Act (Van Hollen)- drug pricing S. 2446, Medicare Audiologist Access and Services Act of 2019 (Warren)-Medicare coverage of audiologist services S. 2650 - Medicare Prescription Drug Savings and Choice Act of 2019 (Durbin) - lowering prescription drug costs S. 2807, Hospice Care Improvement Act of 2019 (Portman) - Medicare hospice programs S. 2846, Protecting Patients Transportation to Care Act (Isakson) - Medicaid coverage of transportation S. 2911, Seniors Prescription Drug Relief Act of 2019 (Cassidy) - Part D smoothing S. 3000, Patient Shared Savings Act (Cassidy) - prescription drug plans S. 3001, Permanent Relief for Seniors and Medicare, Medicaid, Human Services Extension Act of 2019 (Toomey) - extensions S. 3029, Territories Medicare Prescription Drug Assistance Equity Act of 2019 (Menendez) - Territories, low-income Medicare part D beneficiaries S. 3078, Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2019 (Grassley) - Medicare appeals process S. 3129, Lower Costs, More Cures Act of 2019 (Crapo) - drug pricing H.R. 19, Lower Costs, More Cures Act of 2019 (Walden) - drug pricing H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program, health homes for children with medically complex conditions H.R. 2131, Medicare Advantage Quality Payment Relief Act (Kind-Kelly) - MA benchmark cap H.R. 2757, Creating Lower Cost Alternatives for Your Prescription Drugs Act (Cunningham) - eliminate copay for generic drugs in Medicare Part D H.R. 3107, Improving Seniors' Timely Access to Care Act (DelBene) - Medicare Advantage prior authorization H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act (Dingell) - MFP demonstration, spousal impoverishment protections, Medicaid drug rebate program H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act (Neal) - funding for quality measurement initiatives, Medicare coverage of mental health telehealth services, real-time benefit tools in Medicare Part D, Medicare eligibility and enrollment notices H.R. 3461, Community-Based Independence for Seniors Act (Sanchez-Kelly) - Community-Based Institutional Special Needs Plan H.R. 3613, State Accountability, Flexibility, and Equity for Hospitals Act of 2019 (Bilirakis) -Medicaid DSH payments H.R. 3631, Territories Health Care Improvement Act (Soto) -Medicaid funding H.R. 3644, Independence at Home Demonstration Act of 2019 (Burgess)-Medicare demonstration program H.R. 3925, Reducing Barriers to Substance Use Treatment Act (Tonko)- Opioids H.R. 3935, Protecting Patients Transportation to Care Act (Carter)-Medicaid coverage for transportation H.R. 4378, Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (Lowey)-Health extenders H.R. 4453, Protecting Seniors from Health Care Fraud Act of 2019 (Ruiz)-Distributing information to Medicare beneficiaries to prevent fraud H.R. 4527, Expanding Health Care Options for Early Retirees Act (Malinowski)-Option for first responders to buy-in to Medicare H.R. 4529, Promoting Access to Broadband Act of 2019 (Maloney)-Medicaid H.R. 4583, Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 (Schneider) - prescription drug affordability H.R. 4597, Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars Act of 2019 (Peters) - biosimilars, Part B H.R. 4618, Medicare Hearing Act of 2019 (McBath) - coverage for certain hearing items and services under part B H.R. 4619, Pharmaceutical Rebates for Excessive Pricing Above Inflation Act (Schakowsky) - drug rebates, Part D H.R. 4620, More Help for Seniors Act of 2019 (Rose) - expand eligibility for low-income subsidies under Part D of the Medicare program H.R. 4621, Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 (Blunt Rochester) - best practices re social determinants of health H.R. 4628, Better Tools to Lower Costs Act of 2019 (Scanlon) - resource requirements H.R. 4629, Star Rating for Biosimilars Act (Tonko) - biosimilars H.R. 4632, Better Transparency in Information for Medicare Beneficiaries Act of 2019 (Kind) - provides consumers information regarding premiums under LIS benchmark plans H.R. 4649, Capping Drug Costs for Seniors Act of 2019 (Horsford) - cap on beneficiary liability under part D of the Medicare program H.R. 4650, Medicare Dental Act of 2019 (Kelly) - Medicare dental coverage H.R. 4655, Enhancing Retirement Security for Medicare Beneficiaries Act of 2019 (Lee) - eligibility of individuals for premium and cost-sharing subsidies under part D H.R. 4661, Advancing Enrollment and Reducing Drug Costs Act of 2019 (Pappas) - Medicaid in territories H.R. 4663, Freedom from Price Gouging Act (Porter) - drug rebates, Part B H.R. 4665, Medicare Vision Act of 2019 (Schrier) - vision items and services under part B H.R. 4666, To amend title XVIII of the Social Security Act to provide certain low-income territorial residents with automatic eligibility for premium and cost-sharing subsidies under the Medicare program, and for other purposes (Shalala) - Medicare in territories H.R. 4669, Maximizing Drug Coverage for Low-Income Seniors Act of 2019 (Stevens) - auto enrollment and intelligent assignment H.R. 4671, Helping Seniors Afford Health Care Act (Kim) - Medicare affordability and low income beneficiaries H.R. 4676, Protecting Medicare Beneficiaries with Pre-Existing Conditions Act (Schneider) - Medigap H.R. 4699, To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals (Gonzales-Colon) - Part D, territories H.R. 4769, Medicare Prescription Drug Savings and Choice Act of 2019 (Schakowsky) - lowering prescription drug costs H.R. 4946, Ensuring Seniors Access to Local Pharmacies Act of 2019 (Welch) - equal access of Medicare beneficiaries to community pharmacies in underserved areas H.R. 4996, Helping Medicaid Offer Maternity Services Act of 2019 (Kelly) - State extension of Medicaid H.R. 5006, Expanding Access to Inpatient Mental Health Act (Emmer) - Medicaid coverage for SUD/mental health for institutionalized H.R. 5039, Life Sustaining Prescription Drug Price Relief Act of 2019 (Lipinski) - part D H.R. 5057, Pass- Through Technical Corrections Act (Tonko) - drug pass-through status under Medicare outpatient payment H.R. 5201, Telemental Health Expansion Act of 2019 (Matsui) - Medicare coverage of mental telehealth H.R. 5232, Road to Recovery Act (Fitzpatrick) - Medicaid and CHIP SUD treatment H.R. 5281, Drug Price Transparency in Medicaid Act of 2019 (Carter) - transparency and spread pricing affordability Discussion Draft, Medicare Part D Reform (Neal-Pallone-Brady-Walden) - maximum out-of-pocket limit, federal reinsurance payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2021 Rate Notice and Call Letter; issues related to MLTSS; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

