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Territories Health Care Improvement Act
Legislative Progress
Momentum (last 30 days)
0
score
0 actions · 0 new cosponsors · 0 votes
Speed vs cohort
62pct
2d open
vs 9,062 other HR bills in the 116th — cohort avg 39d
Territories Health Care Improvement Act This bill makes a series of changes relating to Medicaid funding for U.S. territories, including by (1) establishing a specific funding cap through FY2023 for Puerto Rico and through FY2025 for the other U.S. territories, (2) establishing program integrity measures and reporting requirements relating to the use of funds, and (3) increasing the applicable Federal Medical Assistance Percentage (i.e., the federal matching rate).
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Filing registrants (10)
Forwarded by Subcommittee to Full Committee by Voice Vote .
Subcommittee Consideration and Mark-up Session Held.
Referred to the Subcommittee on Health.
Referred to the House Committee on Energy and Commerce.
Introduced in House
Congress.gov source codes: 1000, Intro-H
Hearings Held by the Subcommittee on Health Prior to Introduction and Referral.
Bills with similar content found using semantic analysis.
Sources: Congress.gov
2020 · fourth_quarter · Medicare/Medicaid
Urged Congress to extend the moratorium on looming automatic 2% cuts (sequestration) in the Medicare program and $4 billion cuts in the Medicaid Disproportionate Share Hospital (DSH) program the duration of the public health emergency and at least until the end of 2021 to ensure providers have the resources to continue to care for patients and communities during this pandemic. Urged Congress to include language in the Continuing Resolution (CR) that eliminates the Medicaid Disproportionate Share Hospital (DSH) reductions slated to begin on December 1 of this year. Urged the House to support H.R. 2477, the Beneficiary Enrollment Notification an Eligibility Simplification (BENES) Act of 2019 which would modernize and simplify the Medicare Part B enrollment process as recommended by the Medicare Payment Advisory Commission (MedPAC). Urged the House to support H.R. 3935, the Protecting Patients Transportation to Care Act which would amend the Medicaid statute to include non-emergency medical transportation (NEMT) in the list of mandatory Medicaid benefits by codifying current Medicaid NEMT regulations. Urged the House to support H.R. 5201, the Tele-Mental Health Expansion Act of 2019 would permanently include a patients home as an eligible originating site for mental health services delivered via telehealth in the Medicare program. Urged Congress to increase the FMAP for Medicaid by 5.8 percent for a total increase of 12 percent to ensure states capacity to provide access to care though Medicaid in then next round of financial relief. Urged HHS to ensure that a proportional amount of the remaining Public Health and Social Services Emergency Fund (PHSSEF) and any additional relief funding appropriated by Congress, is provided quickly to ALL Medicaid providers and health professionals impacted by the COVID-19 pandemic. Urged the House to support the H.R. 826, Expressing disapproval of the Trump administrations harmful actions towards Medicaid. This resolution seeks to reverse the recent guidance from the Centers for Medicare and Medicaid Services (CMS) titled Healthy Adult Opportunity, which would essentially cap or block grant funding for certain populations. CMS-2393-P Medicaid Program; Medicaid Fiscal Accountability Regulation; Proposed Rule (84 Federal Register 63722, November 18, 2019) - Urged CMS not to finalize the proposed MFAR. The proposed rule could force states to reduce the size of their Medicaid programs by covering fewer beneficiaries, restricting health care services or reducing provider payment rates. Urged the House to support H.R. 3, the Lower Drug Costs Act Now of 2019, which includes proposals to lower the costs of prescription drugs through Medicare negotiation authority and also includes new Medicare protections and additional coverage. Urged the House to support H.R. 4650, the Medicare Dental Act of 2019, which would add a dental benefit to Medicare Part B. Urged the House to support H.R. 4665, the Medicare Vision Act of 2019, which would a vision benefit to Medicare Part B. Urged the House to support H.R. 4618, the Medicare Hearing Act of 2019, which would add a hearing benefit to Part B including hearing aids. 2393-P - Request for Extension of Comment Period for Medicaid Program; Medicaid Fiscal Accountability Regulation, 84 Fed. Reg. 63722 (November 18, 2019) - Urged CMS to extend the comment period on the proposed rule for at least 60 days, until March 17, 2020, to ensure that states and other stakeholders have sufficient time to provide CMS with the information it needs to make sound policy decisions. Territories Health Care Improvement Act (HR 3631) - Urged the Senate to adopt new funding levels for Medicaid in the Territories to address outdated funding mechanisms and matching rates. Urged the House and Senate to delay FY2020 funding cuts to Medicaid disproportionate share hospitals. Beneficiary Education Tools, Telehealth, and Extenders Re-authorization Act of 2019 (H.R. 3417) - Supported expanding mental and behavioral health telemedicine services to Medicare beneficiaries. Patient Centered Outcomes Research Institute (H.R. 3439) - Supported extending the legislation to provide research on substance use disorders, mental health, and maternal morbidity and mortality. The HEARTS and Rural Relief Act (H.R. 3429) - Supported extending the rural and critical access hospital moratorium for two years on direct supervision requirements for outpatient therapeutic services. Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019 (H.R. 3253) - Supported extending Medicaid demonstration programs to improve person-centered health care across the continuum of care. Maternal Health Quality Improvement Act (H.R. 4995) and Helping Medicaid Offer Maternity Services Act of (H.R. 4996) - Urged the Senate to pass both to help to eliminate preventable pregnancy-related deaths and improve maternal health outcomes. Reauthorizing and Extending America's Community Health (REACH) Act (H.R. 2328) - Opposed a statutory payment rate. Supported elimination of DSH funding cuts for FY 2020 and 2021. Supported permanent Medicaid funding in the United States territories. Supported demonstrations for Medicare beneficiaries that promote enrollment, education, and outreach.
Client expense: $196,341 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Natl Institutes of Health (NIH), Office of the Vice President of the United States, President of the U.S., SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of
2020 · third_quarter · Medicare/Medicaid
Urged Congress to include language in the Continuing Resolution (CR) that eliminates the Medicaid Disproportionate Share Hospital (DSH) reductions slated to begin on December 1 of this year. Urged the House to support H.R. 2477, the Beneficiary Enrollment Notification an Eligibility Simplification (BENES) Act of 2019 which would modernize and simplify the Medicare Part B enrollment process as recommended by the Medicare Payment Advisory Commission (MedPAC). Urged the House to support H.R. 3935, the Protecting Patients Transportation to Care Act which would amend the Medicaid statute to include non-emergency medical transportation (NEMT) in the list of mandatory Medicaid benefits by codifying current Medicaid NEMT regulations. Urged the House to support H.R. 5201, the Tele-Mental Health Expansion Act of 2019 would permanently include a patients home as an eligible originating site for mental health services delivered via telehealth in the Medicare program. Urged Congress to increase the FMAP for Medicaid by 5.8 percent for a total increase of 12 percent to ensure states capacity to provide access to care though Medicaid in then next round of financial relief. Urged HHS to ensure that a proportional amount of the remaining Public Health and Social Services Emergency Fund (PHSSEF) and any additional relief funding appropriated by Congress, is provided quickly to ALL Medicaid providers and health professionals impacted by the COVID-19 pandemic. Urged the House to support the H.R. 826, Expressing disapproval of the Trump administrations harmful actions towards Medicaid. This resolution seeks to reverse the recent guidance from the Centers for Medicare and Medicaid Services (CMS) titled Healthy Adult Opportunity, which would essentially cap or block grant funding for certain populations. CMS-2393-P Medicaid Program; Medicaid Fiscal Accountability Regulation; Proposed Rule (84 Federal Register 63722, November 18, 2019) - Urged CMS not to finalize the proposed MFAR. The proposed rule could force states to reduce the size of their Medicaid programs by covering fewer beneficiaries, restricting health care services or reducing provider payment rates. Urged the House to support H.R. 3, the Lower Drug Costs Act Now of 2019, which includes proposals to lower the costs of prescription drugs through Medicare negotiation authority and also includes new Medicare protections and additional coverage. Urged the House to support H.R. 4650, the Medicare Dental Act of 2019, which would add a dental benefit to Medicare Part B. Urged the House to support H.R. 4665, the Medicare Vision Act of 2019, which would a vision benefit to Medicare Part B. Urged the House to support H.R. 4618, the Medicare Hearing Act of 2019, which would add a hearing benefit to Part B including hearing aids. 2393-P - Request for Extension of Comment Period for Medicaid Program; Medicaid Fiscal Accountability Regulation, 84 Fed. Reg. 63722 (November 18, 2019) - Urged CMS to extend the comment period on the proposed rule for at least 60 days, until March 17, 2020, to ensure that states and other stakeholders have sufficient time to provide CMS with the information it needs to make sound policy decisions. Territories Health Care Improvement Act (HR 3631) - Urged the Senate to adopt new funding levels for Medicaid in the Territories to address outdated funding mechanisms and matching rates. Urged the House and Senate to delay FY2020 funding cuts to Medicaid disproportionate share hospitals. Beneficiary Education Tools, Telehealth, and Extenders Re-authorization Act of 2019 (H.R. 3417) - Supported expanding mental and behavioral health telemedicine services to Medicare beneficiaries. Patient Centered Outcomes Research Institute (H.R. 3439) - Supported extending the legislation to provide research on substance use disorders, mental health, and maternal morbidity and mortality. The HEARTS and Rural Relief Act (H.R. 3429) - Supported extending the rural and critical access hospital moratorium for two years on direct supervision requirements for outpatient therapeutic services. Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019 (H.R. 3253) - Supported extending Medicaid demonstration programs to improve person-centered health care across the continuum of care. Maternal Health Quality Improvement Act (H.R. 4995) and Helping Medicaid Offer Maternity Services Act of (H.R. 4996) - Urged the Senate to pass both to help to eliminate preventable pregnancy-related deaths and improve maternal health outcomes. Reauthorizing and Extending America's Community Health (REACH) Act (H.R. 2328) - Opposed a statutory payment rate. Supported elimination of DSH funding cuts for FY 2020 and 2021. Supported permanent Medicaid funding in the United States territories. Supported demonstrations for Medicare beneficiaries that promote enrollment, education, and outreach.
Client expense: $181,961 · 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), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Natl Institutes of Health (NIH), Office of the Vice President of the United States, President of the U.S., SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of
2020 · second_quarter · Medicare/Medicaid
Urged congress to increase the FMAP for Medicaid by 5.8 percent for a total increase of 12 percent to ensure states capacity to provide access to care though Medicaid in then next round of financial relief. Urged HHS to ensure that a proportional amount of the remaining Public Health and Social Services Emergency Fund (PHSSEF) and any additional relief funding appropriated by Congress, is provided quickly to ALL Medicaid providers and health professionals impacted by the COVID-19 pandemic. Urged the House to support the H.R. 826, Expressing disapproval of the Trump administrations harmful actions towards Medicaid. This resolution seeks to reverse the recent guidance from the Centers for Medicare and Medicaid Services (CMS) titled Healthy Adult Opportunity, which would essentially cap or block grant funding for certain populations. CMS-2393-P Medicaid Program; Medicaid Fiscal Accountability Regulation; Proposed Rule (84 Federal Register 63722, November 18, 2019) - Urged CMS not to finalize the proposed MFAR. The proposed rule could force states to reduce the size of their Medicaid programs by covering fewer beneficiaries, restricting health care services or reducing provider payment rates. Urged the House to support H.R. 3, the Lower Drug Costs Act Now of 2019, which includes proposals to lower the costs of prescription drugs through Medicare negotiation authority and also includes new Medicare protections and additional coverage. Urged the House to support H.R. 4650, the Medicare Dental Act of 2019, which would add a dental benefit to Medicare Part B. Urged the House to support H.R. 4665, the Medicare Vision Act of 2019, which would a vision benefit to Medicare Part B. Urged the House to support H.R. 4618, the Medicare Hearing Act of 2019, which would add a hearing benefit to Part B including hearing aids. 2393-P - Request for Extension of Comment Period for Medicaid Program; Medicaid Fiscal Accountability Regulation, 84 Fed. Reg. 63722 (November 18, 2019) - Urged CMS to extend the comment period on the proposed rule for at least 60 days, until March 17, 2020, to ensure that states and other stakeholders have sufficient time to provide CMS with the information it needs to make sound policy decisions. Territories Health Care Improvement Act (HR 3631) - Urged the Senate to adopt new funding levels for Medicaid in the Territories to address outdated funding mechanisms and matching rates. Urged the House and Senate to delay FY2020 funding cuts to Medicaid disproportionate share hospitals. Beneficiary Education Tools, Telehealth, and Extenders Re-authorization Act of 2019 (H.R. 3417) - Supported expanding mental and behavioral health telemedicine services to Medicare beneficiaries. Patient Centered Outcomes Research Institute (H.R. 3439) - Supported extending the legislation to provide research on substance use disorders, mental health, and maternal morbidity and mortality. The HEARTS and Rural Relief Act (H.R. 3429) - Supported extending the rural and critical access hospital moratorium for two years on direct supervision requirements for outpatient therapeutic services. Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019 (H.R. 3253) - Supported extending Medicaid demonstration programs to improve person-centered health care across the continuum of care. Maternal Health Quality Improvement Act (H.R. 4995) and Helping Medicaid Offer Maternity Services Act of (H.R. 4996) - Urged the Senate to pass both to help to eliminate preventable pregnancy-related deaths and improve maternal health outcomes. Reauthorizing and Extending America's Community Health (REACH) Act (H.R. 2328) - Opposed a statutory payment rate. Supported elimination of DSH funding cuts for FY 2020 and 2021. Supported permanent Medicaid funding in the United States territories. Supported demonstrations for Medicare beneficiaries that promote enrollment, education, and outreach.
