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Outpatient Therapy Modernization and Stabilization Act
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Outpatient Therapy Modernization and Stabilization Act This bill modifies payment and funding for certain outpatient therapy services under Medicare. Among other things, the bill specifically includes physicians, physical therapists, occupational therapists, and other specified practitioners who are enrolled as Medicare suppliers as eligible suppliers who may receive COVID-19 (i.e., coronavirus disease 2019) relief funds under the Public Health and Social Services Emergency Fund. The bill also permanently allows physical therapists, occupational therapists, and speech-language pathologists to provide telehealth services under Medicare, and includes specified therapy services as eligible Medicare telehealth services. (Currently, the Centers for Medicare & Medicaid Services is authorized to waive requirements for Medicare telehealth services during the public health emergency relating to COVID-19, and it has done so to allow all providers that are otherwise eligible to furnish in-person services under Medicare to also furnish telehealth services.)
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Filing registrants (14)
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Congress.gov source codes: 1000, Intro-H
Bills with similar content found using semantic analysis.
Sources: Congress.gov
2020 · fourth_quarter · Health Issues
Engaged with both legislative chambers and CMS in order to prevent CMS proposed steep cuts to Medicare in 2021 (projected 9% cut for physical therapy) by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes or other policy options to drastically reduce the cut to Medicare reimbursement. This was achieved by writing letters to Congress as well as supporting client's efforts to endorse and advocate for The Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) would allow PT, OT, and SLP professionals, and facilities that provide outpatient therapy to bill Medicare for outpatient therapy services furnished via telehealth, modify the plan of care certification requirement in order to reduce administrative burden and delays in care; and prevent CMS proposed steep cuts to Medicare in 2021 by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes. Summarized impact of CMS 2021 Medicare Physician Fee Schedule final rule upon PPS members. Engaged with lawmakers and their staff as well as CMS in order to achieve Medicare coverage of PT provided via telehealth. Advised clients on the impacts of COVID-19 related legislation such as FFCRA, CARES (the PPP and other features), PPPFA, Consolidated Appropriations Act, etc. Successfully lobbied Congressional to clarify that forgiven PPP expenses also be tax deductible. Sent letter to Congressional leadership asking that Provider Relief Fund payments be tax free. Successfully advocated for the inclusion of language from S.4117/H.R.7777 in order to facilitate a one-page form EZ PPP loan forgiveness process for PPP loans of $150,000 or less in the Consolidated Appropriations Act. Advocated successfully for the delay of the reinstatement of the 2% Medicare sequester cut (a derivative of H.R.8840 which called for a delay for the duration of the public health emergency)
Client expense: Not reported · Firm income: $30,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2020 · fourth_quarter · Health Issues
Monitored the expansion of telehealth for rehabilitation therapy. Tracked and advised client re: The Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) would allow PT, OT, and SLP professionals, and facilities that provide outpatient therapy to bill Medicare for outpatient therapy services furnished via telehealth, modify the plan of care certification requirement in order to reduce administrative burden and delays in care; and prevent CMS proposed steep cuts to Medicare in 2021 by asking Congress to mitigate the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes. Reviewed and summarized impact of CMS 2021 Medicare Physician Fee Schedule.
Client expense: Not reported · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2020 · fourth_quarter · Medicare/Medicaid
H.R. 8840, Medicare Sequester COVID Moratorium Act, all provisions H.R. 8702, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions S. 5007, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions H.R. 7154, Outpatient Therapy Modernization and Stabilization Act, all provisions H.R. 3107, Improving Seniors Timely Access to Care Act of 2019, all provisions S. 5044, Improving Seniors Timely Access to Care Act of 2020y, all provisions H.R. 8727, Telehealth Modernization Act, all provisions S. 4375, Telehealth Modernization Act, all provisions H.R. 7663, Protecting Access to Post-COVID-19 Telehealth Act of 2020, all provisions H.R. 7391, Protect Telehealth Access Act of 2020, all provisions H.R. 1301, Mental Health Telemedicine Expansion Act, all provisions H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019, all provisions H.R. 5201, Telemental Health Expansion Act of 2020, provisions relating to 1834(m) of the Social Security Act; geographic and originating sites H.R. 7233, Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, all provisions H.R. 5172, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions S. 3067, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions H.R. 3414, Opioid Workforce Act of 2019, all provisions H.R. 7791, Value in Health Care Act of 2020, provisions relating to qualifying APM physician thresholds H.R. 6837, Medicare Accelerated and Advance Payments Improvement Act of 2020, all provisions S. 3750, Medicare Accelerated and Advance Payments Improvement Act, all provisions H.R. 8505, To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes, all provisions H.R. 884, Medicare Mental Health Access Act, all provisions H.R. 945, Mental Health Access Improvement Act of 2019, all provisions H.R. 6744, Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2020, all provisions H.R. 4004, Social Determinants Accelerator Act of 2019, all provisions H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions S. 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, provisions related to PBM and prescription drug price transparency H.R. 19, Lower Costs, More Cures Act of 2019, provisions related to PBM and prescription drug price transparency H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2020, all provisions H.R. 6090, Physician Shortage GME Cap Flex Act of 2020, all provisions H.R. 6142, Black Maternal Health Momnibus Act of 2020, all provisions Medicare program: P.L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) implementation/Accountable Care Organizations/APM thresholds Medicare program: Patient Protection and Affordable Care Act (PPACA)/Prior authorization provider and patient burdens/patient electronic access to health information Medicare program: P.L. 113-93 Protecting Access to Medicare Act (PAMA)/Imaging appropriate use criteria/Radiation Oncology APM Medicare program: FY 2021 Inpatient Rehab Facility Prospective Payment System (IRF PPS)/scope of practice issues Medicare program: CY 2021 physician fee schedule/E&M services/Budget neutrality/Part B/Sequester Medicare program: Alternative payment models (APMs) Medicare program: Merit-based Incentive Payment System (MIPS)/cost/quality/interoperability/hardship exemption Medicare program: Regulatory relief/Advanced APMs, prior authorization, and utilization management Medicare program: Shared Savings Program Medicare program: Quality Payment Program/prior authorization/electronic funds transfer Medicare program: Surprise medical billing Medicare program: Medicare-For-All Medicare program: Electronic Health Records (EHR) Certification Medicare program: 21st Century Cures Act Medicare program: Quality payment program/physician burdens Medicare program: National Coverage determination/validated home blood pressure monitors Medicare program: Health IT/physician burden Medicare program: Drug pricing Medicare program: Most favored nation drug pricing Medicare program: Provider compliance/regulatory relief Medicare program: Provider Enrollment, Chain and Ownership (PECOS) enrollment/revalidation Medicare and Medicaid programs: 21st Century Cures Act/health data and privacy Medicaid program: CMS proposed regulation Medicaid Program Medicaid program: FMAP increases Medicaid program: Interoperability
2020 · fourth_quarter · Medicare/Medicaid
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage 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. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud 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. 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. 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. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 4996 - Helping Medicaid Offer Maternity Services Act of 2020 - Kelly - extend Medicaid coverage post-partum H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized 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. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program -Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - Increasing Hospital Capacity to Fight the Coronavirus Act of 2020 - Bishop - Medicare and Medicaid payments during COVID-19 emergency H.R. 6462 - Emergency Medicaid for Coronavirus Treatment Act - Gallego - Medicaid coverage H.R. 6511 - Ensuring Vaccination and Treatment Affordability Act - Pappas - COVID H.R. 6521 - To prohibit the Secretary of Health and Human Services from taking certain actions with respect to Medicaid supplemental payments reporting requirements, and for other purposes - Diaz Barragan - Medicaid, delays implementation of MFAR H.R. 6538 - Modernized Medicine Act - Kennedy - Medicaid, Telehealth H.R. 6539 - Coronavirus Medicaid Response Act - Lee - FMAP H.R. 6572 - To direct the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, to carry out a national campaign to increase awareness and knowledge of COVID-19. -Bilirakis - COVID H.R. 6583 - To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes. - Houlahan - COVID H.R. 6616 - Stronger Medicaid Response to the COVID-19 Pandemic Act -Cardenas - COVID H.R. 6640 - Medicare Advantage COVID Treatment Act - Mucarsel-Powell - COVID H.R. 6658 - Insular Area Medicaid Coronavirus Recovery Act - Sablan - FMAP H.R. 6727 - To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program - Schrier - COVID H.R. 6744 - Computer and Internet Equity Act - Davis - internet access for Lifeline program H.R. 6753 - Save Rural Hospitals Act of 2020 - Finkenauer - Medicare hospital payments H.R. 6792 - Improving Telehealth for Underserved Communities Act of 2020 - Smith - telehealth H.R. 6797 - CHIPPER Act - Wild - CHIP, COVID H.R. 6837 - Medicare Accelerated and Advance Payments Improvement Act of 2020 -Schneider - COVID H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act -Boyle - outpatient therapy services H.R. 7187 - HEALTH Act of 2020 -Thompson -Smith - telehealth H.R. 7292 - To amend title XVIII of the Social Security Act to provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. - Kaptur - advance payments H.R. 7338 - To amend title XVIII of the Social Security Act to permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program, and for other purposes. - Cheney - Telehealth H.R. 7391 - To amend title XVIII of the Social Security Act to remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program - Sherrill- Telehealth H.R. 7606 - MFAR Transparency Act - Williams - report on impact of MFAR to Congress H.R. 7627 - MORE Savings Act - Dean - Medicare access to opioid treatment and MAT H.R. 7663 - Protecting Access to Post-COVID-19 Telehealth Act of 2020 - Thompson - waive or modify application of Medicare requirements with respect to telehealth during PHE H.R. 7791 - Value in Health Care Act of 2020 - Welch - Medicare shared savings program and alternative payment arrangements H.R. 7877 - Lowering Drug Costs for Seniors Act of 2020 - Katko - Medicare Part D costs H.R. 7892 - Medicaid Expansion During Crisis Act - Coleman - extend eligibility period for Medicaid enrollment application H.R. 8177 - Renal Anemia Innovation Support and Expansion Act - OHalleran - Medicare prescription drug coverage for chronic kidney disease H.R. 8218 - Rural Ambulance Reimbursement Fairness Act - Gianforte - Medicare payment for rural ambulance services H.R. 8254 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Blumenauer - integrated care for Medicare beneficiaries with ESRD H.R. 8427 - To provide for certain reports on enrollment in the Lifeline program, and for other purposes - Luria - Lifeline program H.R. 8476 - TIKES Act -Blunt Rochester - telehealth coverage in Medicaid H.R. 8505 - To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule - Burgess - Medicare physician fee schedule H.R. 8525 - Expanded Genetic Screening Act of 2020 - Speier - Medicaid coverage of non-invasive prenatal genetic screening H.R. 8529 - Protecting Access to Affordable Medicines Act of 2020 - Butterfield - rebates under the Medicaid program for certain noninnovator multiple source drugs H.R. 8546 - Fair Drug Prices for Kids Act -Wild - Medicaid drug rebate program in CHIP H.R. 8558 - Comprehensive Breast Reconstruction Act of 2020 - Hastings - extends coverage of certain breast reconstructive services following mastectomy under the Medicare and Medicaid programs H.R. 8561 - Restoring Fairness to Medicaid Reimbursement Act of 2020 - Johnson - FMAP H.R. 8574 - PROTECT Long Term Care Facilities Act -Sherrill - long term care in COVID-19 H.R. 8586 - Medicaid Coverage for Addiction Recovery Expansion Act -Foster - Substance Use Disorder H.R. 8623 - SAVE for Seniors Act - Spanberger - Medicare coverage of COVID-19 vaccines H.R. 8624 - Protecting Access to Innovation During COVID-19 Act - Wenstrup - extension of pass-through status under the Medicare program H.R. 8702 - Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 -Bera - part B Medicare payments during COVID H.R. 8725 - HAPI Act - Soto - Medicaid Coverage of adult vaccines H.R. 8727 - Telehealth Modernization Act - Carter - Medicare telehealth payments H.R. 8755 - Expanded Telehealth Access Act -Sherrill - Medicare telehealth coverage H.R. 8756 - COVID Health Care Provider Assurance Act of 2020 - Riggleman - Medicare Part B payments during COVID-19 H.R. 8826 - The Resetting the Impact Act (TRIA) of 2020 - Sewell - amends the IMPACT Act of 2014 H.R. 8840 - Medicare Sequester COVID Moratorium Act - Schneider - extend temporary Medicare sequestration H.R. 8871 - COVID HCBS Relief Act of 2020 - Dingell - funding for state Medicaid programs HCBS H.R. 8934 - Community Integration Act of 2020 - Cartwright - Medicaid HCBS H.R. 8958 - Supporting Best Practices for Healthy Moms Act - Kelly - guidance for state Medicaid programs on maternal health H.R. 9002 - To amend title XIX of the Social Security Act to provide States an option to cover a children's program of all-inclusive coordinated care (ChiPACC) under Medicaid program - DeGette - Childrens health under Medicaid H.R. 9006 - To amend title XIX of the Social Security Act to provide for coverage under the Medicaid program under such title of routine patient costs associated with participation in certain clinical trials - Garcia - Medicaid coverage of clinical trials H.R. 9035 - Permanency for Audio-Only Telehealth Act - Smith - Audio only telehealth in Medicare 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. 