Legislative and administrative monitoring and outreach on healthcare policy. Legislative and administrative monitoring and outreach on prescription drug pricing/PBMs. Legislative and administrative monitoring and outreach on policy issues affecting Medicaid programs. Legislative and administrative monitoring and outreach on the implementation of the Affordable Care Act (ACA) (P.L. 111-148) Monitor the implementation of SAMHSA final rule regarding the Confidentiality of substance use disorder patient records (83 FR 239). Legislative and administrative monitoring and outreach on issues regarding the health insurance tax (HIT). H.R. 3 Lower Drug Costs Now Act of 2019 H.R. 259 Medicaid Extenders Act of 2019 (P.L. 116-3). H.R. 987 Strengthening Health Care and Lowering Prescription Drug Costs Act H.R. 1343 Protecting Married Seniors from Impoverishment Act H.R. 1398 Health Insurance Tax Relief Act of 2019 H.R. 2447 Jobs and Premium Protection Act HR 3253 Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019 S. 172 Health Insurance Tax Relief Act of 2019 S. 1895 Lower Health Care Costs Act HR 1865 Further Consolidated Appropriations Act (PL 116-94)

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

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. Expansion of Medicare benefits to include hearing, vision, and dental benefits 8. Administration of the Medicare State Health Insurance Assistance Programs 9. Medicare Observation Status Regulations 10. Nursing Home Arbitration Regulations 11. Medicare 340(B) drug reimbursement policy 12. Home care workers and Medicare Reassignment Policy 13. Medicare equitable relief policy 14. S. 340, CREATES Act of 2019, entire bill 15. H.R. 965, CREATES Act of 2019, entire bill 16. H.R. 1046, Medicare Negotiation and Competitive Licensing Act of 2019, entire bill 17. CMS Proposals on Part D Drug Pricing 18. S. 691, Medicare Extra Rx HELP Act of 2019, entire bill 19. H.R. 1342, EMPOWER Care Act, entire bill 20. S. 548, EMPOWER Care Act, entire bill 21. H.R. 1343, Protecting Married Seniors from Impoverishment Act, entire bill 22. S. 97, Affordable and Safe Prescription Drug Importation Act, entire bill 23. S. 99, Medicare Drug Price Negotiation Act, entire bill 24. H.R. 3, Lower Drug Costs Now Act of 2019, entire bill 25. H.R. 1393, Medicare Dental, Vision and Hearing Benefit Act of 2019, entire bill 26. H.R. 1394, Medigap Consumer Protection Act of 2019, entire bill 27. H.R. 1682, Improving Access to Medicare Coverage Act of 2019, entire bill 28. H.R. 4386, Stop the Wait Act, entire bill 29. Proposals regarding the tiering generic drugs under Medicare Part D