Client expense: $256,610 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Natl Institutes of Health (NIH), President of the U.S., SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of
2020 · second_quarter · Medicare/Medicaid
Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (HR 6800). Territories Health Care Improvement Act (H.R. 3631)
Client expense: Not reported · Firm income: $50,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Medicare/Medicaid
Issues related to Puerto Rico Medicare & Medicaid, including H.R. 3631 - Territories Health Care Improvement Act; H.R. 6800 - The HEROES Act.
Client expense: $50,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Medicare/Medicaid
Territories Health Care Improvement Act (H.R. 3631); Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3); Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (H.R. 6800).
Client expense: Not reported · Firm income: $60,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Medicare/Medicaid
Territories Health Care Improvement Act (H.R. 3631); Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3); Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (H.R. 6800).
Client expense: Not reported · Firm income: $20,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · first_quarter · Medicare/Medicaid
Urged the House to support the H.R. 826, Expressing disapproval of the Trump administrations harmful actions towards Medicaid. This resolution seeks to reverse the recent guidance from the Centers for Medicare and Medicaid Services (CMS) titled Healthy Adult Opportunity, which would essentially cap or block grant funding for certain populations. CMS-2393-P Medicaid Program; Medicaid Fiscal Accountability Regulation; Proposed Rule (84 Federal Register 63722, November 18, 2019) - Urged CMS not to finalize the proposed MFAR. The proposed rule could force states to reduce the size of their Medicaid programs by covering fewer beneficiaries, restricting health care services or reducing provider payment rates. Urged the House to support H.R. 3, the Lower Drug Costs Act Now of 2019, which includes proposals to lower the costs of prescription drugs through Medicare negotiation authority and also includes new Medicare protections and additional coverage. Urged the House to support H.R. 4650, the Medicare Dental Act of 2019, which would add a dental benefit to Medicare Part B. Urged the House to support H.R. 4665, the Medicare Vision Act of 2019, which would a vision benefit to Medicare Part B. Urged the House to support H.R. 4618, the Medicare Hearing Act of 2019, which would add a hearing benefit to Part B including hearing aids. 2393-P - Request for Extension of Comment Period for Medicaid Program; Medicaid Fiscal Accountability Regulation, 84 Fed. Reg. 63722 (November 18, 2019) - Urged CMS to extend the comment period on the proposed rule for at least 60 days, until March 17, 2020, to ensure that states and other stakeholders have sufficient time to provide CMS with the information it needs to make sound policy decisions. Territories Health Care Improvement Act (HR 3631) - Urged the Senate to adopt new funding levels for Medicaid in the Territories to address outdated funding mechanisms and matching rates. Urged the House and Senate to delay FY2020 funding cuts to Medicaid disproportionate share hospitals. Beneficiary Education Tools, Telehealth, and Extenders Re-authorization Act of 2019 (H.R. 3417) - Supported expanding mental and behavioral health telemedicine services to Medicare beneficiaries. Patient Centered Outcomes Research Institute (H.R. 3439) - Supported extending the legislation to provide research on substance use disorders, mental health, and maternal morbidity and mortality. The HEARTS and Rural Relief Act (H.R. 3429) - Supported extending the rural and critical access hospital moratorium for two years on direct supervision requirements for outpatient therapeutic services. Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019 (H.R. 3253) - Supported extending Medicaid demonstration programs to improve person-centered health care across the continuum of care. Maternal Health Quality Improvement Act (H.R. 4995) and Helping Medicaid Offer Maternity Services Act of (H.R. 4996) - Urged the Senate to pass both to help to eliminate preventable pregnancy-related deaths and improve maternal health outcomes. Reauthorizing and Extending America's Community Health (REACH) Act (H.R. 2328) - Opposed a statutory payment rate. Supported elimination of DSH funding cuts for FY 2020 and 2021. Supported permanent Medicaid funding in the United States territories. Supported demonstrations for Medicare beneficiaries that promote enrollment, education, and outreach.