3013 - Encouraging Innovative Benefit Design to Lower Costs for Seniors Act - Crapo - offer additional prescription drugs under Part D S. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program S. 3615 - Rural Community Hospital Demonstration Extension Act of 2020 - Murkowski - rural community hospital demonstration program S. 3665 - Save Rural Hospitals Act of 2020 - Alexander - Medicare hospital payments S. 3750 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Shaheen - COVID S. 3881 - CHIPPER Act - Casey - CHIP, COVID S. 3998 - HEALTH Act of 2020 - Hyde-Smith - telehealth S. 3999 - Mental and Behavioral Health Connectivity Act - King - Mental Health S. 4108 - A bill to amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns - Casey - FMAP S. 4151 - SOS: Sustaining Outpatient Services Act - Hoeven - Medicare OPPS coverage S. 4230 - Telehealth Expansion Act of 2020 - Wyden - Telehealth mental health services in Medicare S. 4274 - Legalizing Drug Discounts for Seniors Act of 2020 - Paul - exclude discounts for covered part D drugs from the anti-kickback prohibition S. 4295 - Public Health Emergency Pass-Through Payment Fairness Act of 2020 - Paul - access to drugs and devices under Medicare S. 4358 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Bennet - Medicaid coverage for vaccines and treatment for COVID-19 for uninsured without cost-sharing S. 4375 - Telehealth Modernization Act - Alexander - make permanent Medicare telehealth flexibilities S. 4423 - COVID-19 Hospice Respite Care Relief Act of 2020 - Brown - Medicare hospice care S. 4448- Fair Drug Prices for Kids Act - Warner - extend Medicaid drug rebate program to CHIP S. 4574 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Young - integrated care for Medicare beneficiaries with ESRD S. 4690 - Maternal Immunization Enhancement Act - Hassan - Medicaid and maternal health S. 4705 - Maternal Immunization Coverage Act - Cassidy - Medicaid coverage S. 4717 - Accelerating Kids Access to Care Act - Grassley - Medicaid enrollment S. 4742 - CLINICAL TREATMENT Act - Burr - Medicaid coverage S. 4825 - Ensuring Access to COVID-19 Vaccines for Seniors Act - Reed - Medicare coverage of COVID-19 vaccines S. 4840 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2020 -Roberts - audio-only risk adjustment in Medicare Advantage S. 4859 - Connected MOM Act - Cassidy - expanded coverage of remote physiologic devices and related services under Medicaid S. 4864 - HAPI Act - Brown - Medicaid coverage of adult vaccines S. 4944 - Equality in Medicare and Medicaid Treatment Act of 2020 - Booker - CMMI models for SDOH in Medicare/Medicaid S. 4949 - Supporting Best Practices for Healthy Moms Act - Toomey - guidance for state Medicaid programs on maternal health S. 4957 - COVID HCBS Relief Act of 2020 - Casey - funding for state Medicaid programs HCBS S. 5007 - Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 - Boozman - increase in Medicare part B payment S. 5044 - Bill to amend title XVIII of the SSA to establish requirement with respect to the use of prior authorization under the Medicare Advantage plans - Brown - Prior authorization S. 5077 - A bill to amend title XIX of the Social Security Act to adjust the limitations on Medicaid disproportionate share hospital payments - Cornyn - Medicaid DSH 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 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; issues related to health insurance tax for MA and Part D plans; implications of physician fee schedule on MA; 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 health plan models; 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.
2020 · fourth_quarter · Medicare/Medicaid
Medicare prospective payment system; Long Term Acute Care Hospitals (LTCH); implementation of health care reform; Physician fee schedule and IMPACT Act; HR 7154, the Outpatient Therapy Modernization and Stabilization Act
Client expense: Not reported · Firm income: $140,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
| Democratic |
| FL |
| Eleanor Holmes Norton | Democratic | DC |
| Grace F. Napolitano | Democratic | CA |
| Josh Harder | Democratic | CA |
| Joyce Beatty | Democratic | OH |
| Lisa Blunt Rochester | Democratic | DE |
| Max Rose | Democratic | NY |
| Michael F. Doyle | Democratic | PA |
| Mikie Sherrill | Democratic | NJ |
| Terri A. Sewell | Democratic | AL |
| Vern Buchanan | Republican | FL |
Client expense: $3,870,000 · Firm income: Not reported
Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA), White House Office
Client expense: $2,400,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Council of Economic Advisers (CEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of the Vice President of the United States, SENATE, Treasury, Dept of, White House Office
2020 · fourth_quarter · Medicare/Medicaid
H.R. 8840, Medicare Sequester COVID Moratorium Act, all provisions H.R. 8702, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions S. 5007, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions H.R. 7154, Outpatient Therapy Modernization and Stabilization Act, all provisions H.R. 3107, Improving Seniors Timely Access to Care Act of 2019, all provisions S. 5044, Improving Seniors Timely Access to Care Act of 2020y, all provisions H.R. 8727, Telehealth Modernization Act, all provisions S. 4375, Telehealth Modernization Act, all provisions H.R. 7663, Protecting Access to Post-COVID-19 Telehealth Act of 2020, all provisions H.R. 7391, Protect Telehealth Access Act of 2020, all provisions H.R. 1301, Mental Health Telemedicine Expansion Act, all provisions H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019, all provisions H.R. 5201, Telemental Health Expansion Act of 2020, provisions relating to 1834(m) of the Social Security Act; geographic and originating sites H.R. 7233, Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, all provisions H.R. 5172, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions S. 3067, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions H.R. 3414, Opioid Workforce Act of 2019, all provisions H.R. 7791, Value in Health Care Act of 2020, provisions relating to qualifying APM physician thresholds H.R. 6837, Medicare Accelerated and Advance Payments Improvement Act of 2020, all provisions S. 3750, Medicare Accelerated and Advance Payments Improvement Act, all provisions H.R. 8505, To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes, all provisions H.R. 884, Medicare Mental Health Access Act, all provisions H.R. 945, Mental Health Access Improvement Act of 2019, all provisions H.R. 6744, Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2020, all provisions H.R. 4004, Social Determinants Accelerator Act of 2019, all provisions H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions S. 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, provisions related to PBM and prescription drug price transparency H.R. 19, Lower Costs, More Cures Act of 2019, provisions related to PBM and prescription drug price transparency H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2020, all provisions H.R. 6090, Physician Shortage GME Cap Flex Act of 2020, all provisions H.R. 6142, Black Maternal Health Momnibus Act of 2020, all provisions Medicare program: P.L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) implementation/Accountable Care Organizations/APM thresholds Medicare program: Patient Protection and Affordable Care Act (PPACA)/Prior authorization provider and patient burdens/patient electronic access to health information Medicare program: P.L. 113-93 Protecting Access to Medicare Act (PAMA)/Imaging appropriate use criteria/Radiation Oncology APM Medicare program: FY 2021 Inpatient Rehab Facility Prospective Payment System (IRF PPS)/scope of practice issues Medicare program: CY 2021 physician fee schedule/E&M services/Budget neutrality/Part B/Sequester Medicare program: Alternative payment models (APMs) Medicare program: Merit-based Incentive Payment System (MIPS)/cost/quality/interoperability/hardship exemption Medicare program: Regulatory relief/Advanced APMs, prior authorization, and utilization management Medicare program: Shared Savings Program Medicare program: Quality Payment Program/prior authorization/electronic funds transfer Medicare program: Surprise medical billing Medicare program: Medicare-For-All Medicare program: Electronic Health Records (EHR) Certification Medicare program: 21st Century Cures Act Medicare program: Quality payment program/physician burdens Medicare program: National Coverage determination/validated home blood pressure monitors Medicare program: Health IT/physician burden Medicare program: Drug pricing Medicare program: Most favored nation drug pricing Medicare program: Provider compliance/regulatory relief Medicare program: Provider Enrollment, Chain and Ownership (PECOS) enrollment/revalidation Medicare and Medicaid programs: 21st Century Cures Act/health data and privacy Medicaid program: CMS proposed regulation Medicaid Program Medicaid program: FMAP increases Medicaid program: Interoperability
Client expense: $4,170,000 · Firm income: Not reported
Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA), White House Office
2020 · fourth_quarter · Medicare/Medicaid
Payment issues relating to orthopaedic practices that own in-office ancillary services Bundled Payments for Care Improvement Advanced Model Issues related to Stark Laws and AKS Comprehensive joint replacements Medicare Access and CHIP Reauthorization Act implementation Issues related to total knee anthroplasty HR 6654 - Emergency COVID-19 Telehealth Response Act HR 7233 - Keep Telehealth Options Act S.2741/H.R.4932 - CONNECT for Health Act of 2019 H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act
Client expense: Not reported · Firm income: $60,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · fourth_quarter · Medicare/Medicaid
No bill: Support inclusion of occupational therapy services via telehealth under Medicare Part B, Medicare Advantage and any demonstration programs such as telehealth within accountable care organizations. HR 3127/S 1725 - The Home Health Flexibility Act: Support the ability of occupational therapists to conduct the initial and comprehensive assessments for Medicare Home Health cases. No bill: Support for Congressional attention to the issue of falls related injuries and falls prevention. HR 4932/S 2741 - CONNECT for Health Act of 2019: Support expanded coverage for services provided to Medicare patients via telehealth, including occupational therapy and other therapy services. HR 1329 - Medicaid Reentry Act (mental health and Medicaid policy): Support passage S 1754/HR 3215 - The Disaster Relief Medicaid Act (DRMA): Support passage No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, that support caregivers for people with dementia. No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, to support aging in place. S 1202 - Independence At Home Act: support passage HR 7154 - Outpatient Therapy Modernization and Stabilization Act: Support passage. HR 6634 - Emergency COVID Telehealth Response Act: Support introduction and passage. S. 4375/HR 8727 - Telehealth Modernization Act: Advocate for provisions that would allow the Secretary of Health and Human Services to permanently add occupational therapy practitioners to the Medicare telehealth benefit. Support passage. Support various House and Senate proposals to extend and make permanent the Public Health Emergency provisions that enable occupational therapists to provide services to Medicare patients via telehealth. HR 8755-Expanded Telehealth Access Act: Support passage of bill that would allow occupational therapists and other therapists to provide services to Medicare Part B Patients via telehealth after public health emergency ends. S 4343/HR 8581-Triple A Study Bill: advocate to add occupational therapists to list of providers included in legislation mandating study of amputee healthcare. H.R. 133 - Consolidated Appropriations Act of 2021, Division CC Section 115: Advocate to permit occupational therapists to conduct the initial assessment visit and complete the comprehensive assessment with respect to certain rehabilitation services for home health agencies under the Medicare Part B program. HR 8702/S. 5007 - Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020; Division CC Section 113 of HR 133-Consolidated Appropriations Act, 2021; and HR 8505-a bill to provide a one year waiver of budget neutrality under the Medicare physician fee schedule: Advocate for changes to evaluation and management coding redistribution in Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2021 (CMS-1734-F). No bill: Advocated to pause Medicare sequestration for 2021.
