Medicare Advantage Quality Payment Relief Act of 2019

General healthcare issues General issues related to Medicaid and Medicare Private Insurance The Medicare Advantage Quality Payment Relief Act (S. 1114/H.R. 2131) COVID relief proposals

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocated for amending testing language in Section 3201 of the CARES Act to clarify responsibility for diagnostic testing related to COVID-19. Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; and program integrity audits. Medicare Advantage Quality Payments, including H.R.2131 the "Medicare Advantage Quality Payment Relief Act," corresponding Senate bill is S.1114. Legislation related to the COVID-19 Public Health Emergency - Issues included risk corridors for Medicare Advantage, maintaining payment parity between Medicare Advantage and traditional fee-for-service Medicare, establishing a Medicaid Stabilization Fund. Advocated for making telehealth regulatory flexibilities during the COVID-19 Public Health Emergency permanent. Advocated to allow audio-only telehealth services for risk adjustment in Medicare Advantage plans, including support for H.R. 7659, the "Ensuring Parity in MA for Audio-Only Telehealth Act of 2020." Advocated for suspending the Medicare sequester for Rural Hospitals, other providers, and health plans. Advocated for access to CDCs data lake to determine whether a patient has received a COVID-19 vaccination, which vaccine they received, and when they will need to receive a second dose. Advocated for allowing MA organizations to use a 24-month look-back period to supplement 2020 data for the calculation of 2021 risk scores.

Client expense: $480,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

HR 7659 Re: ensuring parity for Audio Only Telehealth (Sewell) S. 3001 Toomey, regarding Medicare and Medicaid program extensions HR 4932, Thompson regarding telehealth in the Medicare program S. 2741 Schatz, regarding telehealth in the Medicare program HR 1839, the Medicaid Services Investment and Accountability Act HR 3253, The Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act (regarding Medicaid) HR 2131 and S. 1114, regarding the Medicare Advantage benchmark cap HR 3107, regarding the use of preauthorization in the Medicare Advantage program HR 3417 the Beneficiary Education Tools, Telehealth and Extenders Reauthorization Act (regarding Medicare) Legislation and regulation regarding the Medicare Advantage program HR 1839, regarding multiple Medicaid program changes, including the Medicaid Drug Rebate program. HR 1046 and S. 377, regarding Medicare Part D and requirements for HHS to negotiate drug prices HR 1781 Regarding MedPAC and MACPAC access to drug pricing and rebate data.

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

assist client with budget issues pertaining to nutrition programs for women, infants and children and medicare/medicaid. HR 2131-S1114 Medicare Advantage Quality Payment Relief Act of 2019; H1551 Quality Care for Moms & Babies; HR 2740 Labor, Health and Human Services, Education, Defense, State, Foreign Operations, and Energy and Water Development Appropriations Act, 2020; HR7614 Labor, Health and Human Services, Education and related Agencies as it relates to maternal and child health and medicare/medicaid; HR6132 Social Determinants for Moms Act 2020; HR7617 Defense, State, Foreign Operations, and Energy and Water Development LHHS Appropriations Act, 2021; HRes 107 Further Additional Continuing Approps Act 2021; HRes 110 Ext of Cont Approps Act 2021.

Client expense: Not reported · Firm income: $11,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage (MLR, risk adjustment, 2022 star ratings), Medicare Prior Authorization (HR 3107), MA Quality Payments (H.R. 2131, S. 1114), Interoperability, Prescription Drug Rebates, Medicare Part D and Part D restructuring (S. 2543, H.R. 3, H.R. 19, S. 3129), Telehealth, Federal Coronavirus Response (H.R. 6074, H.R. 6201, H.R. 748, H.R. 266, H.R. 6800, H.R. 7010); Parity for Audio-Only Risk Adjustment (H.R. 7659, S. 4840).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; and program integrity audits. Medicare Advantage Quality Payments, including H.R.2131 the "Medicare Advantage Quality Payment Relief Act," corresponding Senate bill is S.1114. Legislation related to the COVID-19 Public Health Emergency - Issues included risk corridors for Medicare Advantage, maintaining payment parity between Medicare Advantage and traditional fee-for-service Medicare, establishing a Medicaid Stabilization Fund. Advocated for making telehealth regulatory flexibilities during the COVID-19 Public Health Emergency permanent. Advocated for additional guidance about financial responsibility for COVID-19 testing and additional public funding for COVID-19 testing. Advocated to allow audio-only telehealth services for risk adjustment in Medicare Advantage plans, including support for H.R. 7659, the "Ensuring Parity in MA for Audio-Only Telehealth Act of 2020." Advocated for rural health issues including suspending the Medicare sequester for Rural Hospitals, other providers, and health plans for 5 years.