H.R. 3 Lower Drug Costs Now Act of 2019 -allowing Medicare to negotiate prescription drug prices, limiting the ability of drug companies to spike their prices overnight, ensuring that actions to address egregious prices apply to coverage beyond Medicare S. 2543 Prescription Drug Pricing Reduction Act of 2019 - comprehensive legislation to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers H.AR. 4663 Freedom from Price Gouging Act - require drug manufacturers to pay a Medicare part B rebate for certain drugs if the price of such drugs increases faster than inflation. S. 64 Preserve Access to Affordable Generics and Biosimilars Act - prohibit brand name drug companies from compensating generic drug companies to delay the entry of a generic drug into the market, and to prohibit biological product manufacturers from compensating biosimilar and interchangeable companies to delay the entry of biosimilar biological products and interchangeable biological products S.3092 Expanding Access to Low Cost Generics Act - Subjecting insulin to the new pathway to bring low-cost, generic insulin products to market S.2628 - Equity in Pretrial Medicaid Coverage Act of 2019 - remove a limitation on an individual's eligibility for medical assistance under the State Medicaid plan while the individual is in custody pending disposition of charges. H.R. 913 - CLINICAL TREAMENT Act - requires state Medicaid programs to cover routine patient costs for items and services that are provided in connection with a qualifying clinical trial regarding cancer or other life-threatening conditions Legislation to restore Medicaid eligibility to people from the Freely Associated States who are living in the U.S. under the terms of the Compacts of Free Association (COFA). H.R.1393 Medicare Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare program. H.R.576 Seniors Have Eyes, Ears, and Teeth Act - expands Medicare coverage to include eyeglasses, hearing aids, and dental care. S.22/H.R.2951 Medicare Dental Benefit Act of 2019 - coverage of dental services under Medicare Part B H.R.1342 EMPOWER Care Act - reauthorize the Money Follows the Person Demonstration Program H.R. 1343 - Protecting Married Seniors Act - provisions regarding Medicaid eligibility that protect against spousal impoverishment for recipients of home and community-based services. S.99 / H.R.448 - The Medicare Drug Price Negotiation Act - negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D H.R.1046 / S.377 Medicare Negotiation and Competitive Licensing Act of 2019 - requiring Secretary of Health and Human Services to negotiate prices of prescription drugs furnished under part D of the Medicare program H.R.4671 Helping Seniors Afford Health Care Act of 2019 - reduce cost-sharing, align income and resource eligibility tests, simplify enrollment, and provide for other program improvements for low-income Medicare beneficiaries. H.R. 4996 Helping Medicaid Offer Maternity Services Act of 2019 - MOMs Act - provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individual H.R.1329 Medicaid Reentry Act - allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release H.R.1354 Territories Health Equity Act - make improvements to the treatment of the United States territories under the Medicare and Medicaid programs H.R.1384, S.1129 Medicare for All Act - establishes a national health insurance program Medicare Prescription Drug Savings and Choice Act - public option for drug coverage within Medicare Part D HEAL for Immigrant Women and Families Act of 2019 - Removes the five year waiting period for immigrants to become eligible for Medicaid and CHIP S.1423Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare and Medicaid programs S.1280BENES Act - establish a system to notify individuals approaching Medicare eligibility, to simplify and modernize the eligibility enrollment process

Issues related to Medicaid Home-Based Care; Medicaid Extenders (H.R. 259, H.R. 1839, H.R. 3253), Protecting Married Seniors from Impoverishment Act (H.R. 1343), EMPOWER Care Act (H.R. 1342).

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

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

Issues related to Medicaid Home-Based Care; Medicaid Extenders (H.R. 259, H.R. 1839, H.R. 3253), Protecting Married Seniors from Impoverishment Act (H.R. 1343), EMPOWER Care Act (H.R. 1342).

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

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

Senate amendment to H.R. 1865 - National Law Enforcement Museum Commemorative Coin Act [Further Consolidated Appropriations Act, 2020], Division N, Secs. 204 and 205. These provisions extend the Medicaid spousal impoverishment protections for home and community based services and the Money Follows the Person demonstration project. Support for: S.2000/H.R. 1343, Protecting Married Seniors from Impoverishment Act H.R. 1342, the Empower Care Act Possible legislation to improve state infrastructure for home and community based services.

Client expense: $66,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

P.L. 111-375 National Alzheimer's Project Act, All Sections P.L. 115-119 Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act P.L. 115-406 Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act S.591 Guardianship Accountability Act S.299 Geriatrics Workforce Improvement Act S.548/H.R.1342 EMPOWER Care Act H.R.1343 Protecting Married Seniors from Impoverishment Act S.740 Alzheimer's Caregiver Support Act H.R. 1955 Study on Use of Anti-Psychotics in Non-nursing Homes S.880/H.R.1873 Improving HOPE for Alzheimer's Act H.R.1903/S.901 Younger-Onset Alzheimer's Disease Act of 2019 S.2080/H.R.647 Palliative Care and Hospice Education and Training Act S.1250/H.R.2401 American Cures Act S.1017 Supporting America's Caregivers and Families Act S.995/H.R.2035 Lifespan Respite Care Reauthorization Act of 2019 S.1126/H.R.2283 Concentrating on High-Value Alzheimer's Needs to Get to an End (CHANGE) Act of 2019 S.1361/H.R.2584 Preventive Health Savings Act of 2019 S.1628 Paid Family Leave Pilot Extension Act H.R.2878 Homecare for Seniors Act S.1618 Expanding Capacity for Health Outcomes (ECHO) Act of 2019 S.1202 Independence at Home Act of 2019 H.R.3644 Independence at Home Demonstration Act of 2019 H.R.3436 Improving Chronic Care Management Act H.R.3107 Improving Seniors' Timely Access to Care Act H.R.4334 Dignity in Aging Act of 2019 S.2469/H.R.4386 Stop the Wait Act

Client expense: $500,000 · Firm income: Not reported

Support for: S.2000/H.R. 1343, Protecting Married Seniors from Impoverishment Act H.R. 1342, the Empower Care Act H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019, Sec. 2 & 4 Possible legislation to improve state infrastructure for home and community based services.