2020 · first_quarter · Medicare/Medicaid
Territories Health Care Improvement Act (H.R. 3631); Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3).
Client expense: Not reported · Firm income: $90,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · first_quarter · Medicare/Medicaid
Territories Health Care Improvement Act (H.R. 3631); Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3).
Client expense: Not reported · Firm income: $100,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · first_quarter · Medicare/Medicaid
Issues related to Puerto Rico Medicare & Medicaid, including H.R. 3631 - Territories Health Care Improvement Act; H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act.
Client expense: $90,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · first_quarter · Medicare/Medicaid
Territories Health Care Improvement Act (H.R. 3631); Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3).
Client expense: Not reported · Firm income: $40,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2019 · fourth_quarter · Medicare/Medicaid
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.
2019 · fourth_quarter · Medicare/Medicaid
Urged the House to support H.R. 3, the Lower Drug Costs Act Now of 2019, which includes proposals to lower the costs of prescription drugs through Medicare negotiation authority and also includes new Medicare protections and additional coverage. Urged the House to support H.R. 4650, the Medicare Dental Act of 2019, which would add a dental benefit to Medicare Part B. Urged the House to support H.R. 4665, the Medicare Vision Act of 2019, which would a vision benefit to Medicare Part B. Urged the House to support H.R. 4618, the Medicare Hearing Act of 2019, which would add a hearing benefit to Part B including hearing aids. CMS-2393-P - Request for Extension of Comment Period for Medicaid Program; Medicaid Fiscal Accountability Regulation, 84 Fed. Reg. 63722 (November 18, 2019) - Urged CMS to extend the comment period on the proposed rule for at least 60 days, until March 17, 2020, to ensure that states and other stakeholders have sufficient time to provide CMS with the information it needs to make sound policy decisions. Territories Health Care Improvement Act (HR 3631) - Urged the Senate to adopt new funding levels for Medicaid in the Territories to address outdated funding mechanisms and matching rates. Urged the House and Senate to delay FY2020 funding cuts to Medicaid disproportionate share hospitals. Beneficiary Education Tools, Telehealth, and Extenders Re-authorization Act of 2019 (H.R. 3417) - Supported expanding mental and behavioral health telemedicine services to Medicare beneficiaries. Patient Centered Outcomes Research Institute (H.R. 3439) - Supported extending the legislation to provide research on substance use disorders, mental health, and maternal morbidity and mortality. The HEARTS and Rural Relief Act (H.R. 3429) - Supported extending the rural and critical access hospital moratorium for two years on direct supervision requirements for outpatient therapeutic services. Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019 (H.R. 3253) - Supported extending Medicaid demonstration programs to improve person-centered health care across the continuum of care. Maternal Health Quality Improvement Act (H.R. 4995) and Helping Medicaid Offer Maternity Services Act of (H.R. 4996) - Urged the Senate to pass both to help to eliminate preventable pregnancy-related deaths and improve maternal health outcomes. Reauthorizing and Extending America's Community Health (REACH) Act (H.R. 2328) - Opposed a statutory payment rate. Supported elimination of DSH funding cuts for FY 2020 and 2021. Supported permanent Medicaid funding in the United States territories. Supported demonstrations for Medicare beneficiaries that promote enrollment, education, and outreach.