Client expense: $480,000 · Firm income: Not reported

General healthcare issues General issues related to Medicaid and Medicare Private Insurance The Medicare Advantage Quality Payment Relief Act (S. 1114/H.R. 2131) COVID relief proposals

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General healthcare issues General issues related to Medicaid and Medicare Private Insurance The Medicare Advantage Quality Payment Relief Act (S. 1114/H.R. 2131) COVID relief proposals

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

assist client with budget issues pertaining to nutrition programs for women, infants and children and medicare/medicaid. HR 2131-S1114 Medicare Advantage Quality Payment Relief Act of 2019; H1551 Quality Care for Moms & Babies; HR 2740 Labor, Health and Human Services, Education, Defense, State, Foreign Operations, and Energy and Water Development Appropriations Act, 2020; HR7614 Labor, Health and Human Services, Education and related Agencies as it relates to maternal and child health and medicare/medicaid; HR6132 Social Determinants for Moms Act 2020

Client expense: Not reported · Firm income: $11,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 7659 Re: ensuring parity for Audio Only Telehealth (Sewell) S. 3001 Toomey, regarding Medicare and Medicaid program extensions HR 4932, Thompson regarding telehealth in the Medicare program S. 2741 Schatz, regarding telehealth in the Medicare program HR 1839, the Medicaid Services Investment and Accountability Act HR 3253, The Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act (regarding Medicaid) HR 2131 and S. 1114, regarding the Medicare Advantage benchmark cap HR 3107, regarding the use of preauthorization in the Medicare Advantage program HR 3417 the Beneficiary Education Tools, Telehealth and Extenders Reauthorization Act (regarding Medicare) Legislation and regulation regarding the Medicare Advantage program HR 1839, regarding multiple Medicaid program changes, including the Medicaid Drug Rebate program. HR 1046 and S. 377, regarding Medicare Part D and requirements for HHS to negotiate drug prices HR 1781 Regarding MedPAC and MACPAC access to drug pricing and rebate data.

Client expense: $200,000 · Firm income: Not reported

Medicare Advantage (MLR, risk adjustment, 2022 star ratings), Medicare Prior Authorization (HR 3107), MA Quality Payments (H.R. 2131, S. 1114), Interoperability, Prescription Drug Rebates, Medicare Part D and Part D restructuring (S. 2543, H.R. 3, H.R. 19, S. 3129), Telehealth, Federal Coronavirus Response (H.R. 6074, H.R. 6201, H.R. 748, H.R. 266, H.R. 6800, H.R. 7010); Parity for Audio-Only Risk Adjustment (H.R. 7659).

Client expense: $470,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

assist client with budget issues pertaining to nutrition programs for women, infants and children and medicare/medicaid. HR 2131-S1114 Medicare Advantage Quality Payment Relief Act of 2019; H1551 Quality Care for Moms & Babies; HR 2740 Labor, Health and Human Services, Education, Defense, State, Foreign Operations, and Energy and Water Development Appropriations Act, 2020; HR7614 Labor, Health and Human Services, Education and related Agencies as it relates to maternal and child health and medicare/medicaid; HR6132 Social Determinants for Moms Act 2020

Client expense: Not reported · Firm income: $11,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General healthcare issues General issues related to Medicaid and Medicare Private Insurance The Medicare Advantage Quality Payment Relief Act (S. 1114/H.R. 2131) Paycheck Protection Program and Healthcare Enhancement Act (CARES Act 2.0) (H.R. 266)

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General healthcare issues General issues related to Medicaid and Medicare Private Insurance The Medicare Advantage Quality Payment Relief Act (S. 1114/H.R. 2131) Paycheck Protection Program and Healthcare Enhancement Act (CARES Act 2.0) (H.R. 266)

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 3001 Toomey, regarding Medicare and Medicaid program extensions HR 4932, Thompson regarding telehealth in the Medicare program S. 2741 Schatz, regarding telehealth in the Medicare program HR 1839, the Medicaid Services Investment and Accountability Act HR 3253, The Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act (regarding Medicaid) HR 2131 and S. 1114, regarding the Medicare Advantage benchmark cap HR 3107, regarding the use of preauthorization in the Medicare Advantage program HR 3417 the Beneficiary Education Tools, Telehealth and Extenders Reauthorization Act (regarding Medicare) Legislation and regulation regarding the Medicare Advantage program HR 1839, regarding multiple Medicaid program changes, including the Medicaid Drug Rebate program. HR 1046 and S. 377, regarding Medicare Part D and requirements for HHS to negotiate drug prices HR 1781 Regarding MedPAC and MACPAC access to drug pricing and rebate data.