Client expense: $66,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Social Security Administration (SSA)

Support H.R. 1265 and H.R. 4468, the Nursing Home Workforce Quality Act, to end the mandatory certified nursing assistant training lock-out Support H.R. 1343 and H.R. 1839, to extend the Money Follows the Person Act and protection against impoverishment for spouses of Medicaid beneficiaries receiving long-term services and supports at home. Support H.R. 1342, the EMPOWER Act, to reauthorize Money Follows the Person for 5 years. Support H.R. 1682/S. 753, to solve the Medicare "observation days" issue by counting all time a beneficiary spends in a hospital toward the 3-day stay requirement for coverage of post-acute care Support H.R. 2594/S. 1190, Rural Access to Hospice Act Support H.R. 2150, Home Health Care Planning Improvement Act Support H.R. 4063, Adult Day Services Act Support H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act

Client expense: $38,793 · Firm income: Not reported

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

Issues related to Medicaid Home-Based Care; Medicaid Extenders (H.R. 259, H.R. 1839, H.R. 3253), Protecting Married Seniors from Impoverishment Act (H.R. 1343), EMPOWER Care Act (H.R. 1342).

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

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

Issues related to Medicaid Home-Based Care; Medicaid Extenders (H.R. 259, H.R. 1839, H.R. 3253), Protecting Married Seniors from Impoverishment Act (H.R. 1343), EMPOWER Care Act (H.R. 1342).

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

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

Legislative and administrative monitoring and outreach on healthcare policy. Legislative and administrative monitoring and outreach on prescription drug pricing/PBMs. Legislative and administrative monitoring and outreach on policy issues affecting Medicaid programs. Legislative and administrative monitoring and outreach on the implementation of the Affordable Care Act (ACA) (P.L. 111-148) Monitor the implementation of SAMHSA final rule regarding the Confidentiality of substance use disorder patient records (83 FR 239). Legislative and administrative monitoring and outreach on issues regarding the health insurance tax (HIT). H.R. 3 Lower Drug Costs Now Act of 2019 H.R. 259 Medicaid Extenders Act of 2019 (P.L. 116-3). H.R. 987 Strengthening Health Care and Lowering Prescription Drug Costs Act H.R. 1343 Protecting Married Seniors from Impoverishment Act H.R. 1398 Health Insurance Tax Relief Act of 2019 H.R. 2447 Jobs and Premium Protection Act HR 3253 Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019 S. 80 Jobs and Premium Protection Act S. 172 Health Insurance Tax Relief Act of 2019 S. 1895 Lower Health Care Costs Act

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

S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims S. 1114, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap S. 2081, Stop Drug Companies from Overcharging Seniors in Medicare Part B Act of 2019 (Peters)- drugs in Part B S. 2252, Empowering States to Address Drug Costs Act (Van Hollen)- drug pricing S. 2446, Medicare Audiologist Access and Services Act of 2019 (Warren)-Medicare coverage of audiologist services H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program, health homes for children with medically complex conditions H.R. 2131, Medicare Advantage Quality Payment Relief Act (Kind-Kelly) - MA benchmark cap H.R. 2757, Creating Lower Cost Alternatives for Your Prescription Drugs Act (Cunningham) - eliminate copay for generic drugs in Medicare Part D H.R. 3107, Improving Seniors' Timely Access to Care Act (DelBene) - Medicare Advantage prior authorization H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act (Dingell) - MFP demonstration, spousal impoverishment protections, Medicaid drug rebate program H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act (Neal) - funding for quality measurement initiatives, Medicare coverage of mental health telehealth services, real-time benefit tools in Medicare Part D, Medicare eligibility and enrollment notices H.R. 3461, Community-Based Independence for Seniors Act (Sanchez-Kelly) - Community-Based Institutional Special Needs Plan Discussion Draft, Medicare Part D Reform (Neal-Pallone-Brady-Walden) - maximum out-of-pocket limit, federal reinsurance payments H.R. 3613, State Accountability, Flexibility, and Equity for Hospitals Act of 2019 (Bilirakis) -Medicaid DSH payments H.R. 3631, Territories Health Care Improvement Act (Soto) -Medicaid funding H.R. 3644, Independence at Home Demonstration Act of 2019 (Burgess)-Medicare demonstration program H.R. 3925, Reducing Barriers to Substance Use Treatment Act (Tonko)- Opioids H.R. 3935, Protecting Patients Transportation to Care Act (Carter)-Medicaid coverage for transportation H.R. 4378, Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (Lowey)-Health extenders H.R. 4453, Protecting Seniors from Health Care Fraud Act of 2019 (Ruiz)-Distributing information to Medicare beneficiaries to prevent fraud H.R. 4527, Expanding Health Care Options for Early Retirees Act (Malinowski)-Option for first responders to buy-in to Medicare H.R. 4529, Promoting Access to Broadband Act of 2019 (Maloney)-Medicaid Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2020 Rate Notice and Call Letter; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. Expansion of Medicare benefits to include hearing, vision, and dental benefits 8. Administration of the Medicare State Health Insurance Assistance Programs 9. Medicare Observation Status Regulations 10. Nursing Home Arbitration Regulations 11. Medicare 340(B) drug reimbursement policy 12. Home care workers and Medicare Reassignment Policy 13. Medicare equitable relief policy 14. S. 340, CREATES Act of 2019, entire bill 15. H.R. 965, CREATES Act of 2019, entire bill 16. H.R. 1046, Medicare Negotiation and Competitive Licensing Act of 2019, entire bill 17. CMS Proposals on Part D Drug Pricing 18. S. 691, Medicare Extra Rx HELP Act of 2019, entire bill 19. H.R. 1342, EMPOWER Care Act, entire bill 20. S. 548, EMPOWER Care Act, entire bill 21. H.R. 1343, Protecting Married Seniors from Impoverishment Act, entire bill 22. S. 97, Affordable and Safe Prescription Drug Importation Act, entire bill 23. S. 99, Medicare Drug Price Negotiation Act, entire bill 24. H.R. 3, Lower Drug Costs Now Act of 2019, entire bill 25. H.R. 1393, Medicare Dental, Vision and Hearing Benefit Act of 2019, entire bill 26. H.R. 1394, Medigap Consumer Protection Act of 2019, entire bill 27. H.R. 1682, Improving Access to Medicare Coverage Act of 2019, entire bill 28. H.R. 4386, Stop the Wait Act, entire bill