Client expense: $160,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · fourth_quarter · Medicare/Medicaid
Medicare coverage and reimbursement for therapy services and rehabilitation telehealth services including H.R. 7154, the Outpatient Therapy Modernization and Stabilization Act; Policies impacting the U.S. response to the COVID-19 pandemic including H.R. 604, the Coronavirus Preparedness and Response Supplemental Appropriations Act, Public Law No. 116-123; H.R. 6201, Families First Coronavirus Response Act, Public Law No. 116-127; H.R. 748, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), Public Law No. 116-136; and H.R. 6800, the Health and Economic Recovery Omnibus Emergency Solutions Act (HEROES Act). Medicare payment reform for post acute care services. Matters affecting bundled payments and value-based reimbursement; Implementation of physician fee schedule for CY 2020. Legislation to waive the budget neutrality requirement for E/M codes under the CY 2021 physician fee schedule including H.R. 8505. S. 5007, Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020; H.R. 8702, Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020. H.R. 133, Consolidated Appropriations Act, 2021, Pub. L. No. 116-260.
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE
2020 · fourth_quarter · Medical/Disease Research/Clinical Labs
NIH Rehab issues APTA role with NIH Traumatic brain injury research Support of work done at CDC Injury Center on elder adult falls, TBI, youth sports concussions NIH Research and Development funding Physical Therapist role in childhood obesity Relocate TBI State Grant Program to ACL NIDILRR - Rehab research Nomination to NIH Committees Safety of Children in School (Restraint & Seclusion) Falls and Falls Prevention HR 7154 Outpatient Therapy Modernization and Stabilization Act
Client expense: $236,490 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office
2020 · fourth_quarter · Medicare/Medicaid
HR 4994/PL 113-185 Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (all sections) HR 3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (all sections) HR 807 - Medicare Access to Rehabilitation Services Act of 2017 (all sections) S 253 - Medicare Access to Rehabilitation Services Act of 2017 (all sections) HR 2797 - Patient Choice and Quality Care Act (all sections) S 1334 - Patient Choice and Quality Care Act (all sections) HR 1892 - Bipartisan Budget Act of 2018 (Sec. 51005. Extension of Blended Site-Neutral Payment Rate for Certain Long-Term Care Hospital Discharges; Temporary Adjustment to Site Neutral Payment Rates, Sec. 50202. Repeal of Medicare payment cap for therapy services; limitation to ensure appropriate therapy, Title III-Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care.) S. 594 - Preserving Rehabilitation Innovation Centers Act of 2019 (all sections) HR 1901 - Preserving Rehabilitation Innovation Centers Act of 2019 (all sections) HR 3417 - Beneficiary Education Tools, Telehealth, and Extenders (BETTER) Act of 2019 (Sec. 103. Medicare coverage of certain mental health telemedicine, Sec. 204. Improving measurements under the skilled nursing value-based purchasing program under the Medicare program) HR 3107 - Improving Seniors Timely Access to Care Act of 2019 (all sections) HR 266 - Paycheck Protection Program and Health Care Enforcement Act (all sections) HR 748 - Coronavirus Aid, Relief, and Economic Security (CARES) Act (all sections) HR 7154 - Outpatient Therapy Modernization and Stabilization Act (all sections) HR 8600 - Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (all sections) HR 8702 - Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 (all sections) HR 8826 - The Resetting the Impact Act (TRIA) of 2020 (all sections) HR 133/PL 116-260 - Consolidated Appropriations Act, 2021 (Division M - Coronavirus Response & Relief Supplemental Appropriations Act, 2021)
Client expense: $720,300 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE
2020 · fourth_quarter · Medicare/Medicaid
DMEPOS payment and coverage Medicare Part B reimbursement Extension of telehealth flexibilities H.R.7154 - Outpatient Therapy Modernization and Stabilization Act H.R. 8702/S. 5007 - Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 H.R.8505 - To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes.
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2020 · fourth_quarter · Medicare/Medicaid
The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753) National Defense Authorization Act of 2018 (H.R. 2810) S. AMDT. 621 (H.R. 2810)--Authorization of Physical Therapist Assistants and Occupational Therapy Assistants to Provide Services Under the TRICARE Program Trusted Exchange Framework and Common Agreement (TEFCA) CONNECT for Health Act of 2017 (H.R. 2556/S. 1016) The Laboratory Access for Beneficiaries (LAB) Act of 2019 (H.R. 3584) The Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 (H.R. 2408) The Protecting Access to Wheelchairs Act of 2019 (H.R. 2293) The Protecting Beneficiary Access to Complex Rehab Technology Act of 2019 (S. 1223) The Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019 (H.R.3417) The Creating Opportunities Now and Effective Care Technologies (CONNECT) Act of 2019 (S.2741) The Safeguarding Medicare Access to Respiratory Therapy (SMART) Act of 2019 (H.R.4945) The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020(H.R.6074) The Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 (S.3548) The Outpatient Therapy Modernization and Stabilization Act (H.R.7154) The Nursing Home COVID-19 Protection and Prevention Act (S.3768) The Infection Control Training and Support Act (H.R.7254) The Consolidated Appropriations Act of 2021 (PL 116-260) The Holding Providers Harmless from Medicare Cuts during COVID-19 Act of 2020 (H.R. 8702/S.5007)
Client expense: $39,516 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2020 · third_quarter · Medicare/Medicaid
The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753) National Defense Authorization Act of 2018 (H.R. 2810) S. AMDT. 621 (H.R. 2810)--Authorization of Physical Therapist Assistants and Occupational Therapy Assistants to Provide Services Under the TRICARE Program Trusted Exchange Framework and Common Agreement (TEFCA) CONNECT for Health Act of 2017 (H.R. 2556/S. 1016) The Laboratory Access for Beneficiaries (LAB) Act of 2019 (H.R. 3584) The Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 (H.R. 2408) The Protecting Access to Wheelchairs Act of 2019 (H.R. 2293) The Protecting Beneficiary Access to Complex Rehab Technology Act of 2019 (S. 1223) The Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019 (H.R.3417) The Creating Opportunities Now and Effective Care Technologies (CONNECT) Act of 2019 (S.2741) The Safeguarding Medicare Access to Respiratory Therapy (SMART) Act of 2019 (H.R.4945) The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020(H.R.6074) The Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 (S.3548) The Outpatient Therapy Modernization and Stabilization Act (H.R.7154) The Nursing Home COVID-19 Protection and Prevention Act (S.3768) The Infection Control Training and Support Act (H.R.7254)
Client expense: $39,516 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2020 · third_quarter · Medicare/Medicaid
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage 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. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud 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. 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. 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. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 4996 - Helping Medicaid Offer Maternity Services Act of 2020 - Kelly - extend Medicaid coverage post-partum H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized 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. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program -Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - Increasing Hospital Capacity to Fight the Coronavirus Act of 2020 - Bishop - Medicare and Medicaid payments during COVID-19 emergency H.R. 6462 - Emergency Medicaid for Coronavirus Treatment Act - Gallego - Medicaid coverage H.R. 6511 - Ensuring Vaccination and Treatment Affordability Act - Pappas - COVID H.R. 6521 - To prohibit the Secretary of Health and Human Services from taking certain actions with respect to Medicaid supplemental payments reporting requirements, and for other purposes - Diaz Barragan - Medicaid, delays implementation of MFAR H.R. 6538 - Modernized Medicine Act - Kennedy - Medicaid, Telehealth H.R. 6539 - Coronavirus Medicaid Response Act - Lee - FMAP H.R. 6572 - To direct the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, to carry out a national campaign to increase awareness and knowledge of COVID-19. -Bilirakis - COVID H.R. 6583 - To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes. - Houlahan - COVID H.R. 6616 - Stronger Medicaid Response to the COVID-19 Pandemic Act -Cardenas - COVID H.R. 6640 - Medicare Advantage COVID Treatment Act - Mucarsel-Powell - COVID H.R. 6658 - Insular Area Medicaid Coronavirus Recovery Act - Sablan - FMAP H.R. 6727 - To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program - Schrier - COVID H.R. 6744 - Computer and Internet Equity Act - Davis - internet access for Lifeline program H.R. 6753 - Save Rural Hospitals Act of 2020 - Finkenauer - Medicare hospital payments H.R. 6792 - Improving Telehealth for Underserved Communities Act of 2020 - Smith - telehealth H.R. 6797 - CHIPPER Act - Wild - CHIP, COVID H.R. 6837 - Medicare Accelerated and Advance Payments Improvement Act of 2020 -Schneider - COVID H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act -Boyle - outpatient therapy services H.R. 7187 - HEALTH Act of 2020 -Thompson -Smith - telehealth H.R. 7292 - To amend title XVIII of the Social Security Act to provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. - Kaptur - advance payments H.R. 7338 - To amend title XVIII of the Social Security Act to permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program, and for other purposes. - Cheney - Telehealth H.R. 7391 - To amend title XVIII of the Social Security Act to remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program - Sherrill- Telehealth H.R. 7606 - MFAR Transparency Act - Williams - report on impact of MFAR to Congress H.R. 7627 - MORE Savings Act - Dean - Medicare access to opioid treatment and MAT H.R. 7663 - Protecting Access to Post-COVID-19 Telehealth Act of 2020 - Thompson - waive or modify application of Medicare requirements with respect to telehealth during PHE H.R. 7791 - Value in Health Care Act of 2020 - Welch - Medicare shared savings program and alternative payment arrangements H.R. 7877 - Lowering Drug Costs for Seniors Act of 2020 - Katko - Medicare Part D costs H.R. 7892 - Medicaid Expansion During Crisis Act - Coleman - extend eligibility period for Medicaid enrollment application H.R. 8177 - Renal Anemia Innovation Support and Expansion Act - OHalleran - Medicare prescription drug coverage for chronic kidney disease H.R. 8218 - Rural Ambulance Reimbursement Fairness Act - Gianforte - Medicare payment for rural ambulance services H.R. 8254 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Blumenauer - integrated care for Medicare beneficiaries with ESRD H.R. 8427 - To provide for certain reports on enrollment in the Lifeline program, and for other purposes - Luria - Lifeline program 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. 3013 - Encouraging Innovative Benefit Design to Lower Costs for Seniors Act - Crapo - offer additional prescription drugs under Part D S. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program S. 3615 - Rural Community Hospital Demonstration Extension Act of 2020 - Murkowski - rural community hospital demonstration program S. 3665 - Save Rural Hospitals Act of 2020 - Alexander - Medicare hospital payments S. 3750 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Shaheen - COVID S. 3881 - CHIPPER Act - Casey - CHIP, COVID S. 3998 - HEALTH Act of 2020 - Hyde-Smith - telehealth S. 3999 - Mental and Behavioral Health Connectivity Act - King - Mental Health S. 4108 - A bill to amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns - Casey - FMAP S. 4151 - SOS: Sustaining Outpatient Services Act - Hoeven - Medicare OPPS coverage S. 4230 - Telehealth Expansion Act of 2020 - Wyden - Telehealth mental health services in Medicare S. 4274 - Legalizing Drug Discounts for Seniors Act of 2020 - Paul - exclude discounts for covered part D drugs from the anti-kickback prohibition S. 4295 - Public Health Emergency Pass-Through Payment Fairness Act of 2020 - Paul - access to drugs and devices under Medicare S. 4358 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Bennet - Medicaid coverage for vaccines and treatment for COVID-19 for uninsured without cost-sharing S. 4375 - Telehealth Modernization Act - Alexander - make permanent Medicare telehealth flexibilities S. 4423 - COVID-19 Hospice Respite Care Relief Act of 2020 - Brown - Medicare hospice care S. 4448 - Fair Drug Prices for Kids Act - Warner - extend Medicaid drug rebate program to CHIP S. 4574 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Young - integrated care for Medicare beneficiaries with ESRD S. 4690 - A bill to increase vaccination rates among pregnant women enrolled in Medicaid or CHIP, and for other purposes - Hassan - Medicaid and maternal health S. 4705 - A bill to amend title XIX requiring coverage under Medicaid of vaccines for pregnant women - Cassidy - Medicaid coverage S. 4717 - A bill to amend title XIX of the Social Security Act to streamline enrollment of certain Medicaid providers across State lines, and for other purposes - Grassley - Medicaid enrollment S. 4742 - A bill to amend title XIX of the Social Security Act to promote access to life-saving therapies for Medicaid enrollees by ensuring coverage of routine patient costs for items and services furnished in connection with participation in qualifying clinical trials, and for other purposes - Burr - Medicaid coverage 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 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to COVID-19, including testing; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; 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.