2019 · fourth_quarter · Medicare/Medicaid
Issues related to implementation of legislative or regulatory changes to Medicare and Medicaid, including: HR 1948, Lymphedema Treatment Act; HR 6808, Patient Navigation Assistance Act; HR 1570 and S. 668, the Removing Barriers to Colorectal Cancer Screening Act, and regulatory issues related to the Medicare coinsurance issue in these bills; S.2218 and H.R 4821, the Covering Our FAS Allies (COFA) Act & issues related to Medicaid coverage for Compacts of Free Association (COFA) migrants; CMS-issued regulations pertaining to Medicare Part B reimbursement - the CY2020 Medicare Physician Fee Schedule; HR 913, The CLINICAL TREATMENT Act, Medicaid covering routine care costs for beneficiaries who participate in an approved clinical trial; Issues related to potential Administration guidance relating to giving states the option to block grant their Medicaid program; Issues related to Puerto Ricos Medicaid program, including H.R. 3631, Territories Health Care Improvement Act; H.R. 3, the Lower Drug Prices Now Act - legislation for lowering prescription drug costs, lowering out of pocket expenses for Medicare beneficiaries, and placing a cap on Medicare Part D; S. 2543, the Prescription Drug Pricing Reduction Act of 2019 - legislation for lowering prescription drug costs, lowering out of pocket costs for Medicare beneficiaries, and placing a cap on Medicare Part D; Issues related to Medicaid Non-Emergency Medical Transportation; and S. 2911 - Seniors Prescription Drug Relief Act of 2019, would allow Medicare beneficiaries who reach an out of pocket cap to spread their payments over the course of the entire year.
Client expense: $1,650,000 · Firm income: Not reported
2019 · fourth_quarter · Medicare/Medicaid
Issues related to Puerto Rico Medicare & Medicaid, Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (H.R. 4378), Territories Health Care Improvement Act (H.R. 3631), Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of 2019 (H.R. 3055), H.R. 4666, Further Consolidated Appropriations Act, 2020 (H.R. 1865)
Client expense: Not reported · Firm income: $80,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2019 · fourth_quarter · Medicare/Medicaid
Issues related to Puerto Rico Medicare & Medicaid, Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (H.R. 4378), Territories Health Care Improvement Act (H.R. 3631), Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of 2019 (H.R. 3055), H.R. 4666, Further Consolidated Appropriations Act, 2020 (H.R. 1865)
Client expense: Not reported · Firm income: $70,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2019 · fourth_quarter · Medicare/Medicaid
Issues related to Puerto Rico Medicare & Medicaid, including H.R. 3631 - Territories Health Care Improvement Act, H.R. 4378 - Continuing Appropriations Act, 2020, and Health Extenders Act of 2019, H.R. 3055 - Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of 2019, and H.R. 1865 - Further Consolidated Appropriations Act, 2020.
Client expense: $80,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2019 · fourth_quarter · Medicare/Medicaid
Issues related to Medicare and Medicaid funding for Puerto Rico, including H.R. 3631, The Territories Health Care Improvement Act, and H.R. 4378, The Continuing Appropriations Act 2020, and Health Extenders Act of 2019, and H.R. 1865, the Consolidated Domestic and International Assistance Bill
Client expense: Not reported · Firm income: $80,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2019 · fourth_quarter · Medicare/Medicaid
Issues related to Puerto Rico Medicare and Medicaid, Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (H.R. 4378), Territories Health Care Improvement Act (H.R. 3631), Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of 2019 (H.R. 3055), H.R. 4666, Further Consolidated Appropriations Act, 2020 (H.R. 1865)
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2019 · fourth_quarter · Medicare/Medicaid
Medicaid funding for Puerto Rico (HR 3631, HR 3371)
Client expense: Not reported · Firm income: $27,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2019 · fourth_quarter · Health Issues
Supported HR 4388, the Human Trafficking and Exploitation Prevention Training Act of 2019 to give priority to eligible entities serving geographic areas with high incidence of human trafficking. Supported passage of the Dignity in Aging Act (HR 4334) to reauthorize the Older Americans Act to develop, coordinate, and deliver home and community-based services to older adults. Supported passage of the International Violence Against Women Act which puts Gender Based Violence at the center of US foreign policy. Supported the Territories Health Care Act (HR 3631) to extend critical funding for the Medicaid program in US Territories. Urged Congress to extend the U.S. Department of Agriculture's authority to fund the Supplemental Nutrition Assistance Program for 120 days following expiration of legislation. Supported the Healthy Outcomes for Mothers and Infants Act of 2019 to help WIC services respond to emerging factors impacting the health of WIC recipients. Supported the Universal School Meals Program Act which includes free school breakfast, school lunch, and after school supper for all children. Supported the Summer Meals Act of 2019 ( S 1908 / HR 2818) to improve the area eligibility test by lowering it from 50 percent to 40 percent in addition to other improvements to reduce childhood hunger. Supported passage of the COFA Medicaid Restoration to restore Medicaid eligibility to citizens of the Compact of Free Associations nations who live and work in the United States. Signed onto letter to lower health care costs for women and families. Includes important steps to improve maternal health.