H.R. 3 Lower Drug Costs Now Act of 2019 -allowing Medicare to negotiate prescription drug prices, limiting the ability of drug companies to spike their prices overnight, ensuring that actions to address egregious prices apply to coverage beyond Medicare S. 2543 Prescription Drug Pricing Reduction Act of 2019 - comprehensive legislation to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers H.R. 3853 Personal Needs Allowance Modernization Act of 2019 - increase under the Medicaid program the minimum monthly personal needs allowance for institutionalized individuals and couples H.R.4386 Stop the Wait Act - eliminate the Medicare and disability insurance benefits waiting periods for disabled individuals. H.R.1393 Medicare Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare program. H.R.576 Seniors Have Eyes, Ears, and Teeth Act - expands Medicare coverage to include eyeglasses, hearing aids, and dental care. S.22/H.R.2951 Medicare Dental Benefit Act of 2019 - coverage of dental services under Medicare Part B H.R.1342 EMPOWER Care Act - reauthorize the Money Follows the Person Demonstration Program H.R. 1343 - Protecting Married Seniors Act - provisions regarding Medicaid eligibility that protect against spousal impoverishment for recipients of home and community-based services. S.99 / H.R.448 - The Medicare Drug Price Negotiation Act - negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D H.R.1046 / S.377 Medicare Negotiation and Competitive Licensing Act of 2019 - requiring Secretary of Health and Human Services to negotiate prices of prescription drugs furnished under part D of the Medicare program S.470 Medicare at 50 Act - option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R.1329 Medicaid Reentry Act - allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release H.R.1354 Territories Health Equity Act - make improvements to the treatment of the United States territories under the Medicare and Medicaid programs H.R.1384, S.1129 Medicare for All Act - establishes a national health insurance program Medicare Prescription Drug Savings and Choice Act - public option for drug coverage within Medicare Part D HEAL for Immigrant Women and Families Act of 2019 - Removes the five year waiting period for immigrants to become eligible for Medicaid and CHIP H.R.2463, S.1261 Choose Medicare Act - establishment of Medicare part E public health plans S.1423Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare and Medicaid programs

P.L. 111-375 National Alzheimer's Project Act, All Sections P.L. 115-119 Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act P.L. 115-406 Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act S.591 Guardianship Accountability Act S.299 Geriatrics Workforce Improvement Act S.548/H.R.1342 EMPOWER Care Act H.R.1343 Protecting Married Seniors from Impoverishment Act S.740 Alzheimer's Caregiver Support Act H.R. 1955 Study on Use of Anti-Psychotics in Non-nursing Homes S.880/H.R.1873 Improving HOPE for Alzheimer's Act H.R.1903/S.901 Younger-Onset Alzheimer's Disease Act of 2019 H.R.647 Palliative Care and Hospice Education and Training Act S.1250/H.R.2401 American Cures Act S.1017 Supporting America's Caregivers and Families Act S.995/H.R.2035 Lifespan Respite Care Reauthorization Act of 2019 S.1126/H.R.2283 Concentrating on High-Value Alzheimer's Needs to Get to an End (CHANGE) Act of 2019 S.1361/H.R.2584 Preventive Health Savings Act of 2019 S.1628 Paid Family Leave Pilot Extension Act H.R.2878 Homecare for Seniors Act S.1618 Expanding Capacity for Health Outcomes (ECHO) Act of 2019 S.1202 Independence at Home Act of 2019 H.R.3436 Improving Chronic Care Management Act

Client expense: $871,000 · Firm income: Not reported

S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims S. 1114, Medicare Advantage Quality Payment Relief Act (Daines-King) - MA benchmark cap H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program, health homes for children with medically complex conditions H.R. 2131, Medicare Advantage Quality Payment Relief Act (Kind-Kelly) - MA benchmark cap H.R. 2757, Creating Lower Cost Alternatives for Your Prescription Drugs Act (Cunningham) - eliminate copay for generic drugs in Medicare Part D H.R. 3107, Improving Seniors' Timely Access to Care Act (DelBene) - Medicare Advantage prior authorization H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act (Dingell) - MFP demonstration, spousal impoverishment protections, Medicaid drug rebate program H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act (Neal) - funding for quality measurement initiatives, Medicare coverage of mental health telehealth services, real-time benefit tools in Medicare Part D, Medicare eligibility and enrollment notices H.R. 3461, Community-Based Independence for Seniors Act (Sanchez-Kelly) - Community-Based Institutional Special Needs Plan Discussion Draft, Medicare Part D Reform (Neal-Pallone-Brady-Walden) - maximum out-of-pocket limit, federal reinsurance payments Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2020 Rate Notice and Call Letter; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