Client expense: $2,230,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
2020 · third_quarter · Medicare/Medicaid
Payment issues relating to orthopaedic practices that own in-office ancillary services Bundled Payments for Care Improvement Advanced Model Issues related to Stark Laws and AKS Comprehensive joint replacements Medicare Access and CHIP Reauthorization Act implementation Issues related to total knee anthroplasty HR 6654 - Emergency COVID-19 Telehealth Response Act HR 7233 - Keep Telehealth Options Act S.2741/H.R.4932 - CONNECT for Health Act of 2019 H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act
Client expense: Not reported · Firm income: $60,000
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
2020 · third_quarter · Medicare/Medicaid
H.R. 5201, Telemental Health Expansion Act of 2019, provisions relating to 1834(m) of the Social Security Act; geographic and originating sites H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019, all provisions H.R. 7391, Protect Telehealth Access Act of 2020, all provisions H.R. 7233, KEEP Telehealth Options Act of 2020, all provisions H.R. 7663, Protecting Access to Post-COVID-19 Telehealth Act of 2020, all provisions S. 4375, Telehealth Modernization Act, all provisions H.R. 1301, Mental Health Telemedicine Expansion Act, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 19, Lower Costs, More Cures Act of 2019, all provisions H.R. 3414, Opioid Workforce Act of 2019, all provisions H.R. 7791, Value in Health Care Act of 2020, all provisions H.R. 3107, Improving Seniors' Timely Access to Care Act of 2019, all provisions H.R. 6379, Take Responsibility for Workers and Families Act, provisions related to Medicare and Medicaid H.R. 6837, Medicare Accelerated and Advance Payments Improvement Act of 2020, all provisions S. 3750, Medicare Accelerated and Advance Payments Improvement Act of 2020, all provisions H.R. 7154, Outpatient Therapy Modernization and Stabilization Act, all provisions H.R. 6585, Equitable Data Collection and Disclosure on COVID-19 Act, all provisions H.R. 884, Medicare Mental Health Access Act, all provisions S. 2772, Medicare Mental Health Access Act, all provisions H.R. 945, Mental Health Access Improvement Act of 2019, all provisions H.R. 1763, Resident Physician Shortage Reduction Act of 2019, all provisions H.R. 6774, Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2020, all provisions H.R. 4004, Social Determinants Accelerator Act of 2019, all provisions H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2020, all provisions H.R. 6090, Physician Shortage GME Cap Flex Act of 2020, all provisions H.R. 913, CLINICAL TREATMENT Act, all provisions H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions S, 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions Medicare program: P.L. 113-93 Protecting Access to Medicare Act (PAMA), provisions relating to imaging appropriate use criteria Medicare program: Sequester exemption Medicare program: Laboratory developed tests for COVID-19/coverage Medicare program: Medicare for All Medicare program: CY 2021 Medicare Physician Fee Schedule/E&M/Budget Neutrality Medicare program: Inpatient Rehab Facility/Prospective Payment System (IRF/PPS)/Scope issues Medicare program: Public Health Emergency/Scope and licensure waivers sunset Medicare program: Medicare Advanced Payment Program improvements Medicare program: Regulatory Relief/Advanced Alternative Payment Models (APMs)/Prior authorization and utilization management Medicare program: Merit-based Incentive Payment System (MIPS)/Quality/cost/improvement activity/interoperability Medicare program: Program integrity Medicare program: Interoperability and data blocking Medicare program: Quality Payment Program/physician burdens Medicare program: Health IT physician burdens Medicare program: Open Payments Medicare program: PECOS Enrollment/Revalidation Medicare program: Graduate Medical Education/cap flexibility Medicare program: Diabetes Prevention Program Medicare program: MACRA/Alternative Payment Model (APM) bonus payments Medicare program: MACRA/radiation oncology payments Medicare program: Accelerated and Advance Payment Program/physician relief Medicare and Medicaid programs: Medicare Provider Relief Fund extension Medicare and Medicaid programs: 21st Century Cures Act/health data and privacy Medicare and Medicaid program: Electronic health record (EHR) certification Medicare and Medicaid programs: P.L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) Medicare and Medicaid programs: Accountable Care Organizations Medicare and Medicaid programs: Telehealth waivers Medicare and Medicaid programs: Qualifying APM Physician Thresholds Medicare and Medicaid programs: Opioid use disorder Medicare and Medicaid programs: Validated home blood pressure monitors/coverage Medicaid program: Federal Medical Assistance Percentages (FMAP) increases Medicaid program: Georgia's Section 1332 waiver
Client expense: $4,260,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Institutes of Health (NIH), Office of Natl Drug Control Policy (NDCP), President of the U.S., SENATE, State, Dept of (DOS), U.S. Immigration & Customs Enforcement (ICE), Veterans Affairs, Dept of (VA), White House Office
2020 · third_quarter · Medicare/Medicaid
No bill: Support inclusion of occupational therapy services via telehealth under Medicare Part B, Medicare Advantage and any demonstration programs such as telehealth within accountable care organizations. HR 3127/S 1725 - The Home Health Flexibility Act: Support the ability of occupational therapists to conduct the initial and comprehensive assessments for Medicare Home Health cases. S 518/HR 1948 - Lymphedema Treatment Act - Support passage. No bill: Advocate for Congressional oversight of new Medicare payment models - PDPM & PDGM. No bill: Support for Congressional attention to the issue of falls related injuries and falls prevention. No bill: Advocated to stop proposed cuts to therapy services in the 2021 Physician Fee Schedule. HR 4932/S 2741 - CONNECT for Health Act of 2019: Support expanded coverage for services provided to Medicare patients via telehealth, including occupational therapy and other therapy services. HR 1329 - Medicaid Reentry Act (mental health and Medicaid policy): Support passage S 1754/HR 3215 - The Disaster Relief Medicaid Act (DRMA): Support passage No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, that support caregivers for people with dementia. No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, to support aging in place. S 1202 - Independence At Home Act: support passage HR2408 - Ensuring Access to Complex Rehabilitation Technology Act of 2019: support passage HR 748, CARES Act: Advocated to include occupational therapy practitioners as eligible Medicare telehealth service providers for both the duration of the COVID-19 public health emergency and on a permanent basis. HR 7154 - Outpatient Therapy Modernization and Stabilization Act: Support passage. HR 6634 - Emergency COVID Telehealth Response Act: Support introduction and passage. No bill #: Support for waiving statutory budget neutrality requirements, or exempting certain provider specialties from the application of budget neutrality, for the implementation of new Evaluation and Management Codes in the 2021 Medicare Physician Fee Schedule, and inclusion of this waiver in any COVID-19 legislation. HR 6365/3559 -Immediate Relief for Rural Facilities and Providers Act of 2020: Support passage. CMS - Met with CMS to discuss Medicare Part B payment reductions to therapy provider payments proposed in the 2021 physician fee schedule: Participants included Demetrios Kouzoukas, Director of Medicare. S. 4375 - Telehealth Modernization Act: Support , particularly for provisions that would allow the Secretary of Health and Human Services to permanently add occupational therapy practitioners to the Medicare telehealth benefit. Support various House and Senate proposals to extend and make permanent the Public Health Emergency provisions that enable occupational therapists to provide services to Medicare patients via telehealth.
Client expense: $130,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2020 · third_quarter · Medicare/Medicaid
Medicare coverage and reimbursement for therapy services and rehabilitation telehealth services including H.R. 7154, the Outpatient Therapy Modernization and Stabilization Act; Policies impacting the U.S. response to the COVID-19 pandemic including H.R. 604, the Coronavirus Preparedness and Response Supplemental Appropriations Act, Public Law No. 116-123; H.R. 6201, Families First Coronavirus Response Act, Public Law No. 116-127; H.R. 748, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), Public Law No. 116-136; and H.R. 6800, the Health and Economic Recovery Omnibus Emergency Solutions Act (HEROES Act). Medicare payment reform for post acute care services. Matters affecting bundled payments and value-based reimbursement; Implementation of physician fee schedule for CY 2020. Legislation to waive the budget neutrality requirement for E/M codes under the CY 2021 physician fee schedule including H.R. 8505.