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

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; and program integrity audits. Medicare Advantage Quality Payments, including H.R.2131 the "Medicare Advantage Quality Payment Relief Act," corresponding Senate bill is S.1114. Legislation related to the COVID-19 Public Health Emergency - Issues included risk corridors for Medicare Advantage, maintaining payment parity between Medicare Advantage and traditional fee-for-service Medicare, suspending Medicare sequester, establishing a Medicaid Stabilization Fund. Advocated for making telehealth regulatory flexibilities during the COVID-19 Public Health Emergency permanent. Advocated for additional guidance about financial responsibility for COVID-19 testing and additional public funding for COVID-19 testing.

Client expense: $480,000 · Firm income: Not reported

Medicare Advantage (MLR, risk adjustment, 2022 star ratings), Medicare Prior Authorization (HR 3107), MA Quality Payments (H.R. 2131, S. 1114), Interoperability, Prescription Drug Rebates, Medicare Part D and Part D restructuring (S. 2543, H.R. 3, H.R. 19, S. 3129), Telehealth, Federal Coronavirus Response (H.R. 6074, H.R. 6201, H.R. 748, H.R. 266, H.R. 6800, H.R. 7010)

Client expense: $440,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and ratings systems; quality bonus payments; and prescription drug costs. Medicare Advantage Quality Payments, including H.R.2131 the "Medicare Advantage Quality Payment Relief Act," corresponding Senate bill is S.1114. Legislation related to the COVID-19 Public Health Emergency: S.3548, the Coronavirus Aid, Relief and Economic Security (CARES) Act. Issues included risk corridors for Medicare Advantage, maintaining payment parity between Medicare Advantage and traditional fee-for-service Medicare, and suspending the Medicare sequester.

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

General healthcare issues General issues related to Medicaid and Medicare Private Insurance The Medicare Advantage Quality Payment Relief Act (S. 1114/H.R. 2131) Outreach on CARES Act (H.R. 748/S. 3548--Coronavirus Aid, Relief, and Economic Security Act)

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General healthcare issues General issues related to Medicaid and Medicare Private Insurance The Medicare Advantage Quality Payment Relief Act (S. 1114/H.R. 2131) Outreach on CARES Act (H.R. 748/S. 3548--Coronavirus Aid, Relief, and Economic Security Act)

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

assist client with budget issues pertaining to nutrition programs for women, infants and children and medicare/medicaid. HR 2131-S1114 Medicare Advantage Quality Payment Relief Act of 2019; H1551 Quality Care for Moms & Babies; HR 2740 Labor, Health and Human Services, Education, Defense, State, Foreign Operations, and Energy and Water Development Appropriations Act, 2020; HR 748, S3548 CARES Act

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage, Medicare Prior Authorization (HR 3107), MA Quality Payments (H.R. 2131, S. 1114), Interoperability, Prescription Drug Rebates, Medicare Part D and Part D restructuring (S. 2543, H.R. 3, H.R. 19, S. 3129), Telehealth

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

S. 3001 Toomey, regarding Medicare and Medicaid program extensions HR 4932, Thompson regarding telehealth in the Medicare program S. 2741 Schatz, regarding telehealth in the Medicare program HR 4378, Continuing Appropriations and Health Extenders Act HR 1839, the Medicaid Services Investment and Accountability Act HR 3253, The Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act (regarding Medicaid) HR 2131 and S. 1114, regarding the Medicare Advantage benchmark cap HR 3107, regarding the use of preauthorization in the Medicare Advantage program HR 3417 the Beneficiary Education Tools, Telehealth and Extenders Reauthorization Act (regarding Medicare) Legislation and regulation regarding the Medicare Advantage program HR 1839, regarding multiple Medicaid program changes, including the Medicaid Drug Rebate program. HR 1046 and S. 377, regarding Medicare Part D and requirements for HHS to negotiate drug prices HR 1781 Regarding MedPAC and MACPAC access to drug pricing and rebate data.