H.R. 2740 Labor-HHS Appropriations bill, FY 2020 - lobbied in support of increased funding for CMS' state survey and certification program and opposition to hostile policy riders re Patient Protection and Affordable Care Act. Discussed civil money penalties for enforcement in nursing homes. Lobbied CMS. Discussed nursing home quality and enforcement issues and shared relevant information. Discussed draft nursing home bill. Submitted and shared statement for the record for Senate Finance Committee nursing home hearing. Discussed nursing homes, including the Special Focus Facility Program (no bill number). Discussed emergency preparedness regulations for nursing homes. S. 117/H.R. 555, Disability Integration Act -discussed bill language, support for, and introduction of the bill. No bill number - discussed Money Follows the Person Rebalancing Demonstration Program and Medicaid home and community-based services (HCBS) spousal impoverishment protections and extending them. S. 753/H.R. 1682 - Improving Access to Medicare Coverage Act - shared AARP support letters for the legislation, discussed the bill, and shared related information. P.L. 114-42, NOTICE Act - discussed transparency/surprise medical billing, including observation issues and related prior legislation. S. 548/H.R. 1342, EMPOWER Care Act - discussed and shared AARPs support for the bill. H.R. 1343, Protecting Married Seniors from Impoverishment Act - discussed and shared AARPs support for the bill. S. 296, Home Health Planning Improvement Act - discussed and shared support for the bill. No bill number - discussed issues affecting dully eligible individuals. Discussed surprise billing and health care price transparency. Discussed oral health coverage in Medicare. S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 - joined letter of endorsement. S. 286/H.R. 945 - Mental Health Access Improvement Act - sent letter of endorsement. H.R. 1301 - Mental Health Telemedicine Expansion Act - sent letter of endorsement. S.1999 - Improving Low Income Access to Prescription Drugs Act. H.R. 1682/S. 753, Improving Access to Medicare Coverage Act - discussed support for bill and urged cosponsorship. H.R. 2150, Home Health Care Planning Improvement Act - discussed and shared support letter for bill. Discussed extension of Money Follows the Person Rebalancing Demonstration Program and Medicaid home and community-based services spousal impoverishment protections. Lobbied House and Senate staff. S. 2000, Protecting Married Spouses from Impoverishment Act - discussed and supported bill with Senate staff. H.R. 1342, EMPOWER Care Act - discussed support for the bill and provided information on the Money Follows the Person Rebalancing Demonstration Program. H.R. 555/S. 117, Disability Integration Act - discussed the bill and shared endorsement letter. S. 1895 - Lower Health Care Costs Act - Discussed and sent letter to HELP committee S. 1531 - Stopping The Outrages Practice (STOP) of Surprise Medical Bills Act - Discussed with bill sponsors S. 1280/H.R. 2477 - Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act - Sent letter of endorsement No bill number. Provided feedback on Home Health Care CAHPS survey (CMS). No bill number. Discussed nursing home bill regarding nursing home resident personal needs allowances. No bill number. Discussed Medicaid provisions in federal domestic worker bill of rights. No bill number. Discussed nursing home quality, regulation, enforcement, and arbitration. No bill number - discussed skilled nursing facility value-based purchasing. No bill number - responded to inquiry regarding Medicaid and Senior Care Act. S. 1202, Independence at Home Act of 2019 - discussed the bill. No bill number. Discussed Medicaid managed long-term services and supports and family caregiving. No bill number - Discussed draft No Surprises Act bill on surprise medical billing Discussed oral health coverage in Medicare

Issues related to Medicaid Home-Based Care; Medicaid Extenders (H.R. 259, H.R. 1839, H.R. 3253), Protecting Married Seniors from Impoverishment Act (H.R. 1343), EMPOWER Care Act (H.R. 1342).

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

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

Issues related to Medicaid Home-Based Care; Medicaid Extenders (H.R. 259, H.R. 1839, H.R. 3253), Protecting Married Seniors from Impoverishment Act (H.R. 1343), EMPOWER Care Act (H.R. 1342).

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

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

Support H.R. 1265, the Nursing Home Workforce Quality Act, to end the mandatory certified nursing assistant training lock-out Support H.R. 1343 and H.R. 1839, to extend the Money Follows the Person Act and protection against impoverishment for spouses of Medicaid beneficiaries receiving long-term services and supports at home. Support H.R. 1342, the EMPOWER Act, to reauthorize Money Follows the Person for 5 years. Support H.R. 1682/S. 753, to solve the Medicare "observation days" issue by counting all time a beneficiary spends in a hospital toward the 3-day stay requirement for coverage of post-acute care

Client expense: $82,498 · Firm income: Not reported

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

H.R.2757 Creating Lower Cost Alternative for Your (CLAY) Prescription Drug Act - would eliminate cost-sharing for generic drugs for low-income Medicare beneficiaries H.R.1393 Medicare Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare program. H.R.576 Seniors Have Eyes, Ears, and Teeth Act - expands Medicare coverage to include eyeglasses, hearing aids, and dental care. S.22 Medicare Dental Benefit Act of 2019 - coverage of dental services under Medicare Part B H.R.1342 EMPOWER Care Act - reauthorize the Money Follows the Person Demonstration Program H.R. 1343 - Protecting Married Seniors Act - provisions regarding Medicaid eligibility that protect against spousal impoverishment for recipients of home and community-based services. S.99 / H.R.448 - The Medicare Drug Price Negotiation Act - negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D H.R.1046 / S.377 Medicare Negotiation and Competitive Licensing Act of 2019 - requiring Secretary of Health and Human Services to negotiate prices of prescription drugs furnished under part D of the Medicare program S.470 Medicare at 50 Act - option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R.1329 Medicaid Reentry Act - allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release H.R.1354 Territories Health Equity Act - make improvements to the treatment of the United States territories under the Medicare and Medicaid programs H.R.3215, S.1754 The Disaster Relief Medicaid Act - provide Medicaid assistance to individuals and families affected by a disaster or emergency H.R.1384, S.1129 Medicare for All Act - establishes a national health insurance program H.R.2477, S.1280 Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act - establish a system to notify individuals approaching Medicare eligibility, to simplify and modernize the eligibility enrollment process Medicare Prescription Drug Savings and Choice Act - public option for drug coverage within Medicare Part D H.R.2463, S.1261 Choose Medicare Act - establishment of Medicare part E public health plans S.1423 Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare and Medicaid programs

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. Expansion of Medicare benefits to include hearing, vision, and dental benefits 8. Administration of the Medicare State Health Insurance Assistance Programs 9. Medicare Observation Status Regulations 10. Nursing Home Arbitration Regulations 11. Medicare 340(B) drug reimbursement policy 12. Home care workers and Medicare Reassignment Policy 13. Medicare equitable relief policy 14. S. 340, CREATES Act of 2019, entire bill 15. H.R. 965, CREATES Act of 2019, entire bill 16. H.R. 1046, Medicare Negotiation and Competitive Licensing Act of 2019, entire bill 17. CMS Proposals on Part D Drug Pricing 18. S. 691, Medicare Extra Rx HELP Act of 2019, entire bill 19. H.R. 1342, EMPOWER Care Act, entire bill 20. S. 548, EMPOWER Care Act, entire bill 21. H.R. 1343, Protecting Married Seniors from Impoverishment Act, entire bill 22. S. 97, Affordable and Safe Prescription Drug Importation Act, entire bill 23. S. 99, Medicare Drug Price Negotiation Act, entire bill 24. CMS efforts regarding Medicare outreach and enrollment

Client expense: $90,000 · Firm income: Not reported

Support for: S.2000/H.R. 1343, Protecting Married Seniors from Impoverishment Act H.R. 1342, the Empower Care Act H.R. 3253, Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019, Sec. 2 & 4 S. 651/H.R. 1814, the ABLE Age Adjustment Act - H.R. 1994, SECURE Act, Sec. 401, impact on trusts

Client expense: $66,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

P.L. 111-375 National Alzheimer's Project Act, All Sections P.L. 115-119 Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act P.L. 115-406 Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act S.591 Guardianship Accountability Act S.299 Geriatrics Workforce Improvement Act S.548/H.R.1342 EMPOWER Care Act H.R.1343 Protecting Married Seniors from Impoverishment Act S.740 Alzheimer's Caregiver Support Act H.R. 1955 Study on Use of Anti-Psychotics in Non-nursing Homes S.880/H.R.1873 Improving HOPE for Alzheimer's Act H.R.1903/S.901 Younger-Onset Alzheimer's Disease Act of 2019 S.995/H.R.2035 Lifespan Respite Care Reauthorization Act H.R.647 Palliative Care and Hospice Education and Training Act

Client expense: $820,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Indian Health Service, Interior, Dept of (DOI), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

Support H.R. 1265, the Nursing Home Workforce Quality Act, to end the mandatory certified nursing assistant training lock-out Support H.R. 1343 and H.R. 1839, to extend the Money Follows the Person Act and protection against impoverishment for spouses of Medicaid beneficiaries receiving long-term services and supports at home. Support H.R. 1342, the EMPOWER Act, to reauthorize Money Follows the Person for 5 years.