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE
2020 · third_quarter · Medicare/Medicaid
HR 4994/PL 113-185 Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (all sections) HR 3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (all sections) HR 807 - Medicare Access to Rehabilitation Services Act of 2017 (all sections) S 253 - Medicare Access to Rehabilitation Services Act of 2017 (all sections) HR 2797 - Patient Choice and Quality Care Act (all sections) S 1334 - Patient Choice and Quality Care Act (all sections) HR 1892 - Bipartisan Budget Act of 2018 (Sec. 51005. Extension of Blended Site-Neutral Payment Rate for Certain Long-Term Care Hospital Discharges; Temporary Adjustment to Site Neutral Payment Rates, Sec. 50202. Repeal of Medicare payment cap for therapy services; limitation to ensure appropriate therapy, Title III-Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care.) S. 594 - Preserving Rehabilitation Innovation Centers Act of 2019 (all sections) HR 1901 - Preserving Rehabilitation Innovation Centers Act of 2019 (all sections) HR 3417 - Beneficiary Education Tools, Telehealth, and Extenders (BETTER) Act of 2019 (Sec. 103. Medicare coverage of certain mental health telemedicine, Sec. 204. Improving measurements under the skilled nursing value-based purchasing program under the Medicare program) HR 3107 - Improving Seniors Timely Access to Care Act of 2019 (all sections) HR 266 - Paycheck Protection Program and Health Care Enforcement Act (all sections) HR 748 - Coronavirus Aid, Relief, and Economic Security (CARES) Act (all sections) HR 7154 - Outpatient Therapy Modernization and Stabilization Act (all sections) HR 8600 - Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act (all sections)
Client expense: $316,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE
2020 · third_quarter · Medical/Disease Research/Clinical Labs
NIH Rehab issues APTA role with NIH Traumatic brain injury research Support of work done at CDC Injury Center on elder adult falls, TBI, youth sports concussions NIH Research and Development funding Physical Therapist role in childhood obesity Relocate TBI State Grant Program to ACL NIDILRR - Rehab research Nomination to NIH Committees Safety of Children in School (Restraint & Seclusion) Falls and Falls Prevention HR 7154 Outpatient Therapy Modernization and Stabilization Act
Client expense: $236,490 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office
2020 · third_quarter · Medicare/Medicaid
DEMEPOS payment and coverage Medicare Part B reimbursement Extension of telehealth flexibilities H.R.7154 - Outpatient Therapy Modernization and Stabilization Act
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2020 · third_quarter · Health Issues
Engaged with both legislative chambers and CMS in order to prevent CMS proposed steep cuts to Medicare in 2021 (projected 9% cut for physical therapy) by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes. This was achieved by writing letters to Congress as well as supporting client's efforts to endorse and advocate for The Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) would allow PT, OT, and SLP professionals, and facilities that provide outpatient therapy to bill Medicare for outpatient therapy services furnished via telehealth, modify the plan of care certification requirement in order to reduce administrative burden and delays in care; and prevent CMS proposed steep cuts to Medicare in 2021 by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes. Wrote and filed PPS comment letter to CMS re: 2021 Medicare Physician Fee Schedule proposed rule. Engaged with lawmakers and their staff as well as CMS in order to achieve Medicare coverage of PT provided via telehealth. Advised clients on the impacts of COVID-19 related legislation such as FFCRA, CARES (the PPP and other features), PPPFA, etc. Asked for Congressional action to clarifiy desire for PPP loan forgiveness to be tax free and highlighted the tax implications of not allowing for forgiven PPP expenses to also be tax deductible. Sent letter to Congressional leadership asking that Provider Relief Fund payments be tax free. Advocated for the passage of S.4117/H.R.7777 which would facilitate a one-page form EZ PPP loan forgiveness process for PPP loans of $150,000 or less.
Client expense: Not reported · Firm income: $10,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2020 · third_quarter · Health Issues
Monitored the expansion of telehealth for rehabilitation therapy. Tracked and advised client re: The Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) would allow PT, OT, and SLP professionals, and facilities that provide outpatient therapy to bill Medicare for outpatient therapy services furnished via telehealth, modify the plan of care certification requirement in order to reduce administrative burden and delays in care; and prevent CMS proposed steep cuts to Medicare in 2021 by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes. Assisted client in writing and sending comment letter to CMS re: 2021 Medicare Physician Fee Schedule.
Client expense: Not reported · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Health Issues
Engaged with both legislative chambers and CMS in order to prevent CMS proposed steep cuts to Medicare in 2021 by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes. This was achieved by writing letters to Congress as well as supporting client's efforts to endorse and advocate for The Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) would allow PT, OT, and SLP professionals, and facilities that provide outpatient therapy to bill Medicare for outpatient therapy services furnished via telehealth, modify the plan of care certification requirement in order to reduce administrative burden and delays in care; and prevent CMS proposed steep cuts to Medicare in 2021 by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes. Engaged with lawmakers and their staff as well as CMS in order to achieve Medicare coverage of PT provided via telehealth. Advised clients on the impacts of COVID-19 related legislation such as FFCRA, CARES (the PPP and other features), PPPFA, etc. Asked for Congressional action to clarifiy desire for PPP loan forgiveness to be tax free and highlighted the tax implications of not allowing for forgiven PPP expenses to also be tax deductible. Sent letter to Congressional leadership asking that Provider Relief Fund payments be tax free. Wrote to CMS suggesting the following administrative burdens could support the economic recovery sought by the President's Executive Order: Waive budget neutrality requirement of Physician Fee Schedule in order to prevent the 8% cut to PT, allow for the general supervision of PTAs by PTs in outpatient physical therapy settings, allow for PTAs to provide maintenance therapy, and modify the plan of care certification requirement to reduce delays in car
Client expense: Not reported · Firm income: $13,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Medicare/Medicaid
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage 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. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud 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. 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. 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. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized 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. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Jodey Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program - Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Abby Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - Increasing Hospital Capacity to Fight the Coronavirus Act of 2020 - Bishop - Medicare and Medicaid payments during COVID-19 emergency H.R. 6462 - Emergency Medicaid for Coronavirus Treatment Act - Gallego - Medicaid coverage H.R. 6511 - Ensuring Vaccination and Treatment Affordability Act - Pappas - COVID H.R. 6521 - To prohibit the Secretary of Health and Human Services from taking certain actions with respect to Medicaid supplemental payments reporting requirements, and for other purposes - Diaz Barragan H.R. 6538 - Modernized Medicine Act - Kennedy - Medicaid, Telehealth H.R. 6539 - Coronavirus Medicaid Response Act - Lee - FMAP H.R. 6572 - To direct the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, to carry out a national campaign to increase awareness and knowledge of COVID-19. - Bilirakis - COVID H.R. 6583 - To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes. - Houlahan - COVID H.R. 6616 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Cardenas - COVID H.R. 6640 - Medicare Advantage COVID Treatment Act - Mucarsel-Powell - COVID H.R. 6658 - Insular Area Medicaid Coronavirus Recovery Act - Sablan - FMAP H.R. 6727 - To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program - Schrier - COVID H.R. 6744 - Computer and Internet Equity Act - Davis - internet access for Lifeline program H.R. 6753 - Save Rural Hospitals Act of 2020 - Finkenauer - Medicare hospital payments H.R. 6792 - Improving Telehealth for Underserved Communities Act of 2020 - Smith - telehealth H.R. 6797 - CHIPPER Act - Wild - CHIP, COVID H.R. 6837 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Schneider - COVID H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act - Boyle - outpatient therapy services H.R. 7187 - HEALTH Act of 2020 -Thompson -Smith - telehealth H.R. 7297 - To amend title XVIII of the Social Security Act to provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. - Kaptur H.R. 7338 - To amend title XVIII of the Social Security Act to permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program, and for other purposes. - Cheney - Telehealth H.R. 7391 - To amend title XVIII of the Social Security Act to remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program - Sherrill - Telehealth 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. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program S. 3615 - Rural Community Hospital Demonstration Extension Act of 2020 - Murkowski - rural community hospital demonstration program S. 3665 - Save Rural Hospitals Act of 2020 - Alexander - Medicare hospital payments S. 3750 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Shaheen - COVID S. 3881 - CHIPPER Act - Casey - CHIP, COVID S. 3998 - HEALTH Act of 2020 - Hyde-Smith - telehealth S. 3999 - Mental and Behavioral Health Connectivity Act - King - Mental Health S. 4108 - A bill to amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns - Casey - FMAP 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); issues relating to COVID-19; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; 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.
Client expense: $2,250,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
2020 · second_quarter · Medicare/Medicaid
No bill: Support inclusion of occupational therapy services via telehealth under Medicare Part B, Medicare Advantage and any demonstration programs such as telehealth within accountable care organizations. HR 3127/S 1725 - The Home Health Flexibility Act: Support the ability of occupational therapists to conduct the initial and comprehensive assessments for Medicare Home Health cases. S 518/HR 1948 - Lymphedema Treatment Act - Support passage. No bill: Advocate for Congressional oversight of new Medicare payment models - PDPM & PDGM. No bill: Support for Congressional attention to the issue of falls related injuries and falls prevention. No bill: Advocated to stop proposed cuts to therapy services in the 2021 Physician Fee Schedule. HR 4932/S 2741 - CONNECT for Health Act of 2019: Support expanded coverage for services provided to Medicare patients via telehealth, including occupational therapy and other therapy services. HR 1329 - Medicaid Reentry Act (mental health and Medicaid policy): Support passage S 1754/HR 3215 - The Disaster Relief Medicaid Act (DRMA): Support passage No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, that support caregivers for people with dementia. No bill: Support for Medicare payment for evidence-based programs, led by occupational therapists, to support aging in place. S 1202 - Independence At Home Act: support passage HR2408 - Ensuring Access to Complex Rehabilitation Technology Act of 2019: support passage HR 748, CARES Act: Advocated to include occupational therapy practitioners as eligible Medicare telehealth service providers for both the duration of the COVID-19 public health emergency and on a permanent basis. HR 7154 - Outpatient Therapy Modernization and Stabilization Act: Support introduction and passage. HR 6634 - Emergency COVID Telehealth Response Act: Support introduction and passage. No bill #: Support for waiving statutory budget neutrality requirements, or exempting certain provider specialties from the application of budget neutrality, for the implementation of new Evaluation and Management Codes in the 2021 Medicare Physician Fee Schedule, and inclusion of this waiver in any COVID-19 legislation. HR 6365/3559 -Immediate Relief for Rural Facilities and Providers Act of 2020: Support passage. Meeting with CMS officials from Division of Non-Institutional Quality Standards both Mary Rossi-Coajou, Senior Nurse Consultant and Maria Hammel, Director; from Division of Continuing and Acute Care Providers both James Cowher, Branch Manager and Tara Lemons, RDN,RN,MA,MSN; and from Division of Home Health, Hospice and HCPCS Kelly Vontran, Acting Deputy Director: Advocated making permanent the public health emergency provisions that enable occupational therapists to open Medicare home health therapy cases. CMS - Met with Demetrios Kouzoukas, Director of Medicare, Ing-Jyu Cheng, Acting Director of Hospital and Ambulatory Policy Group, and Gift Tee, Director of the Division of Practitioner Services: Discussed Medicare Part B payment reductions to therapy provider payments proposed for the 2021 physician fee schedule in 84 FR 62568. GAO - Met with officials from the Office of Management and Budget and official from the Office of Information and Regulatory Affairs: Discussed Medicare Part B payment reductions to therapy provider payments proposed for the 2021 physician fee schedule in 84 FR 62568