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

General healthcare issues General issues related to Medicaid and Medicare Private Insurance The Medicare Advantage Quality Payment Relief Act (S. 1114/H.R. 2131)

Client expense: Not reported · Firm income: Not reported

General healthcare issues General issues related to Medicaid and Medicare Private Insurance The Medicare Advantage Quality Payment Relief Act (S. 1114/H.R. 2131)

Client expense: Not reported · Firm income: Not reported

Legislation and regulation regarding the Medicare Advantage program HR 1839, regarding multiple Medicaid program changes, including the Medicaid Drug Rebate program. HR 2131 and S. 1114, to remove the Medicare benchmark cap. HR 1046 and S. 377, regarding Medicare Part D and requirements for HHS to negotiate drug prices HR 1781 Regarding MedPAC and MACPAC access to drug pricing and rebate data.

Client expense: $660,000 · Firm income: Not reported

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

HR 4378, Continuing Appropriations and Health Extenders Act HR 1839, the Medicaid Services Investment and Accountability Act HR 3253, The Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act (regarding Medicaid) HR 2131 and S. 1114, regarding the Medicare Advantage benchmark cap HR 3107, regarding the use of preauthorization in the Medicare Advantage program HR 3417 the Beneficiary Education Tools, Telehealth and Extenders Reauthorization Act (regarding Medicare) Legislation and regulation regarding the Medicare Advantage program HR 1839, regarding multiple Medicaid program changes, including the Medicaid Drug Rebate program. HR 2131 and S. 1114, to remove the Medicare benchmark cap. HR 1046 and S. 377, regarding Medicare Part D and requirements for HHS to negotiate drug prices HR 1781 Regarding MedPAC and MACPAC access to drug pricing and rebate data.

Client expense: $180,000 · Firm income: Not reported

Medicare Advantage; H.R. 2131, Medicare Advantage Quality Payment Relief Act of 2019; drug pricing.

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

Government targets: 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 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.

assist client with budget issues pertaining to nutrition programs for women, infants and children and medicare/medicaid. HR 2131-S1114 Medicare Advantage Quality Payment Relief Act of 2019; H1551 Quality Care for Moms & Babies; HR1955 Understanding Appropriations for Alzheimer Care Act 2019; HR 2740 Labor, Health and Human Services, Education, Defense, State, Foreign Operations, and Energy and Water Development Appropriations Act, 2020; HR 3055 Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of 2019.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and ratings systems; quality incentive payments; and prescription drug costs. Medicare Advantage Quality Payments, including H.R.2131 the "Medicare Advantage Quality Payment Relief Act," corresponding Senate bill is S.1114. H.R.3, the "Lower Drug Costs Now Act," including the Part D restructuring components of the bill.

Client expense: $460,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)

S. 3001 Toomey, regarding Medicare and Medicaid program extensions HR 4932, Thompson regarding telehealth in the Medicare program S. 2741 Schatz, regarding telehealth in the Medicare program HR 4378, Continuing Appropriations and Health Extenders Act HR 1839, the Medicaid Services Investment and Accountability Act HR 3253, The Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act (regarding Medicaid) HR 2131 and S. 1114, regarding the Medicare Advantage benchmark cap HR 3107, regarding the use of preauthorization in the Medicare Advantage program HR 3417 the Beneficiary Education Tools, Telehealth and Extenders Reauthorization Act (regarding Medicare) Legislation and regulation regarding the Medicare Advantage program HR 1839, regarding multiple Medicaid program changes, including the Medicaid Drug Rebate program. HR 1046 and S. 377, regarding Medicare Part D and requirements for HHS to negotiate drug prices HR 1781 Regarding MedPAC and MACPAC access to drug pricing and rebate data.

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

Medicare Advantage, Medicare Prior Authorization (HR 3107), MA Quality Payments (H.R. 2131, S. 1114), Interoperability, Prescription Drug Rebates, Medicare Part D and Part D restructuring (S. 2543, H.R. 3)

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicare Advantage; H.R. 2131, Medicare Advantage Quality Payment Relief Act of 2019; drug pricing.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and ratings systems; quality incentive payments; and prescription drug costs. Medicare Advantage Quality Payments, including H.R.2131 the "Medicare Advantage Quality Payment Relief Act," corresponding Senate bill is S.1114. H.R.3, the "Lower Drug Costs Now Act," including the Part D restructuring components of the bill.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), 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 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.

assist client with budget issues pertaining to nutrition programs for women, infants and children and medicare/medicaid. HR 2131-S1114 Medicare Advantage Quality Payment Relief Act of 2019; H1551 Quality Care for Moms & Babies; HR1955 Understanding Appropriations for Alzheimer Care Act 2019; HRes 445 Providing for consideration of the bill (H.R. 3055) making appropriations for the Departments of Commerce and Justice, Science, and Related Agencies for the fiscal year ending September 30, 2020, and for other purposes; relating to consideration of the bill (H.R. 2740) making appropriations for the Departments of Labor, Health and Human Services, and Education, and related agencies for the fiscal year ending September 30, 2020, and for other purposes; and providing for proceedings during the period from June 28, 2019, through July 8, 2019; HR 2740 Labor, Health and Human Services, Education, Defense, State, Foreign Operations, and Energy and Water Development Appropriations Act, 2020.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 4378, Continuing Appropriations and Health Extenders Act HR 1839, the Medicaid Services Investment and Accountability Act HR 3253, The Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act (regarding Medicaid) HR 2131 and S. 1114, regarding the Medicare Advantage benchmark cap HR 3107, regarding the use of preauthorization in the Medicare Advantage program HR 3417 the Beneficiary Education Tools, Telehealth and Extenders Reauthorization Act (regarding Medicare) Legislation and regulation regarding the Medicare Advantage program HR 1839, regarding multiple Medicaid program changes, including the Medicaid Drug Rebate program. HR 2131 and S. 1114, to remove the Medicare benchmark cap. HR 1046 and S. 377, regarding Medicare Part D and requirements for HHS to negotiate drug prices HR 1781 Regarding MedPAC and MACPAC access to drug pricing and rebate data.

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

Medicare Advantage, Medicare Prior Authorization (HR 3107), MA Quality Payments (H.R. 2131, S. 1114), Interoperability, Prescription Drug Rebates, Medicare Part D and Part D restructuring (S. 2543, H.R. 3)

Client expense: $380,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

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.

HR 1839, the Medicaid Services Investment and Accountability Act HR 3253, The Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act (regarding Medicaid) HR 2131 and S. 1114, regarding the Medicare Advantage benchmark cap HR 3107, regarding the use of preauthorization in the Medicare Advantage program HR 3417 the Beneficiary Education Tools, Telehealth and Extenders Reauthorization Act (regarding Medicare) Legislation and regulation regarding the Medicare Advantage program HR 1839, regarding multiple Medicaid program changes, including the Medicaid Drug Rebate program. HR 2131 and S. 1114, to remove the Medicare benchmark cap. HR 1046 and S. 377, regarding Medicare Part D and requirements for HHS to negotiate drug prices HR 1781 Regarding MedPAC and MACPAC access to drug pricing and rebate data.

Client expense: $180,000 · Firm income: Not reported

assist client with budget issues pertaining to nutrition programs for women, infants and children and medicare/medicaid. HR 2131-S1114 Medicare Advantage Quality Payment Relief Act of 2019; H1551 Quality Care for Moms & Babies; HR1955 Understanding Appropriations for Alzheimer Care Act 2019;

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and ratings systems; quality incentive payments; and prescription drug costs. Medicare Advantage Quality Payments, including H.R.2131 the "Medicare Advantage Quality Payment Relief Act," corresponding Senate bill is S.1114.

Client expense: $570,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

HR 2131 and S. 1114--Medicare Advantage Quality Payment Relief Act CMS-2018-0154-- Advance Notice of Methodological Changes for Calendar Year (CY) 2020 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2020 Draft Call Letter CMS-4180-P--Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses S. 1280/H.R. 2477--BENES Act Expanding language access under Medicare OIG-0936-P--Fraud and Abuse; Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection for Certain Point-of-Sale Reductions in Price on Prescription Pharmaceuticals and Certain Pharmacy Benefit Manager Service Fees

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

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

Medicare Advantage; H.R. 2131, Medicare Advantage Quality Payment Relief Act of 2019; drug pricing.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1839, the Medicaid Services Investment and Accountability Act HR 3253, The Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act (regarding Medicaid) HR 2131 and S. 1114, regarding the Medicare Advantage benchmark cap HR 3107, regarding the use of preauthorization in the Medicare Advantage program HR 3417, the Beneficiary Education Tools, Telehealth and Extenders Reauthorization Act (regarding Medicare) Legislation and regulation regarding the Medicare Advantage program HR 1839, regarding multiple Medicaid program changes, including the Medicaid Drug Rebate program HR 2131 and S. 1114, to remove the Medicare benchmark cap HR 1046 and S. 377, regarding Medicare Part D and requirements for HHS to negotiate drug prices HR 1781, regarding MedPAC and MACPAC access to drug pricing and rebate data

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