Client expense: $100,167 · Firm income: Not reported

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

S. 62, Empowering Medicare Seniors to Negotiate Drug Prices Act (Klobuchar) - Part D price negotiations S. 99, Medicare Drug Price Negotiation Act (Sanders) - Part D price negotiations, formulary changes S. 205, Right Rebate Act (Wyden) - Medicaid drug rebate program S. 317, ACE Kids Act (Grassley) - health homes for children with medically complex conditions S. 377, Medicare Negotiation and Competitive Licensing Act (Brown) - Part D price negotiation S. 470, Medicare at 50 Act (Stabenow) - Medicare buy-in option S. 475, RxCAP Act (Wyden) - Part D cost-sharing S. 489, State Public Option Act (Schatz) - Medicaid buy-in option S. 516, Prescription Drug Monitoring Act (Klobuchar) - required use of PDMPs S. 548, EMPOWER Care Act (Portman) - MFP demonstration S. 640, Phair Pricing Act (Kennedy) -- Part D rebates at the point of sale S. 691, Medicare Extra Rx HELP Act (Casey) - Part D assistance for low-income seniors S. 709, Prescription Drug Pricing Dashboard Act (Casey) - interactive dashboard with drug price and utilization data for federal programs S. 773, Telehealth Innovation and Improvement Act (Gardner) - testing expanded coverage of telehealth services in Medicare S. 988, Improving Transparency and Accuracy in Medicare Part D Spending Act (Capito) - payments on clean claims H.R. 259, Medicaid Extenders Act (Pallone) - MFP demonstration, spousal impoverishment protections H.R. 448, Medicare Drug Price Negotiation Act (Cummings) - Part D price negotiations, formulary changes H.R. 789, Improving Transparency and Accuracy in Medicare Part D Spending Act (Welch) - payments on clean claims H.R. 937, Right Rebate Act (Schrader) - Medicaid drug rebate program H.R. 1034, Phair Pricing Act (Collins) - Part D rebates at the point of sale H.R. 1035, Prescription Drug Price Transparency Act (Collins) - Medicare PBM standards H.R. 1046, Medicare Negotiation and Competitive Licensing Act (Doggett) - Part D price negotiation H.R. 1226, ACE Kids Act (Castor) - health homes for children with medically complex conditions H.R. 1277, State Public Option Act (Lujan) - Medicaid buy-in option H.R. 1301, Mental Health Telemedicine Expansion Act (DelBene) - Medicare coverage of mental health telehealth services H.R. 1342, EMPOWER Care Act (Dingell) - MFP demonstration H.R. 1343, Protecting Married Seniors from Impoverishment Act (Dingell) - spousal impoverishment protections H.R. 1346, Medicare Buy-In and Health Care Stabilization Act (Higgins) - Medicare buy-in option H.R. 1375, PAID Act (Kind) - transparency of Medicare secondary payer information H.R. 1384, Medicare for All Act (Jayapal) - Medicare for All health care system H.R. 1394, Medigap Consumer Protection Act (Doggett) - Medicare supplemental consumer protections H.R. 1551, Quality Care for Moms and Babies Act (Engel) - quality measures in Medicaid and CHIP H.R. 1781, Payment Commission Data Act (Carter) - MedPAC and MACPAC access to drug pricing and rebate data in Medicare and Medicaid H.R. 1839, Medicaid Services Investment and Accountability Act (Ruiz) - MFP demonstration, spousal impoverishment protections, ACE Kids Act, Medicaid drug rebate program Draft Medicare Advantage Quality Payment Relief Act (Kelly-Kind) - MA benchmark cap Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); calendar year 2020 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2019 Rate Notice and Call Letter; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Bipartisan Budget Act of 2018 changes to SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) and the Bipartisan Budget Act of 2018 changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS's substantial revisions to the managed care regulations, mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

Support for: H.R. 1343, Protecting Married Seniors from Impoverishment Act H.R. 1342, the Empower Care Act H.R. 1839, Medicaid Services Investment and Accountability Act of 2019

Client expense: $66,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to Medicaid Home-Based Care; Medicaid Extenders (H.R. 259, H.R. 1839), Protecting Married Seniors from Impoverishment Act (H.R. 1343), EMPOWER Care Act (H.R. 1342).

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

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

Issues related to Medicaid Home-Based Care; Medicaid Extenders (H.R. 259, H.R. 1839), Protecting Married Seniors from Impoverishment Act (H.R. 1343), EMPOWER Care Act (H.R. 1342).

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

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

H.R. 21, Consolidated Appropriations Act. FY 2019, H.R. 648, 2nd Consolidated Appropriations Act. FY 2019, H.J.R. 31 Continuing Appropriations for Homeland Security. FY 2019, H.J.R. 143, H.R. 695, Short-term Continuing Appropriations Act Resolution. FY 2019, Labor-HHS Appropriations bill, FY 2020 (no bill numbers) - lobbied in support of increased funding for CMS' state survey and certification program and opposition to hostile policy riders re Patient Protection and Affordable Care Act. No bill number - discussed via letter change in use of civil money penalties for enforcement in nursing homes. Lobbied CMS. No bill number - discussed nursing home quality and enforcement issues and shared relevant information. No bill number - discussed draft nursing home bill. No bill number - submitted and shared statement for the record for Senate Finance Committee nursing home hearing. No bill number - Discussed nursing homes, including the Special Focus Facility Program (no bill number). No bill number - discussed emergency preparedness regulations for nursing homes. S. 117/H.R. 555, Disability Integration Act -discussed bill language, support for, and introduction of the bill. No bill number - discussed Money Follows the Person Rebalancing Demonstration Program and Medicaid home and community-based services (HCBS) spousal impoverishment protections and extending them. S. 753/H.R. 1682 - Improving Access to Medicare Coverage Act - shared AARP support letters for the legislation, discussed the bill, and shared related information. P.L. 114-42, NOTICE Act and no bill number, Improving Access to Medicare Coverage Act - discussed transparency/surprise medical billing, including observation issues and related prior legislation. S. 548/H.R. 1342, EMPOWER Care Act - discussed and shared AARPs support for the bill. H.R. 1343, Protecting Married Seniors from Impoverishment Act - discussed and shared AARPs support for the bill. S. 296, Home Health Planning Improvement Act - discussed and shared support for the bill. No bill number - discussed issues affecting dually eligible individuals. Discussed surprise billing and health care price transparency. Discussed oral health coverage in Medicare. S. 668/H.R. 1570 - Removing Barriers to Colorectal Cancer Screening Act of 2019 - joined letter of endorsement. S. 286/H.R. 945 - Mental Health Access Improvement Act - sent letter of endorsement. H.R. 1301 - Mental Health Telemedicine Expansion Act - sent letter of endorsement.