Client expense: $220,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Medicare/Medicaid
Medicare Advantage; Medicaid Expansion; Medicaid General; Medicare Data Sharing; Privacy; Medicare prescription drug prices, CMS; Generic drugs (CREATES); drug approval; HELP cost reduction package; CHIP; MACRA; Provider funding; Medicaid FMAP Increase; Coronvirus Medicaid Response; Rate Notice and Call Letter H.R.3107 - 116th Congress (2019-2020) Improving Seniors' Timely Access to Care Act of 2019 Sponsor: Rep. Suzan DelBene (D-WA-01) H.R. 5582 - 116th Congress - Second Session Parental Accessibility Rights for Emergency and Negligent Treatment Act Sponsor: Rep. Greg Murphy (R-NC-03) H.R. 5741 - 116th Congress - Second Session Strengthening Innovation in Medicare and Medicaid Act Sponsor: Rep. Terri Sewell (D-AL-07) H.R. 5897 - 116th Congress - Second Session Preventing Abuse and Neglect of Vulnerable Americans Act of 2020 Sponsor: Rep. Ruben Gallego (D-AZ-07) H.R. 5900 - 116th Congress - Second Session Accelerating Kids' Access to Care Act Sponsor: Rep. Joe Kennedy III (D-MA-04) H.R. 6098 - 116th Congress - Second Session To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program, and for other purposes. Sponsor: Rep. Nanette Barragan (D-CA-44) H.R. 6273 - 116th Congress - Second Session Protecting Vulnerable Americans in Times of Crisis Act of 2020 Sponsor: Rep. G.K. Butterfield (D-NC-01) H.R. 5693 - 116th Congress - Second Session Primary Health Services Enhancement Act Sponsor: Rep. Ron Kind (D-WI-03) H.R. 5833 - 116th Congress - Second Session To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain. Sponsor: Rep. Bob Latta (R-OH-05) H.R. 6147 - 116th Congress - Second Session Help Extend Auditory Relief (HEAR) Act of 2020 Sponsor: Rep. Matt Cartwright (D-PA-08) H.R. 6179 - 116th Congress - Second Session Increasing Access to Biosimilars Act of 2020 Sponsor: Rep. Tony Cardenas (D-CA-29) H.R. 6218 - 116th Congress - Second Session Preserving Patient Access to Home Infusion Act Sponsor: Rep. Eliot Engel (D-NY-16) H.R. 5534 116th Congress - First Session Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019 Sponsor: Rep. Ron Kind (D-WI-03) H.R. 6214 - 116th Congress - Second Session To amend title XVIII of the Social Security Act to provide for coverage of testing for COVID-19 at no cost sharing under the Medicare Advantage program. Sponsor: Rep. Ron Kind (D-WI-03) H.R. 6282 - 116th Congress - Second Session Commission on America's Medical Security Act Sponsor: Rep. Raul Ruiz (D-CA-36) H.R. 6462 - 116th Congress - Second Session Emergency Medicaid for Coronavirus Treatment Act Sponsor: Rep. Ruben Gallego (D-AZ-07) H.R. 6486 - 116th Congress - Second Session Care for COVID-19 Act 2.0 Sponsor: Rep. Raul Ruiz (D-CA-36) H.R. 6495 - 116th Congress - Second Session Insular Area Medicaid Parity Act Sponsor: Del. Gregorio Kilili Camacho Sablan (D-MP At-Large) H.R. 6616 - 116th Congress - Second Session Stronger Medicaid Response to the COVID-19 Pandemic Act Sponsor: Rep. Tony Cardenas (D-CA-29) H.R. 6658 - 116th Congress - Second Session Insular Area Medicaid Coronavirus Recovery Act Sponsor: Del. Gregorio Kilili Camacho Sablan (D-MP At-Large) H.R. 6674 - 116th Congress - Second Session Medicare Crisis Program Act of 2020 Sponsor: Rep. Pramila Jayapal (D-WA-07) H.R. 6739 - 116th Congress - Second Session Ensuring Seniors' Access to COVID Treatments Act Sponsor: Rep. Sean Casten (D-IL-06) H.R. 7062 - 116th Congress - Second Session Affordable Insulin for the COVID-19 Emergency Act Sponsor: Rep. Maxine Waters (D-CA-43) H.R. 7127 - 116th Congress - Second Session To amend title XVIII of the Social Security Act to make technical amendments to the separate payment under the Medicare program for disposable negative pressure wound therapy devices. Sponsor: Rep. G.K. Butterfield (D-NC-01) H.R. 7154 - 116th Congress - Second Session Outpatient Therapy Modernization and Stabilization Act Sponsor: Brendan Boyle (D-PA-02) H.R. 6583 - 116th Congress - Second Session To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes. Sponsor: Rep. Chrissy Houlahan (D-PA-06) H.R. 6640 - 116th Congress - Second Session Medicare Advantage COVID Treatment Act Sponsor: Rep. Debbie Mucarsel-Powell (D-FL-26) H.R. 6837 - 116th Congress - Second Session Medicare Accelerated and Advance Payments Improvement Act of 2020 Sponsor: Rep. Brad Schneider (D-IL-10) H.R. 7292 - 116th Congress - Second Session To amend title XVIII of the Social Security Act to provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. Sponsor: Rep. Marcy Kaptur (D-OH-09) H.R. 7323 - 116th Congress - Second Session Medicare Mental Health Inpatient Equity Act of 2019 Sponsor: Rep. Paul Tonko (D-NY-20) H.R. 7338 - 116th Congress - Second Session To amend title XVIII of the Social Security Act to permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program, and for other purposes. Sponsor: Rep. Liz Cheney (R-WY-At-Large) H.R. 5882 - 116th Congress - Second Session Generating Effective and Novel Evidence for Therapy Payment Act Sponsor: Rep. Kurt Schrader (D-OR-05) H.R. 6159 - 116th Congress - Second Session Kids' Access to Primary Care Act of 2020 Sponsor: Rep. Kim Schrier (D-WA-08) H.R. 6281 - 116th Congress - Second Session Medicare Wage Index Parity Act of 2020 Sponsor: Rep. Bill Pascrell (D-NJ-09) H.R. 6649 - 116th Congress - Second Session Lower Drug Costs for Seniors During COVID-19 Act of 2020 Sponsor: Rep. Jan Schakowsky (D-IL-09)
Client expense: $1,690,000 · 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), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, White House Office
2020 · second_quarter · Health Issues
H.R. 1503, Orange Book Transparency Act of 2019, all provisions H.R. 1520, Purple Book Continuity Act of 2019, all provisions H.R. 987, Strengthening Health Care and Lowering Prescription Drug Costs Act, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 6644, Health Care at Home Act of 2020, all provisions S. 3741, Health Care at Home Act of 2020, all provisions H.R. 3502, Protecting People From Surprise Medical Bills Act, all provisions H.R. 3630, No Surprises Act, all provisions S. 1531, Stopping The Outrageous Practice of (STOP) Surprise Medical Bills Act of 2019, all provisions H.R. 4995, Maternal Health Quality Improvement Act of 2019, all provisions S. 3749, Public Health Emergency Privacy Act, all provisions S. 3861, Exposure Notification Privacy Act, all provisions H.R. 6585, Equitable Data Collection and Disclosure on COVID-19 Act, all provisions H.R. 7255, To authorize the Secretary of Health and Human Services to award grants to health care providers to establish or expand programs dedicated to promoting mental wellness among their health care workers, including contractors, on the front lines of the SARS-CoV-2 pandemic, and for other purposes, all provisions H.R. 7120, George Floyd Justice in Policing Act of 2020, all provisions H.R. 7154, Outpatient Therapy Modernization and Stabilization Act, all provisions H.R. 2279, Safe Step Act, all provisions H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions S. 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions S. 1895, Lower Health Care Costs Act, provisions relating to surprise billing H.R. 5826, Consumer Protections Against Surprise Medical Bills Act of 2020, all provisions H.R. 4379, Under Performing Directories that Affect Treating Emergencies (UPDATE) Act, all provisions H.R. 4100, Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act of 2019, all provisions H.R. 2482, Mainstreaming Addiction Treatment (MAT) Act of 2019, all provisions COVID-19/Testing and contact tracing funding/national testing strategy/serology testing COVID-19/National supply chain strategy COVID-19/Data on race, ethnicity, and preferred language COVID-19/Controlled Substances/increased production/prescribing flexibility COVID-19/Physician employment/financial relief COVID-19/Inmates and staff hygienic conditions/health literacy COVID-19/World Health Organization (WHO)/International Classification of Diseases Public Health and Social Services Emergency Fund/provider relief Affordable Care Act stabilization Pharmacy Benefits Manager (PBM) Opioids/pain management Opioids Use Disorder/Medication-assisted treatment (MAT) Opioid Treatment Programs (OTPs)/COVID-19 telemedicine flexibility Narcotic treatment programs/mobile components 21st Century Cures Act 42 CFR Part 2, HIPAA Telehealth waivers Surprise billing Expanded personal protective equipment (PPE)/clearinghouses Expansion of Paycheck Protection Program Health Disparities Pandemic planning and preparedness Resident physicians and students support Prescription drug pricing/transparency/value Prior authorization Health equity Physician burnout/suicide Kidney transplantation/regulatory policies Cybersecurity Electronic health record (EHR) certification Electronic Prescribing for Controlled Substances (EPCS)/biometric technology Defense Production Act Augmented Intelligence (AI)/federal regulation of applications K-12 Health curriculum (including nutrition)
Client expense: $3,840,000 · Firm income: Not reported
Government targets: Bureau of Citizenship & Immigration Services (BCIS), Bureau of Prisons (BOP), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Office of Natl Drug Control Policy (NDCP), President of the U.S., SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA), Vice President of the U.S., White House Office
2020 · second_quarter · Medicare/Medicaid
Medicare Advantage; Medicaid Expansion; Medicaid; Medicare Data Sharing; Privacy; Medicare Prescription Drug Prices; CMS; Generic Drugs (CREATES Act); Drug Approval; HELP Cost Reduction Package; CHIP, MACRA; Provider Funding; Medicaid FMAP Increase; Coronavirus Medicaid Response; Rate Notice and Call Letter HR 3107 (116th Congress), Improving Seniors Timely Access to Care Act of 2019, by Rep. Suzan DelBene (D-WA). Establish requirements with respect to the use of prior authorization under Medicare Advantage plans. HR 5534 (116th Congress), Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019, by Rep. Ron Kind (D-WI). Provide for extended months of Medicare coverage of immunosuppressive drugs for kidney transplant patients. HR 5582 (116th Congress), Parental Accessibility Rights for Emergency and Negligent Treatment Act, by Rep. Gregory Murphy (R-NC). Expands the scope of advance directive policies and related disclosures for providers under Medicaid and the Children's Health Insurance Program (CHIP). HR 5693 (116th Congress), Primary Health Services Enhancement Act, by Rep. Ron Kind (D-WI). Expand Medicare Rural Health Clinic Services and Federally Qualified Health Center Services to include physical therapy services. HR 5741 (116th Congress), Strengthening Innovation in Medicare and Medicaid Act, by Rep. Terri Sewell (D-AL). Clarify parameters for model testing and add accountability to model expansion under the Center for Medicare and Medicaid Innovation. HR 5833 (116th Congress), by Rep. Bob Latta (R-OH). Permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain. HR 5882 (116th Congress), GENE Therapy Payment Act, by Rep. Kurt Schrader (D-OR). Provide States with the option under the Medicaid program to pay for covered outpatient drugs through risk-sharing value-based agreements. HR 5897 (116th Congress), Preventing Abuse and Neglect of Vulnerable Americans Act of 2020, by Rep. Ruben Gallego (D-AZ). Requires the Centers for Medicare & Medicaid Services (CMS) to publish specified information