Client expense: Not reported · Firm income: $10,000
2019 · third_quarter · Medicare/Medicaid
Medicaid funding for Puerto Rico (HR 3631, HR 3371)
Client expense: Not reported · Firm income: $27,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2019 · third_quarter · Medicare/Medicaid
Issues related to Medicare and Medicaid funding for Puerto Rico, including H.R. 3631, The Territories Health Care Improvement Act, and HR 4378, The Continuing Appropriations Act 2020, and Health Extenders Act of 2019
Client expense: Not reported · Firm income: $80,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2019 · third_quarter · Medicare/Medicaid
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.
2019 · third_quarter · Health Issues
H.R.3630 - No Surprises Act H.R. 3631 - Territories Health Care Improvement Act
Client expense: $70,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2019 · third_quarter · Medicare/Medicaid
Issues related to implementation of legislative or regulatory changes to Medicare and Medicaid, including: HR 1570 and S. 668, the Removing Barriers to Colorectal Cancer Screening Act, and regulatory issues related to the Medicare coinsurance issue in these bills; HR 3835, the Cancer Care Planning and Communications Act; CMS-issued regulations pertaining to Medicare Part B reimbursement - the CY2020 Medicare Physician Fee Schedule; HR 913, The CLINICAL TREATMENT Act, Medicaid covering routine care costs for beneficiaries who participate in an approved clinical trial; Issues related to potential Administration guidance relating to giving states the option to block grant their Medicaid program; Issues related to Puerto Ricos Medicaid program, including H.R. 3631, Territories Health Care Improvement Act; H.R. 3, the Lower Drug Prices Now Act - legislation for lowering prescription drug costs, lowering out of pocket expenses for Medicare beneficiaries, and placing a cap on Medicare Part D; S. 2543, the Prescription Drug Pricing Reduction Act of 2019 - legislation for lowering prescription drug costs, lowering out of pocket costs for Medicare beneficiaries, and placing a cap on Medicare Part D; and Issues related to Medicaid Non-Emergency Medical Transportation.
Client expense: $1,230,000 · Firm income: Not reported
2019 · second_quarter · Medicare/Medicaid
Issues related to implementation of legislative or regulatory changes to Medicare and Medicaid, including: HR 1570 and S. 668, the Removing Barriers to Colorectal Cancer Screening Act, and regulatory issues related to the Medicare coinsurance issue in these bills; HR 3107, Improving Seniors Timely Access to Care Act of 2019, on prior authorization in the Medicare Advantage Program CMS-issued regulations pertaining to Medicare Part B reimbursement; HR 913, The CLINICAL TREATMENT Act, Medicaid covering routine care costs for beneficiaries who participate in an approved clinical trial; Issues related to potential Administration guidance relating to giving states the option to block grant their Medicaid program; Issues related to Puerto Ricos Medicaid program, including H.R. 3631, Territories Health Care Improvement Act. Issues related to utilization management in Medicare Part D plans; issues related to the Medicare Part D caps Potential legislation for lowering prescription drug costs and lowering out of pocket costs for Medicare beneficiaries; and CMS proposed regulatory changes on the six protected classes policy within the Medicare Part D prescription drug benefit.
Client expense: $910,000 · Firm income: Not reported
2019 · second_quarter · Medicare/Medicaid
Medicaid funding cliff. (HR 3631, HR 3371)
Client expense: Not reported · Firm income: $27,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
| Republican |
| FL |
| Jenniffer González-Colón | Republican | PR |
| José E. Serrano | Democratic | NY |
| Michael F. Q. San Nicolas | Democratic | GU |
| Nydia M. Velázquez | Democratic | NY |
| Peter T. King | Republican | NY |
| Raúl M. Grijalva | Democratic | AZ |
| Stacey E. Plaskett | Democratic | VI |
Client expense: $180,800 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Office of Administration, SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of
Client expense: $2,340,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
Client expense: $225,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT), U.S. Agency for International Development (USAID), Veterans Affairs, Dept of (VA), White House Office
Government targets: Equal Employment Opportunity Commission (EEOC), Federal Reserve System, HOUSE OF REPRESENTATIVES, Housing & Urban Development, Dept of (HUD), SENATE
Client expense: $2,110,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, White House Office
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), Veterans Affairs, Dept of (VA), White House Office
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), Veterans Affairs, Dept of (VA), White House Office