on its website relating to deficiencies of Medicaid intermediate care facilities for individuals with intellectual disabilities, including information regarding inspections, complaints, and administrative actions. HR 5900 (116th Congress), Accelerating Kids' Access to Care Act, by Rep. Joseph Kennedy (D-MA). Requires state Medicaid programs to establish a process through which qualifying out-of-state providers may enroll as participating providers without undergoing additional screening requirements. HR 6098 (116th Congress), by Rep. Nanette Diaz Barragan (D-CA). Allow States to expand income eligibility standards under the Childrens Health Insurance Program. HR 6147 (116th Congress), Help Extend Auditory Relief (HEAR) Act of 2020, by Rep. Matt Cartwright (D-PA). Provide coverage under the Medicare program of hearing aids and related hearing services. HR 6159 (116th Congress), Kids Access to Primary Care Act of 2020, by Rep. Kim Schrier (D-WA). Renew the application of the Medicare payment rate floor to primary care services furnished under the Medicaid program. HR 6179 (116th Congress), Increasing Access to Biosimilars Act of 2020, by Rep. Tony Cardenas (D-CA). Require the Secretary of Health and Human Services to establish a demonstration project to increase access to biosimilar biological products under the Medicare program. HR 6214 (116th Congress), by Rep. Ron Kind (D-WI). Provide for coverage of testing for COVID-19 at no cost sharing under the Medicare Advantage program. HR 6218 (116th Congress), Preserving Patient Access to Home Infusion Act, by Rep. Eliot Engel (D-NY). Clarify congressional intent and preserve patient access to home infusion therapy under the Medicare program. HR 6263 (116th Congress), by Rep. John Sarbanes (D-MD). Waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19. HR 6273 (116th Congress), Protecting Vulnerable Americans in Times of Crisis Act of 2020, by Rep. G. K. Butterfield (D-NC). Increase allotments under the Medicaid program for territories of the United States, to provide for a temporary increase in the Federal medical assistance percentage for States under the Medicaid program. HR 6281 (116th Congress), Medicare Wage Index Parity Act of 2020, by Rep. Bill Pascrell (D-NJ). Provides statutory authority for, and extends, a specified methodology used to calculate the minimum Medicare hospital wage index for all-urban states. HR 6282 (116th Congress), Commission on America's Medical Security Act, by Rep. Raul Ruiz (D-CA). Establish a commission to assess, evaluate, and address the dependence of the United States on medications, devices, and medical equipment from foreign countries. HR 6336 (116th Congress), Increasing Hospital Capacity to Fight the Coronavirus Act of 2020, by Rep. Dan Bishop (R-NC). Provide a waiver of payment reductions under the Medicare and Medicaid programs for certain nonapproved capital expenditures undertaken by health care facilities during the COVID-19 emergency. HR 6486 (116th Congress), Care for COVID-19 Act 2.0, by Rep. Raul Ruiz (D-CA). Require the Secretary of Health and Human Services to establish a special enrollment period during the COVID-19 emergency period, to require the Secretary to carry out outreach and educational activities for such special enrollment period, to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage without any cost sharing for certain items and services furnished during any portion of such emergency period. HR 6487 (116th Congress), Advancing Connectivity during the Coronavirus to Ensure Support for Seniors Act, by Rep. Jan Schakowsky (D-IL). Increase the ability of nursing facilities to access telehealth services and obtain technologies to allow virtual visits during the public health emergency relating to an outbreak of coronavirus disease 2019 (COVID-19). HR 6583 (116th Congress), by Rep. Chrissy Houlahan (D-PA). Establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency. HR 6616 (116th Congress), Stronger Medicaid Response to the COVID-19 Pandemic Act, by Rep. Tony Cardenas (D-CA). Allows COVID-19 vaccines and treatment, as well as treatment for conditions that may complicate COVID-19 treatment, for uninsured individuals to be covered under Medicaid during the public health emergency. HR 6640 (116th Congress), Medicare Advantage COVID Treatment Act, by Rep. Debbie Mucarsel-Powell (D-FL). Requires Medicare Advantage (MA) plans to cover specified treatment services relating to COVID-19 without cost-sharing during the public health emergency. HR 6649 (116th Congress), Lower Drug Costs for Seniors During COVID-19 Act of 2020, by Rep. Janice Schakowsky (D-IL). Requires the Centers for Medicare & Medicaid Services to establish a process for prescription drug plans under Medicare and Medicare Advantage to allow enrollees to make coinsurance payments in periodic installments, if the enrollee chooses to obtain the entire prescribed supply of a covered drug in a single fill. HR 6674 (116th Congress), Medicare Crisis Program Act of 2020, by Rep. Pramila Jayapal (D-WA). Ensure access to affordable, comprehensive health insurance benefits for certain uninsured individuals during the COVID-19 emergency, and to ensure adequate coverage of treatments for COVID-19 under the Medicare and Medicaid programs and under group health plans and group or individual health insurance coverage. HR 6698 (116th Congress), Quality Care for Nursing Home Residents and Workers During COVID-19 Act of 2020, by Rep. Jan Schakowsky (D-IL). Improve the quality of care in skilled nursing facilities under the Medicare program and nursing facilities under the Medicare program during the COVID-19 emergency period. HR 6739 (116th Congress), Ensuring Seniors' Access to COVID Treatments Act, by Rep. Sean Casten (D-IL). Requires prescription drug plans under Medicare and Medicare Advantage to cover drugs that are approved to treat COVID-19 without cost-sharing during the public health emergency. HR 6753 (116th Congress), Rural Community Hospital Demonstration Extension Act of 2020, by Rep. Abby Finkenauer (D-IA). Amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the rural community hospital demonstration program. HR 6837 (116th Congress), Medicare Accelerated and Advance Payments Improvement Act of 2020, by Rep. Bradley Scott Schneider (D-IL). Modify the accelerated and advance payment programs under parts A and B of the Medicare program during the COVID-19 emergency. HR 6971 (116th Congress), Medical Nutrition Therapy Act of 2020, by Rep. Eliot Engel (D-NY). Expand the availability of medical nutrition therapy services under the Medicare program. HR 7062 (116th Congress), Affordable Insulin for the COVID-19 Emergency Act, by Rep. Maxine Waters (D-CA). Eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period. HR 7127 (116th Congress), by Rep. G. K. Butterfield (D-NC). Makes technical amendments to the separate payment under the Medicare program for disposable negative pressure wound therapy devices. HR 7154 (116th Congress), Outpatient Therapy Modernization and Stabilization Act, by Rep. Brendan Boyle (D-PA). Improve and ensure ongoing Medicare beneficiary access to outpatient therapy services. HR 7292 (116th Congress), COVID-19 Hospital and Health Provider Loan Forgiveness Act of 2020, by Rep. Marcy Kaptur (D-OH). Provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. HR 7323 (116th Congress), Medicare Mental Health Inpatient Equity Act of 2019, by Rep. Paul Tonko (D-NY). Eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program. HR 7338 (116th Congress), by Rep. Liz Cheney (R-WY). Permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program. HR 7391 (116th Congress), by Rep. Mikie Sherrill (D-NJ). Remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program.
Client expense: Not reported · 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
2020 · second_quarter · Medicare/Medicaid
Medicare Advantage; Medicaid Expansion; Medicaid; Medicare Data Sharing; Privacy; Medicare Prescription Drug Prices; CMS; Generic Drugs (CREATES Act); Drug Approval; HELP Cost Reduction Package; CHIP, MACRA; Provider Funding; Medicaid FMAP Increase; Coronavirus Medicaid Response; Rate Notice and Call Letter HR 3107 (116th Congress), Improving Seniors Timely Access to Care Act of 2019, by Rep. Suzan DelBene (D-WA). Establish requirements with respect to the use of prior authorization under Medicare Advantage plans. HR 5534 (116th Congress), Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019, by Rep. Ron Kind (D-WI). Provide for extended months of Medicare coverage of immunosuppressive drugs for kidney transplant patients. HR 5582 (116th Congress), Parental Accessibility Rights for Emergency and Negligent Treatment Act, by Rep. Gregory Murphy (R-NC). Expands the scope of advance directive policies and related disclosures for providers under Medicaid and the Children's Health Insurance Program (CHIP). HR 5693 (116th Congress), Primary Health Services Enhancement Act, by Rep. Ron Kind (D-WI). Expand Medicare Rural Health Clinic Services and Federally Qualified Health Center Services to include physical therapy services. HR 5741 (116th Congress), Strengthening Innovation in Medicare and Medicaid Act, by Rep. Terri Sewell (D-AL). Clarify parameters for model testing and add accountability to model expansion under the Center for Medicare and Medicaid Innovation. HR 5833 (116th Congress), by Rep. Bob Latta (R-OH). Permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain. HR 5882 (116th Congress), GENE Therapy Payment Act, by Rep. Kurt Schrader (D-OR). Provide States with the option under the Medicaid program to pay for covered outpatient drugs through risk-sharing value-based agreements. HR 5897 (116th Congress), Preventing Abuse and Neglect of Vulnerable Americans Act of 2020, by Rep. Ruben Gallego (D-AZ). Requires the Centers for Medicare & Medicaid Services (CMS) to publish specified information on its website relating to deficiencies of Medicaid intermediate care facilities for individuals with intellectual disabilities, including information regarding inspections, complaints, and administrative actions. HR 5900 (116th Congress), Accelerating Kids' Access to Care Act, by Rep. Joseph Kennedy (D-MA). Requires state Medicaid programs to establish a process through which qualifying out-of-state providers may enroll as participating providers without undergoing additional screening requirements. HR 6098 (116th Congress), by Rep. Nanette Diaz Barragan (D-CA). Allow States to expand income eligibility standards under the Childrens Health Insurance Program. HR 6147 (116th Congress), Help Extend Auditory Relief (HEAR) Act of 2020, by Rep. Matt Cartwright (D-PA). Provide coverage under the Medicare program of hearing aids and related hearing services. HR 6159 (116th Congress), Kids Access to Primary Care Act of 2020, by Rep. Kim Schrier (D-WA). Renew the application of the Medicare payment rate floor to primary care services furnished under the Medicaid program. HR 6179 (116th Congress), Increasing Access to Biosimilars Act of 2020, by Rep. Tony Cardenas (D-CA). Require the Secretary of Health and Human Services to establish a demonstration project to increase access to biosimilar biological products under the Medicare program. HR 6214 (116th Congress), by Rep. Ron Kind (D-WI). Provide for coverage of testing for COVID-19 at no cost sharing under the Medicare Advantage program. HR 6218 (116th Congress), Preserving Patient Access to Home Infusion Act, by Rep. Eliot Engel (D-NY). Clarify congressional intent and preserve patient access to home infusion therapy under the Medicare program. HR 6263 (116th Congress), by Rep. John Sarbanes (D-MD). Waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19. HR 6273 (116th Congress), Protecting Vulnerable Americans in Times of Crisis Act of 2020, by Rep. G. K. Butterfield (D-NC). Increase allotments under the Medicaid program for territories of the United States, to provide for a temporary increase in the Federal medical assistance percentage for States under the Medicaid program. HR 6281 (116th Congress), Medicare Wage Index Parity Act of 2020, by Rep. Bill Pascrell (D-NJ). Provides statutory authority for, and extends, a specified methodology used to calculate the minimum Medicare hospital wage index for all-urban states. HR 6282 (116th Congress), Commission on America's Medical Security Act, by Rep. Raul Ruiz (D-CA). Establish a commission to assess, evaluate, and address the dependence of the United States on medications, devices, and medical equipment from foreign countries. HR 6336 (116th Congress), Increasing Hospital Capacity to Fight the Coronavirus Act of 2020, by Rep. Dan Bishop (R-NC). Provide a waiver of payment reductions under the Medicare and Medicaid programs for certain nonapproved capital expenditures undertaken by health care facilities during the COVID-19 emergency. HR 6486 (116th Congress), Care for COVID-19 Act 2.0, by Rep. Raul Ruiz (D-CA). Require the Secretary of Health and Human Services to establish a special enrollment period during the COVID-19 emergency period, to require the Secretary to carry out outreach and educational activities for such special enrollment period, to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage without any cost sharing for certain items and services furnished during any portion of such emergency period. HR 6487 (116th Congress), Advancing Connectivity during the Coronavirus to Ensure Support for Seniors Act, by Rep. Jan Schakowsky (D-IL). Increase the ability of nursing facilities to access telehealth services and obtain technologies to allow virtual visits during the public health emergency relating to an outbreak of coronavirus disease 2019 (COVID-19). HR 6583 (116th Congress), by Rep. Chrissy Houlahan (D-PA). Establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency. HR 6616 (116th Congress), Stronger Medicaid Response to the COVID-19 Pandemic Act, by Rep. Tony Cardenas (D-CA). Allows COVID-19 vaccines and treatment, as well as treatment for conditions that may complicate COVID-19 treatment, for uninsured individuals to be covered under Medicaid during the public health emergency. HR 6640 (116th Congress), Medicare Advantage COVID Treatment Act, by Rep. Debbie Mucarsel-Powell (D-FL). Requires Medicare Advantage (MA) plans to cover specified treatment services relating to COVID-19 without cost-sharing during the public health emergency. HR 6649 (116th Congress), Lower Drug Costs for Seniors During COVID-19 Act of 2020, by Rep. Janice Schakowsky (D-IL). Requires the Centers for Medicare & Medicaid Services to establish a process for prescription drug plans under Medicare and Medicare Advantage to allow enrollees to make coinsurance payments in periodic installments, if the enrollee chooses to obtain the entire prescribed supply of a covered drug in a single fill. HR 6674 (116th Congress), Medicare Crisis Program Act of 2020, by Rep. Pramila Jayapal (D-WA). Ensure access to affordable, comprehensive health insurance benefits for certain uninsured individuals during the COVID-19 emergency, and to ensure adequate coverage of treatments for COVID-19 under the Medicare and Medicaid programs and under group health plans and group or individual health insurance coverage. HR 6698 (116th Congress), Quality Care for Nursing Home Residents and Workers During COVID-19 Act of 2020, by Rep. Jan Schakowsky (D-IL). Improve the quality of care in skilled nursing facilities under the Medicare program and nursing facilities under the Medicare program during the COVID-19 emergency period. HR 6739 (116th Congress), Ensuring Seniors' Access to COVID Treatments Act, by Rep. Sean Casten (D-IL). Requires prescription drug plans under Medicare and Medicare Advantage to cover drugs that are approved to treat COVID-19 without cost-sharing during the public health emergency. HR 6753 (116th Congress), Rural Community Hospital Demonstration Extension Act of 2020, by Rep. Abby Finkenauer (D-IA). Amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the rural community hospital demonstration program. HR 6837 (116th Congress), Medicare Accelerated and Advance Payments Improvement Act of 2020, by Rep. Bradley Scott Schneider (D-IL). Modify the accelerated and advance payment programs under parts A and B of the Medicare program during the COVID-19 emergency. HR 6971 (116th Congress), Medical Nutrition Therapy Act of 2020, by Rep. Eliot Engel (D-NY). Expand the availability of medical nutrition therapy services under the Medicare program. HR 7062 (116th Congress), Affordable Insulin for the COVID-19 Emergency Act, by Rep. Maxine Waters (D-CA). Eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period. HR 7127 (116th Congress), by Rep. G. K. Butterfield (D-NC). Makes technical amendments to the separate payment under the Medicare program for disposable negative pressure wound therapy devices. HR 7154 (116th Congress), Outpatient Therapy Modernization and Stabilization Act, by Rep. Brendan Boyle (D-PA). Improve and ensure ongoing Medicare beneficiary access to outpatient therapy services. HR 7292 (116th Congress), COVID-19 Hospital and Health Provider Loan Forgiveness Act of 2020, by Rep. Marcy Kaptur (D-OH). Provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. HR 7323 (116th Congress), Medicare Mental Health Inpatient Equity Act of 2019, by Rep. Paul Tonko (D-NY). Eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare Program. HR 7338 (116th Congress), by Rep. Liz Cheney (R-WY). Permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program. HR 7391 (116th Congress), by Rep. Mikie Sherrill (D-NJ). Remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program.
Client expense: $350,000 · 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), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, White House Office
2020 · second_quarter · Medicare/Medicaid
Medicare coverage and reimbursement for therapy services and rehabilitation telehealth services including H.R. 7154, the Outpatient Therapy Modernization and Stabilization Act; Policies impacting the U.S. response to the COVID-19 pandemic including H.R. 604, the Coronavirus Preparedness and Response Supplemental Appropriations Act, Public Law No. 116-123; H.R. 6201, Families First Coronavirus Response Act, Public Law No. 116-127; H.R. 748, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), Public Law No. 116-136; and H.R. 6800, the Health and Economic Recovery Omnibus Emergency Solutions Act (HEROES Act). Medicare payment reform for post acute care services. Matters affecting bundled payments and value-based reimbursement; Implementation of physician fee schedule for CY 2020.
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Medicare/Medicaid
HR 3298 - Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (all sections) HR 807 - Medicare Access to Rehabilitation Services Act of 2017 (all sections) S 253 - Medicare Access to Rehabilitation Services Act of 2017 (all sections) HR 2797 - Patient Choice and Quality Care Act (all sections) S 1334 - Patient Choice and Quality Care Act (all sections) HR 1892 - Bipartisan Budget Act of 2018 (Sec. 51005. Extension of Blended Site-Neutral Payment Rate for Certain Long-Term Care Hospital Discharges; Temporary Adjustment to Site Neutral Payment Rates, Sec. 50202. Repeal of Medicare payment cap for therapy services; limitation to ensure appropriate therapy, Title III-Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care.) S. 594 - Preserving Rehabilitation Innovation Centers Act of 2019 (all sections) HR 1901 - Preserving Rehabilitation Innovation Centers Act of 2019 (all sections) HR 3417 - Beneficiary Education Tools, Telehealth, and Extenders (BETTER) Act of 2019 (Sec. 103. Medicare coverage of certain mental health telemedicine, Sec. 204. Improving measurements under the skilled nursing value-based purchasing program under the Medicare program) HR 3107 - Improving Seniors Timely Access to Care Act of 2019 (all sections) HR. 266 - Paycheck Protection Program and Health Care Enforcement Act (all sections) HR. 748 - Coronavirus Aid, Relief, and Economic Security (CARES) Act (all sections) HR. 7154 - Outpatient Therapy Modernization and Stabilization Act (all sections)
Client expense: $320,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE
2020 · second_quarter · Medical/Disease Research/Clinical Labs
NIH Rehab issues APTA role with NIH Traumatic brain injury research Support of work done at CDC Injury Center on elder adult falls, TBI, youth sports concussions NIH Research and Development funding Physical Therapist role in childhood obesity Relocate TBI State Grant Program to ACL NIDILRR - Rehab research Nomination to NIH Committees Safety of Children in School (Restraint & Seclusion) Falls and Falls Prevention HR 7154 Outpatient Therapy Modernization and Stabilization Act
Client expense: $236,490 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office
2020 · second_quarter · Medical/Disease Research/Clinical Labs
NIH Rehab issues APTA role with NIH Traumatic brain injury research Support of work done at CDC Injury Center on elder adult falls, TBI, youth sports concussions NIH Research and Development funding Physical Therapist role in childhood obesity Relocate TBI State Grant Program to ACL NIDILRR - Rehab research Nomination to NIH Committees Safety of Children in School (Restraint & Seclusion) Falls and Falls Prevention HR 7154 Outpatient Therapy Modernization and Stabilization Act
Client expense: $236,490 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office
2020 · second_quarter · Medicare/Medicaid
The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682/S. 753) National Defense Authorization Act of 2018 (H.R. 2810) S. AMDT. 621 (H.R. 2810)--Authorization of Physical Therapist Assistants and Occupational Therapy Assistants to Provide Services Under the TRICARE Program Trusted Exchange Framework and Common Agreement (TEFCA) CONNECT for Health Act of 2017 (H.R. 2556/S. 1016) The Laboratory Access for Beneficiaries (LAB) Act of 2019 (H.R. 3584) The Ensuring Access to Quality Complex Rehabilitation Technology Act of 2019 (H.R. 2408) The Protecting Access to Wheelchairs Act of 2019 (H.R. 2293) The Protecting Beneficiary Access to Complex Rehab Technology Act of 2019 (S. 1223) The Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019 (H.R.3417) The Creating Opportunities Now and Effective Care Technologies (CONNECT) Act of 2019 (S.2741) The Safeguarding Medicare Access to Respiratory Therapy (SMART) Act of 2019 (H.R.4945) The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020(H.R.6074) The Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 (S.3548) The Outpatient Therapy Modernization and Stabilization Act (H.R.7154) The Nursing Home COVID-19 Protection and Prevention Act (S.3768) The Infection Control Training and Support Act (H.R.7254)
Client expense: $39,516 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2020 · second_quarter · Health Issues
Engaged with both legislative chambers and CMS in order to prevent CMS proposed steep cuts to Medicare in 2021 by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes. This was achieved by writing letters to Congress as well as supporting client's efforts to endorse and advocate for The Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) would allow PT, OT, and SLP professionals, and facilities that provide outpatient therapy to bill Medicare for outpatient therapy services furnished via telehealth, modify the plan of care certification requirement in order to reduce administrative burden and delays in care; and prevent CMS proposed steep cuts to Medicare in 2021 by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes. Engaged with lawmakers and their staff as well as CMS in order to achieve Medicare coverage of PT provided via telehealth. Advised clients on the impacts of COVID-19 related legislation such as FFCRA, CARES (the PPP and other features), PPPFA, etc. Asked for Congressional action to clarifiy desire for PPP loan forgiveness to be tax free and highlighted the tax implications of not allowing for forgiven PPP expenses to also be tax deductible. Sent letter to Congressional leadership asking that Provider Relief Fund payments be tax free. Wrote to CMS suggesting the following administrative burdens could support the economic recovery sought by the President's Executive Order: Waive budget neutrality requirement of Physician Fee Schedule in order to prevent the 8% cut to PT, allow for the general supervision of PTAs by PTs in outpatient physical therapy settings, allow for PTAs to provide maintenance therapy, and modify the plan of care certification requirement to reduce delays in car
Client expense: Not reported · Firm income: $13,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Health Issues
Monitored the expansion of telehealth for rehabilitation therapy. Tracked and advised client re: The Outpatient Therapy Modernization and Stabilization Act (H.R. 7154) would allow PT, OT, and SLP professionals, and facilities that provide outpatient therapy to bill Medicare for outpatient therapy services furnished via telehealth, modify the plan of care certification requirement in order to reduce administrative burden and delays in care; and prevent CMS proposed steep cuts to Medicare in 2021 by providing a one-time exemption from the currently mandated Medicare Physician Fee Schedule budget neutrality rules triggered by the re-weighting of the office/outpatient Evaluation & Management (E/M) Codes. Assisted client in writing and sending letter to Congressional leadership asking for legislation waiving the budget neutrality rules with regards to the E/M codes (same issue as above).
Client expense: Not reported · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE