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Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021
Legislative Progress
Momentum (last 30 days)
0
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0 actions · 0 new cosponsors · 0 votes
Speed vs cohort
43pct
1d open
vs 9,698 other HR bills in the 117th — cohort avg 63d
Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 This bill allows audio-only diagnoses that are made via telehealth to be used for purposes of determining risk adjustments to payments under Medicare Advantage. Additionally, the bill requires payments for Medicare telehealth services that are furnished during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019) to be made in the same amounts as those for in-person services.
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Filing registrants (43)
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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
2022 · third_quarter · Medicare/Medicaid
Medicare Advantage (MLR, risk adjustment, star ratings, supplemental benefits), Medicare Prior Authorization (H.R. 3173), Prescription Drug Rebates, Medicare Part D and Part D restructuring (H.R. 3, H.R. 19, S. 2164), Insulin Affordability (S. 3700, H.R. 6833), Telehealth, Build Back Better Act (H. Res. 601 & S. Con. Res. 14), Federal Coronavirus Response (American Rescue Plan, H.R. 1319), Parity for Audio-Only Risk Adjustment (H.R. 2166, S. 150), Inflation Reduction Act (P.L. 117-169), Third Party Marketing Organization Requirements, Behavioral Health (House Ways and Means Committee prints 117-1 & 117-2)
Client expense: $550,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE
2022 · second_quarter · Insurance
H.R. 3137, Improving Seniors Timely Access to Care Act of 2021 Issue: Support streamlining prior authorization procedures to be more seamless, automated, and transparent for physicians. H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 Issue: Support extending telehealth payment parity and ending geographic origination site restriction. H.R. 2163/S. 464, Safe Step Act Issue: Support requiring insurers to implement a clear and fair appeals that allows step therapy to be bypassed in medically necessary circumstances.
Client expense: $150,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · second_quarter · Medicare/Medicaid
H.R. 4014, Physician Shortage GME Cap Flex Act of 2021, provisions relating to Graduate Medical Education S. 2094, Physician Shortage GME Cap Flex Act of 2021, provisions relating to Graduate Medical Education H.R. 1332, Telehealth Modernization Act, all provisions S. 368, Telehealth Modernization Act, all provisions H.R. 4058, Telemental Health Care Access Act of 2021, all provisions S. 2061, Telemental Health Care Access Act of 2021, all provisions H.R. 3173, Improving Seniors Timely Access to Care Act of 2021, provisions relating to Prior Authorization and attachment standards S. 3018, Improving Seniors Timely Access to Care Act of 2021, provisions relating to Prior Authorization and attachment standards H.R. 7995, Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act of 2022, all provisions H.R. 3259, Non-Opioids Prevent Addiction In the Nation (NO PAIN) Act, all provisions S. 586, Non-Opioids Prevent Addiction In the Nation (NO PAIN) Act, all provisions H.R. 4587, Value in Health Care Act of 2021, all provisions H.R. 7213, Equitable Community Access to Pharmacist Services Act, all provisions S. 748, Medicare Sequester Relief Act, all provisions H.R. 2903, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions S. 1512, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions H.R. 2256, Resident Physician Shortage Reduction Act, all provisions S. 834, Resident Physician Shortage Reduction Act, all provisions H.R. 1218, Data Mapping to Save Moms Lives Act, all provisions S. 198, Data Mapping to Save Moms Lives Act, all provisions H.R. 3407, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions S. 411, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions H.R. 3441, Substance Use Disorder Workforce Act, all provisions S. 1438, Opioid Workforce Act of 2021, all provisions H.R. 955, Medicaid Reentry Act of 2021, all provisions S. 285, Medicaid Reentry Act of 2021, all provisions H.R. 2654, Chiropractic Medicare Coverage Modernization Act of 2021, all provisions H.R. 6020, Supporting Medicare Providers Act of 2021, all provisions S. 3314, Supporting Medicare Providers Act of 2021, all provisions H.R. 6311, Comprehensive Addiction Resources Emergency Act of 2021, all provisions S. 3418, Comprehensive Addiction Resources Emergency Act of 2021, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 19, Lower Costs, More Cures Act of 2021, all provisions S. 801, Connected Maternal Online Monitoring Act, all provisions H.R. 1738, Stabilize Medicaid and CHIP Coverage Act, all provisions H.R. 1025, Kids Access to Primary Care Act of 2021, all provisions H.R. 66, Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act, all provisions S. 610, Protecting Medicare and American Farmers from Sequester Cuts Act, all provisions H.R. 6000, Cures 2.0 Act, all provisions H.R. 4043, Ensuring Patient Access to Critical Breakthrough Products Act of 2021, all provisions S. 2416, New Opportunities for Value that Extend Lives (NOVEL) Act of 2021, all provisions H.R. 7666, Restoring Hope for Mental Health and Well-Being Act of 2022, all provisions H.R. 3746, Accountable Care in Rural America Act, all provisions H.R. 4755, Seniors Chronic Care Management Improvement Act of 2021, all provisions H.R. 6308, ACO Assignment Improvement Act of 2021, all provisions H.R. 1868, To prevent across-the-board direct spending cuts, and for other purposes, all provisions H.R. 315, Medicare Sequester COVID Moratorium Act, all provisions H.R. 6048, Medicare Stability for Patients and Providers Act, all provisions H.R. 3348, SOS: Sustaining Outpatient Services Act, all provisions H.R. 366, Protecting Access to Post-COVID-19 Telehealth Act of 2021, all provisions H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021, all provisions H.R. 2228, Rural Behavioral Health Access Act of 2021, all provisions H.R. 3447, Permanency for Audio-Only Telehealth Act, all provisions H.R. 7051, Access to Prescription Digital Therapeutics Act of 2022, all provisions S. 3791, Access to Prescription Digital Therapeutics Act of 2022, all provisions H.R. 7878, Kidney Health Connect Act of 2022, all provisions S. 4307, Kidney Health Connect Act of 2022, all provisions H.R. 6202, Telehealth Extension Act of 2021, all provisions S. 987, CARA 3.0 Act of 2021, all provisions H.R. 1438, Opioid Workforce Act of 2021, all provisions H.R. 925, Data to Save Moms Act, all provisions H.R. 7475, Mamas First Act, all provisions H.R. 3746, Accountable Care in Rural America Act, all provisions H.R. 4587, Value in Health Care Act of 2021, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, all provisions H.R. 3614, Menstrual Equity For All Act of 2021, provisions related to menstrual products coverage in Medicaid Medicare program: Physician Payment and Delivery Reform Medicare program: Impending Medicare payment cuts Medicare program: Medicare Evaluation and Management/budget neutrality Medicare program: Statutory PAYGO/Sequester Relief Medicare program: Accountable Care Organizations/specialty care Medicare program: Alternative Payment Models Medicare program: AMA Recovery Plan for Americas Physicians/payment reform Medicare program: Global and Professional Direct Contracting alternative payment model/REACH ACOs Medicare program: Appropriate Use Criteria and Prior Authorization Medicare program: Medicare Advantage/prior authorization regulation Medicare program: Automatic blood pressure measurement devices/coverage Medicare program: Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) Medicare program: MIPS/Promoting Interoperability/Cost/Improvement Activities Medicare program: MIPS/data sharing/transparency Medicare program: MACRA physician burdens Medicare program: Quality Payment Program Medicare program: Health IT burden Medicare program: Public Health Emergency COVID-19 /Accelerated and Advance Payments Medicare program: Primary Care First models Medicare program: Medicare Shared Savings Program (MSSP) Medicare program: Modifier 25 Medicare program: Split/shared billing Medicare program: Interoperability/data blocking/HIPAA Medicare program: Coding Medicare program: Provider compliance/Regulatory relief Medicare program: Provider Enrollment, Chain, and Ownership System (PECOS) Enrollment/Revalidation Medicare program: Open Payments Medicare program: Prescription drug pricing/Pharmacy Benefits Managers Medicare program: Step Therapy Medicare and Medicaid programs: Medicare Access and Chip Reauthorization Act (MACRA)/implementation Medicare and Medicaid programs: MACRA Oversight Medicaid program: Improving Access to Physical and Mental Health Care for Children and Youth Under Medicaid and CHIP draft Medicare and Medicaid programs: Health Equity Medicaid program: Maternal Mortality Medicaid program: Uninsured and healthcare coverage/COVID-19 Medicaid program: Special Enrollment Period Medicaid program: Sickle Cell Disease
2022 · fourth_quarter · Medicare/Medicaid
Telehealth issues related to COVID-19; H.R. 2617, Consolidated Appropriations Act, 2023 - increasing Medicare Physician Fee Schedule payments and extending all Medicare telehealth flexibilities extended in the Consolidated Appropriations Act of 2022 through December 31, 2024; Medicare and Medicaid dual eligible integration; SDOH and SES issues related to SNP payment rates and quality measures; S. 150/H.R. 2166, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021; Monitoring of Medicare Advantage coding intensity Monitor mental health legislative efforts
Client expense: Not reported · Firm income: $20,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
Medicare Advantage (risk adjustment, coding intensity, encounter data, dual-eligible members, star ratings, extreme and uncontrollable circumstances policy, normalization factors, stars contract consolidation, ESRD, audio-only telehealth) Medicare RAD-V Mental Health and Substance Use (42 CFR Part 2) Medicaid Managed Care Medicaid Expansion Medicaid Reform Medicaid Redeterminations CHIP Reauthorization Medicaid Actuarial Soundness Long-term Services and Supports Medicare Part D prescription drug program Medicare Advantage Pilot Program in TRICARE Pharmacy Benefit Manager (PBM) Operations and Practices, Spread Pricing Direct and Indirect Remuneration (DIR) reforms in the FY 2023 Medicare Part D Notice Affordable Insulin Now Act (H.R.6833) Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R.7666) Social Determents of Health (SDOH) Addressing Social Determinants in Medicare Advantage Act of 2021 (H.R.4074) Health Equity/Health Disparities Maternal health (Medicaid postpartum coverage extension, H.R.959 Black Maternal Health Momnibus Act of 2021) Helping MOMS Act of 2021 Medicare Audio-Only Telehealth (H.R.2166, S.150) Medicaid Funding for Puerto Rico Medicare Savings Program (MSP) in Medicaid Increasing on the Medicare Advantage Benchmarks to a Minimum Level H.R. 7997 (to Amend the SS Act to establish a floor in MA benchmark rates for regions with low Medicare fee-for-service penetration and to make the Medicare Savings Program available in all jurisdictions) H.R. 2217 (Territory Federal Matching Requirement Equity Act of 2021) H.R. 1825 (A Bill to Remove the Matching Requirement for Medicare Part D Drugs) H.R. 1826 (Fairness in Medicare Part B Enrollment Act) S. 3778 (Territories Medicare Prescription Drug Assistance Equity Act of 2022). Build Back Better Act (H.R.5376) Medicaid Eligibility and Redeterminations Inflation Reduction Act of 2022 (H.R. 5376) Medicare Advantage Supplemental Benefits Timely Access to Care Act (H.R. 3173 and S. 3018) 2023 Omnibus Appropriations Bill Mental Health Parity Restore Protections for Dialysis Patients Act (H.R.8594)
| Democratic |
| MN |
| Billy Long | Republican | MO |
| Bob Gibbs | Republican | OH |
| Brian K. Fitzpatrick | Republican | PA |
| Chrissy Houlahan | Democratic | PA |
| Christopher H. Smith | Republican | NJ |
| Cynthia Axne | Democratic | IA |
| Daniel Meuser | Republican | PA |
| David Scott | Democratic | GA |
| Debbie Wasserman Schultz | Democratic | FL |
| Dina Titus | Democratic | NV |
| Dwight Evans | Democratic | PA |
| Earl L. "Buddy" Carter | Republican | GA |
| Elaine G. Luria | Democratic | VA |
| Fred Keller | Republican | PA |
| Grace F. Napolitano | Democratic | CA |
| Gus M. Bilirakis | Republican | FL |
| Jackie Walorski | Republican | IN |
| Jake Auchincloss | Democratic | MA |
| James Comer | Republican | KY |
| James R. Baird | Republican | IN |
| Jason Smith | Republican | MO |
| Jenniffer González-Colón | Republican | PR |
| Joe Neguse | Democratic | CO |
| Kathleen M. Rice | Democratic | NY |
| Kathy E. Manning | Democratic | NC |
| Lloyd Smucker | Republican | PA |
| Lucille Roybal-Allard | Democratic | CA |
| Lucy McBath | Democratic | GA |
| Madeleine Dean | Democratic | PA |
| Marilyn Strickland | Democratic | WA |
| Mary Gay Scanlon | Democratic | PA |
| Michelle Steel | Republican | CA |
| Mike Kelly | Republican | PA |
| Neal P. Dunn | Republican | FL |
| Paul Tonko | Democratic | NY |
| Pete Aguilar | Democratic | CA |
| Ron Kind | Democratic | WI |
| Sanford D. Bishop, Jr. | Democratic | GA |
| Stephen F. Lynch | Democratic | MA |
| Tom Cole | Republican | OK |
| Tom O’Halleran | Democratic | AZ |
| Tony Cárdenas | Democratic | CA |
| Trey Hollingsworth | Republican | IN |
| Troy Balderson | Republican | OH |
| Val Butler Demings | Democratic | FL |
| Vern Buchanan | Republican | FL |
| Young Kim | Republican | CA |
Client expense: $4,550,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
Client expense: $1,270,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2022 · fourth_quarter · Medicare/Medicaid
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R.340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021- Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - Treatment in Place Act - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - Jack Reynolds Memory Medigap Expansion Act - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - KEEP Telehealth Options Act of 2021 - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - Stabilize Medicaid and CHIP Coverage Act - Rep. Dingell, Debbie - Medicaid and CHIP continuous enrollment H.R. 1784 - Medicaid REACH Act - Rep. Doggett, Lloyd - requirements for non-expansion H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - Immediate Coverage for Former Foster Youth Act - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - Foster Youth Dental Act of 2021 - Rep. Bass, Karen - Medicaid dental coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - Territories Medicare Prescription Drug Assistance Equality Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare Part D premium and cost-sharing subsidies H.R. 1826 - Fairness in Medicare Part B Enrollment Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - RUSH Protection Act of 2021 - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - Rural Hospital Support Act - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - Health Insurance Consumer Protection Act - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - CAHOOTS Act - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - Improving Access to Mental Health Act of 2021 - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - SAVE Act - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri - Medicare Advantage payments for audio-only diagnoses H.R. 2168 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 2170 - HAPI Act - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - Affordable Insulin for the COVID-19 Emergency Act - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicaid FMAP for Territories H.R. 2228 - Rural Behavioral Health Access Act of 2021 - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. - Medicare Advantage supplemental benefits H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd - Medigap policies H.R. 6833 - Affordable Insulin Now Act - Rep. Craig, Angie - Insulin prices and cost sharing S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - HAPI Act -Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - KEEP Telehealth Options Act of 2021 - Sen. Fischer, Deb - telehealth expansion S. 644 - Rural Hospital Closure Relief Act of 2021 - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - Stabilize Medicaid and CHIP Coverage Act of 2021 - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - COMP Act - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - Dosha Joi Immediate Coverage for Former Foster Youth Act - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne - Medicare payment sequestration S. 764 - CAHOOTS Act - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - Medicare Patient Empowerment Act of 2021 - Sen. Paul, Rand - Medicaid payment options S. 870 - Improving Access to Mental Health Act of 2021 - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - Save Rural Hospitals Act of 2021 - Sen. Warner, Mark - Medicare hospital 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); issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2024 Rate Notice; issues related to the expiration of Medicaid continuous eligibility and transitions in coverage; issues related to coverage of EUA drugs under Medicare Part D; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; issues related to specialty infant formula; issues related to the Inflation Reduction Act passage and implementation; contraceptive coverage and reproductive health; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; issues related to Managed Long Term Services and Supports (MLTSS); issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; 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 or legislation, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; 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 value based payment 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; 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; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); issues relating to potential Medicare mental health parity requirements; 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 Affordable Care Act (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; 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; 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: $2,470,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2022 · fourth_quarter · Health Issues
H.R. 4911, Medicare Advantage Quality Payment Relief Act; S. 150/H.R. 2166 Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021; CY 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Programs H.R. 3173/S. 3018, Improving Seniors Timely Access to Care Act H.R. 2167, Consolidated Appropriations Act of 2023
Client expense: Not reported · Firm income: $30,000
Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · fourth_quarter · Medicare/Medicaid
H.R. 4911, Medicare Advantage Quality Payment Relief Act; S. 150/H.R. 2166 Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021; CY 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Programs H.R. 3173/S. 3018, Improving Seniors Timely Access to Care Act H.R. 2167, Consolidated Appropriations Act of 2023
Client expense: Not reported · Firm income: $30,000
Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · fourth_quarter · Medicare/Medicaid
H.R. 4911, Medicare Advantage Quality Payment Relief Act S. 150/H.R. 2166 Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 S. 2411/ H.R. 533 Stop COVID-19 Test Surprise Medical Bills Act of 2021 H.R. 5376 Inflation Reduction Act H.R. 3173/S. 3018, Improving Seniors Timely Access to Care Act H.R. 2167, Consolidated Appropriations Act of 2023
Client expense: Not reported · Firm income: $40,000
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · fourth_quarter · Health Issues
H.R. 4911, Medicare Advantage Quality Payment Relief Act S. 150/H.R. 2166 Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 S. 2411/ H.R. 533 Stop COVID-19 Test Surprise Medical Bills Act of 2021 H.R. 5376 Inflation Reduction Act H.R. 3173/S. 3018, Improving Seniors Timely Access to Care Act H.R. 2167, Consolidated Appropriations Act of 2023
Client expense: Not reported · Firm income: $40,000
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · fourth_quarter · Medicare/Medicaid
Telehealth Expansion Act; Telehealth issues related to COVID-19; S. 150/H.R. 2166, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021; Continued monitoring of Provider Relief Fund; H.R. 8800, Supporting Medicare Providers Act of 2022; Issues related to physician payment cuts, including APM bonuses; Issues related to Inflation Reduction Act of 2022 (PL 117-169) and implementation
Client expense: Not reported · Firm income: $50,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
Implementation of American Rescue Plan Act of 2021 (PL 117-2); Continued monitoring of Consolidated Appropriations Act, 2021 (PL 116-260); Extension of the Medicare Sequester; H.R. 1868, To prevent across-the-board direct spending cuts, and for other purposes; S. 748, Medicare Sequester Relief Act; Telehealth Expansion Act; Telehealth issues related to COVID-19; S. 150/H.R. 2166, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021; Medicare Advantage flexibilities; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies; Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model; S. 4293, Pharmacy Benefit Manager Transparency Act of 2022; Issues related to the OIG, GAO, MedPAC reports on Medicare Advantage; S. 3018/H.R. 3173, Improving Seniors Timely Access to Care Act of 2021; CMS RFI on Medicare Advantage S. 4605/H.R. 8581, The Preserving Access to Home Health Act of 2022; Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule CMS-0057-P; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs Proposed Rule CMS-4201-P; CY 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements - Final Rule CMS-1766-F
Client expense: Not reported · Firm income: $90,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
Medicare and Medicaid dual eligible integration; Performance evaluation/quality oversight; SES (socio-economic status) issues related to SNP payment rates and quality measures; Telehealth issues related to COVID-19; S. 150/H.R. 2166, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021; Drug pricing proposals and impact to SNP plans serving beneficiaries with high-cost drugs; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies; Issues related to the OIG, GAO, MedPAC reports on Medicare Advantage; S. 4264, Advancing Integration in Medicare and Medicaid (AIM) Act; S. 4273, Supporting States in Integrating Care Act of 2022; S. 3018/H.R. 3173, Improving Seniors Timely Access to Care Act of 2021; CMS RFI on Medicare Advantage; Cassidy/Scott RFI on dual eligible beneficiaries; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs Proposed Rule CMS-4201-P
Client expense: Not reported · Firm income: $50,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
Medicare and Medicaid dual eligible integration; SES (socio-economic status) issues (including Homelessness) related to special needs plan (SNP) payment rates and quality measures; CMMI discussions re: homelessness and healthcare; Health equity issues; Telehealth issues related to COVID-19; S. 150/H.R. 2166, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies; Draft legislation that seeks to reduce health equity gaps in the Medicare Advantage program; Issues related to the OIG, GAO, MedPAC reports on Medicare Advantage; S. 3018/H.R. 3173, Improving Seniors Timely Access to Care Act of 2021; CMS RFI on Medicare Advantage; Cassidy/Scott RFI on dual eligible beneficiaries; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs Proposed Rule CMS-4201-P
Client expense: Not reported · Firm income: $40,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
Value of prescription drugs; Monitor drug pricing legislation, including H.R. 3, Elijah E. Cummings Lower Drug Costs Now; Prescription Drug Pricing Reduction Act; Extension of the Medicare Sequester; S. 748, Medicare Sequester Relief Act; Telehealth Expansion Act; Telehealth issues related to COVID-19; S. 150/H.R. 2166, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021; Proposed repeal of the CMS Rule on Most Favored Nation Model; Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model; Issues related to the OIG, GAO, MedPAC reports on Medicare Advantage; S. 3018/HR. 3173, Improving Seniors Timely Access to Care Act of 2021; Cassidy/Scott RFI on dual eligible beneficiaries; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs Proposed Rule CMS-4201-P
Client expense: Not reported · Firm income: $60,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Health Issues
Inflation Reduction Act of 2022 (PL 117-169) - extending enhanced premium assistance for ACA marketplace plans through 2025; H.R. 2617, Consolidated Appropriations Act, 2023 - extending all Medicare telehealth flexibilities extended in the Consolidated Appropriations Act of 2022 through December 31, 2024 and possible changes to Medicare provider directory policies; Committee Print 117-1 - Improvements to Medicare Inpatient and Outpatient Mental Health Services (H.R. 8879, Inpatient Psychiatric Facility Improvement Act; H.R. 8878, To amend title XVIII of the Social Security Act to ensure adequate coverage of outpatient mental health services under the Medicare program); Committee Print 117-2 - Improvements to the Medicare Program Related to Physician Services and Education (H.R. 432, Mental Health Access Improvement Act of 2021; H.R. 8910, Behavioral Health Integration Awareness Act of 2022; H.R. 8884, To direct the Secretary of Health and Human Services to provide outreach and reporting on opioid use disorder treatment services furnished by opioid treatment programs under the Medicare program; H.R. 8890, Physician Wellness Program Act of 2022; H.R. 8908, Fighting Stimulant and other Substance Use Disorders Act); Committee Print 117-3 - Requiring Coverage of Forensic Medical Exams with No Cost Sharing (H.R. 8891, No Surprises for Survivors Act of 2022); Committee Print 117-4 - Improved Information in Provider Directories, Plan Definitions and Crisis Services for Private Insurance Plans (H.R. 8885, Better Health Care Directories Act; H.R. 8886, Promoting Clarity in Mental Health and Substance Use Disorder Treatment Act; H.R. 8892, To direct the Secretary of Health and Human Services to conduct a public outreach campaign to inform individuals covered under a group health plan or group or individual health insurance coverage of Federal requirements relating to mental health and substance use disorder crisis services, and for other purposes); Committee Print 117-5 - Improved Information for Network Coverage and Plan Documents in Private Insurance Plans (H.R. 8881, To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to disclose the percentage of in-network participation for certain provider types, and for other purposes; H.R. 8889, Readable Insurance Coverage Explanations Act (RICE Act)); Telehealth issues related to COVID-19; S. 150/H.R. 2166, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021; HELP Committee bipartisan efforts to improve public health and medical preparedness/response programs; Over the Counter Covid Testing Guidance; Test to Treat Initiative; Issues related to the implementation of the No Surprises Act; S. 3799, PREVENT Pandemics Act; S. 3700/H.R. 6833, Affordable Insulin Now Act; Issues related to the Senate Finance report on mental health and mental health legislation; Senate Finance Committee bipartisan Discussion Draft: Ensuring Access to Telemental Health Services; Senate Finance Committee bipartisan Discussion Draft: Improving Access to Physical and Mental Health Care for Children and Youth under Medicaid and CHIP; Senate Finance Committee bipartisan Discussion Draft: Mental Health Workforce; Bipartisan Safer Communities Act, P.L. 117-159, specifically policy related to access to mental health services for youth and families through Medicaid and CHIP and telehealth; H.R. 7666, Restoring Hope for Mental Health and Well-Being Act of 2022; Issues related to FDA user fee reauthorization bills (H.R. 7667, Food and Drug Amendments of 2022; S. 4348, Food and Drug Administration Safety and Landmark Advancements Act of 2022 (FDSLA Act of 2022), including accelerated approval, reimportation, and orphan drugs; Issues related to the Public Health Emergency; H.R. 7007, COVID Supplemental Appropriations Act, 2022; S. 4293, Pharmacy Benefit Manager Transparency Act of 2022; Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act; Executive Order Directing HHS to Explore Additional Actions to Lower Prescription Drug Costs
Client expense: Not reported · Firm income: $80,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
S. 150, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021, all provisions H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act, all provisions Issues related to Medicare Advantage
Client expense: Not reported · Firm income: $20,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S.3018) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments Organ acquisition payment policies Clinical lab fee schedule Medicare Mental Health Inpatient Equity Act (S. 3061/H.R. 5674) HR 4040: Advancing Telehealth Beyond COVID-19 Act
Client expense: $250,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Health Issues
funding for hospitals and physicians related to COVID 19 Health care policy Proposals to strengthen the health care system and achieve Affordable Care Act (ACA) market stability, including extending the expanded ACA subsidies Funding for National Ebola Network/RSPTCs Elimination of Title X Waiver H.R. 1319, "American Rescue Plan Act" - provisions related to healthcare, Medicaid, and federal funding aimed at combating COVID-19, including funding to support vaccination administration, testing and contact tracing and expanding the public health workforce H.R. 3, "Elijah E. Cummings Lower Drug Prices Now Act" Additional legislative proposals to address rising drug costs S. 773, To ensure eligible hospitals continue to have access to the 340B Drug Pricing Program throughout the COVID-19 public health emergency Additional legislative proposals modifying the 340B program including the Protect 340B Act Infrastructure proposals that support the healthcare workforce and hospitals and health facilities, including provisions to improve physical and technical upgrades S.168 / HR 708 Temporary Reciprocity to Ensure Access to Treatment Act or the TREAT Act HR 1195 Workplace Violence Prevention Standard for health care facilities Medicare Coverage for Telehealth - HR 1332/ S 368 Telehealth Modernization Act Ensuring Parity in MA and PACE for Audio-Only Telehealth Act HR 2166 Federal funding to reduce and/or eliminate health care disparities Federal funding to address social determinants of health, especially housing and nutrition Bills to support mental health access and workforce Bills to support funding for nursing working and allied health professionals
Client expense: $293,950 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · fourth_quarter · Medicare/Medicaid
HR 366 Authorize HHS Secretary to waive or modify application of Medicare requirements with respect to telehealth services during any emergency period. HR 955 and S 285 To allow for medical assistance under Medicaid for inmates during 30-day period preceding release from a public institution. HR 1332 and S 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 1349 To provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program. S 834 To create an additional 14,000 Medicare-supported residency slots over seven years. HR 2166 To require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs. HR 3371 To improve access to home health care furnished by telehealth amid PHEs. HR 3589 Medicare AAP loan repayment delay HR 3746 To improve the benchmarking process for the Medicare Shared Savings Program. S. 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 4587 To direct HHS to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage program participation. S. 2622 To provide for Medicaid coverage of comprehensive tobacco cessation services. HR 5514 To improve extended care services by providing Medicare beneficiaries with an option for cost effective home-based extended care. S 3018 To establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Oppose Medicare sequester. S. 3593 To extend certain telehealth services covered by Medicare and to evaluate the impact of telehealth services on Medicare beneficiaries HR 7573 To extend certain telehealth services covered by Medicare and to evaluate the impact of telehealth services on Medicare beneficiaries HR 4407/S 1568 To modify the methodology and application of Medicare Advantage nursing and allied health education payments for hospitals HR 4040 To extend telehealth flexibilities under the Medicare program HR 5370 To establish a CMS demo for medically tailored meals for Medicare beneficiaries. HR 8487 To establish requirements with respect to the use of prior authorization under Medicare Advantage plans. HR 8800 To extend certain increases in payments for physicians services under the Medicare program through 2023
Client expense: $200,000 · 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), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), SENATE
2022 · fourth_quarter · Medicare/Medicaid
Medicare Advantage data and quality improvement. Telehealth coverage under Medicare Advantage Program; Issues related to systems improvement for STARS rating. H.R.2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes. S.150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021. Issues related to assignment of patients for Direct Contracting Entities. Medicare sequestration delay; statutory pay-go. Social determinants of Health; Health equity. ACO Reach Model. H.R. 2617 - Consolidated Appropriation Act, 2023.
Client expense: Not reported · Firm income: $40,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office
2022 · fourth_quarter · Medicare/Medicaid
Medicare Advantage. Rebate Rule. Prescription Drug Pricing. Medicare expansions and Medicare for all. Medicare Part D reform. Medicaid expansion. Medicare for All Act of 2021. H.R.1868 - To prevent across-the-board direct spending cuts, and for other purposes. S.150 - Raise the Wage Act. H.R.2166/S.150 - Global Health Security Act of 2020 on audio-only telehealth parity. Medicare vision, dental, and hearing. Medicare sequestration, statutory pay-go applicability to providers and health plans. CY 2023 Medicare Advantage and Part D Proposed Rule (CMS-4192-P). H.R. 8885 - Better Healthcare Directories Act. H.R. 8886 - Promoting Clarity in Mental Health Substance Use Disorder Treatment Act. H.R.8892 - To direct the Secretary of Health and Human Services to conduct a public outreach campaign to inform individuals covered under a group health plan or group or individual health insurance coverage of Federal requirements relating to mental health and substance use disorder crisis services, and for other purposes. H.R.8881 - To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to disclose the percentage of in-network participation for certain provider types, and for other purposes. H.R.8889 - RICE Act. Implementation of Inflation Reduction Act (H.R. 5376) Public Law 117-169. H.R. 2617 - Consolidated Appropriations Act, 2023.
Client expense: Not reported · Firm income: $90,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office
2022 · fourth_quarter · Medicare/Medicaid
Issues related to Medicare Advantage and Part D prescription drug programs; Issues related to Prescription Drug Rebates; Issues related to Dual Eligible and Medicare Advantage Special Needs Plans; Issues related to Social Determinants of Health (SDOH)/Health Equity; and Issues related to Telehealth. 117th Congress Inflation Reduction Act of 2022 Budget Reconciliation/Biden Administration Build Back Better Plan COVID-19 American Rescue Plan American Jobs Plan Medicare Sequester COVID Moratorium Act (H.R. 315) Delay of the Prescription Drug Rebate Rule Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 (S. 150) The Ensuring Parity in MA and PACE for Audio-Only Telehealth Act (HR 2166) Previous Congresses H.R. 3461, Community-Based Independence for Seniors Act H.R. 3877, Bipartisan Budget Act H.R. 19, Lower Costs, More Cures Act of 2019 S. 3013, Encouraging Innovative Benefit Design to Lower Costs for Seniors Act H.R. 6074, Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 H.R. 6201, Families First Coronavirus Response Act H.R. 748, CARES Act H.R. 6800, HEROES Act H.R. 7659, Ensuring Parity in MA for Audio-Only Telehealth Act of 2020 S. 4318, American Workers, Families and Employers Assistance Act S. 4199, Prescription Drug Pricing Reduction Act of 2020 S.4840, Ensuring Parity in MA for Audio-Only Telehealth Act of 2020 Bipartisan Coronavirus Relief and Omnibus Funding Bill H.R. 4074, Addressing Social Determinants in Medicare Advantage PL 115-123: H.R. 1892, The bipartisan Budget Act of 2018; H.R. 3168, To amend title XVIII of the Social Security Act to provide continued access to specialized Medicare Advantage plans for special needs individuals, and for other purposes; S. 870, CHRONIC Care Bill PL 115-271: H.R. 6, SUPPORT for Patients and Communities Act
Client expense: $170,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · fourth_quarter · Medicare/Medicaid
HR 5376 Inflation Reduction Act of 2022. Provisions related to health care coverage, Medicare, Medicaid, COVID funding and mental/behavioral health HR 4128 VALID Act HR 8487 - Improving Seniors' Timely Access to Care Act of 2022 S 3792 & HR 7053 Hospital Inpatient Services Modernization Act HR 959 Black Maternal Health Omnibus Act of 2021 HR 4074 Addressing Social Determinants in Medicare Advantage Act of 2021 HR 4911 Medicare Advantage Quality Payment Relief Act HR 5370 Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2021 HR 5376 Build Back Better Act, to provide for Budget Reconciliation HR 3 Elijah E. Cummings Lower Drug Costs Now Act HR 19 and S. 2164 Lower Costs, More Cures Act of 2021 HR 3063 Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (Mommies) Act HR 3172 Homes for Every Local Protector, Educator, and Responder (HELPER) Act of 2021 HR 2166 & S 150 Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 S 833 Empowering Medicare Seniors to Negotiate Drug Prices Act of 2021 S 908 Medicare Drug Price Negotiation Act HR 2139 Medicare Drug Price Negotiation Act
Client expense: $180,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · fourth_quarter · Medicare/Medicaid
Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Resetting the Impact (TRIA) Act of 2021 (H.R. 2455) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S.3018) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments Organ acquisition payment policies Clinical lab fee schedule False Claims Act amendments CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule Hospital Inpatient Services Modernization Act (H.R. 7053 /S. 3792) - to extend the hospital at home waiver program Medicare Mental Health Inpatient Equity Act (S. 3061/H.R. 5674) HR 4040: Advancing Telehealth Beyond COVID-19 Act HELP Act Inpatient Psychiatric Facility Improvement Act MIND Act
Client expense: $70,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
TRAIN Act (S. 1568/H.R. 4407) to stop cuts to nursing and allied health programs Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 7961) to protect healthcare workers. Sequestration relief Rural hospital policies (Rural Health Clinic payment - H.R. 1868; Rural Hospital Closure Relief Act H.R. 1639/S.644; Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885); Rural America Health Corps Act (S. 924/H.R. 2130); Rural America Health Corps Act S.54); Rural Hospital Support Act (S. 4009) and the Assistance for Rural Community Hospitals (ARCH) Act (H.R. 8747) to extend the MDH and LVA programs) Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053) Value in Health Care Act (H.R. 4587) Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 S. 834/H.R. 2256); Opioid Workforce Act S. 1438/ Substance Use Disorder Workforce Act H.R. 3441 Telehealth flexibilities and payment (Telehealth Extension Act - H.R. 6202; TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act - S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166) Resetting the Impact (TRIA) Act of 2021 H.R. 2455 Technical Reset to Advance the Instruction of Nurses (TRAIN) Act Value in Healthcare Act (H.R. 4587) Improving Seniors Timely Access to Care Act (S. 3018/H.R. 3173) Annual Prospective Payment System Rules
Client expense: $200,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · fourth_quarter · Medicare/Medicaid
H.R. 2166/S. 150 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 PACE regulations and PACE demonstration. Medicaid and Medicare reimbursement. Medicare Part D reform. COVID provider relief fund, access to COVID treatments and vaccines. Issues related to Audio only Medicare. HCBS issues. Medicare sequestration delay; statutory pay-go impact on Medicare providers. S. 3626 - PACE Expanded Act. H.R. 4941/S. 5106 - PACE Part D Choice Act of 2021. H.R 6770/S. 1162 - PACE Plus Act. H.R. 2617 - Consolidated Appropriations Act, 2023.
Client expense: Not reported · Firm income: $30,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
2022 · fourth_quarter · Medicare/Medicaid
Medicare Advantage (MLR, risk adjustment, star ratings, supplemental benefits), Medicare Prior Authorization (H.R. 3173), Prescription Drug Rebates, Medicare Part D and Part D restructuring (H.R. 3, H.R. 19, S. 2164), Insulin Affordability (S. 3700, H.R. 6833), Telehealth, Build Back Better Act (H. Res. 601 & S. Con. Res. 14), Federal Coronavirus Response (American Rescue Plan, H.R. 1319), Parity for Audio-Only Risk Adjustment (H.R. 2166, S. 150), Inflation Reduction Act (P.L. 117-169), Third Party Marketing Organization Requirements, Behavioral Health (House Ways and Means Committee prints 117-1 & 117-2), Consolidated Appropriations Act, 2023 (P.L. 117-403).
Client expense: $570,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Insurance
H.R. 3137, Improving Seniors Timely Access to Care Act of 2021 Issue: Support streamlining prior authorization procedures to be more seamless, automated, and transparent for physicians. H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 Issue: Support extending telehealth payment parity and ending geographic origination site restriction. H.R. 2163/S. 464, Safe Step Act Issue: Support requiring insurers to implement a clear and fair appeals that allows step therapy to be bypassed in medically necessary circumstances.
Client expense: $240,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Health Issues
Implementation of the ACA (PL 111-148) and stabilization issues; Issues related to the federal COVID response and COVID Testing; Implementation of Coronavirus Preparedness and Response Supplemental Appropriations Act (PL 116-123); Implementation of Families First Coronavirus Response Act (PL 116-127); Coronavirus Aid, Relief, and Economic Security (CARES) Act (PL 116-136); Health; H.R. 925 - the HEROES Act; Implementation of FY2021 Omnibus and COVID Relief and Response Act (PL 116-260); H.R. 2166 - The Ensuring Parity in MA and PACE for Audio-Only Telehealth Act; The American Rescue Plan Act of 2021 (PL 117-2); H.R. 6833/S. 3700 - Affordable Insulin Now Act; Issues related to Medicare Advantage payment policies; Issues related to mental health; Issues related to contraceptive coverage. H.R. 8133 The Transparency of Hospital Billing Act. Consolidated Appropriations Act, 2023 (PL 117-328).
Client expense: Not reported · Firm income: $90,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
HR 2166, Ensuring Parity in MA & PACE for Audio-Only Telehealth Act; Medicare Part D; Medicare Advantage (MA); Medigap; Medicaid; Dual Eligible Coverage.
Client expense: Not reported · Firm income: $60,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · second_quarter · Medicare/Medicaid
HR 2166, Ensuring Parity in MA & PACE for Audio-Only Telehealth Act; Medicare Part D; Medicare Advantage (MA); Medigap; Medicaid; Dual Eligible Coverage; and social determinants of health policy. S .Con. Res. 14 Budget Reconciliation.
Client expense: Not reported · Firm income: $60,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · third_quarter · Medicare/Medicaid
H.R.6833 - Making continuing appropriations for fiscal year 2023, and for other purposes. Medicare and Medicaid dual eligible integration; Telehealth issues related to PHE/COVID-19; SDOH and SES issues related to SNP payment rates and quality measures; S. 150/H.R. 2166, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021; Drug pricing proposals and impact to SNP plans serving beneficiaries with high-cost drugs; Monitoring of Medicare Advantage coding intensity Monitor mental health legislative efforts HR 5376 Inflation Reduction Act
Client expense: Not reported · Firm income: $20,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · third_quarter · Medicare/Medicaid
Medicare Advantage (risk adjustment, coding intensity, encounter data, dual-eligible members, star ratings, extreme and uncontrollable circumstances policy, normalization factors, stars contract consolidation, ESRD, audio-only telehealth) Medicare RAD-V Mental health and substance use (42 CFR Part 2) Medicaid managed care (IMD Exclusion) Medicaid expansion Medicaid reform (block grants, per capita caps) Medicaid and CHIP reauthorization Medicaid actuarial soundness Long-term services and supports Medicare Part D prescription drug program and Medicare Part D coverage gap (donut hole) Opioid addiction issues and response (prescription drug monitoring programs) Medicaid medical loss ratio remittance Medicare Advantage Pilot Program in TRICARE Pharmacy Benefit Manager (PBM) operations and practices, Spread pricing Direct and Indirect Remuneration (DIR) reforms in the FY 2023 Medicare Part D Notice H.R.6833 - Affordable Insulin Now Act Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act H.R.7666 - Restoring Hope for Mental Health and Well-Being Act of 2022 Social Determents of Health (SDOH) H.R.4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 Health Equity/Health Disparities Maternal health (Medicaid postpartum coverage extension, H.R.959 Black Maternal Health Momnibus Act of 2021) Helping MOMS Act of 2021 Medicare Audio-Only Telehealth (H.R.2166, S.150) Continuing Resolution (CR)FY 2022 Medicaid Funding for Puerto Rico Medicare Savings Program (MSP) in Medicaid Increasing on the Medicare Advantage benchmarks to a minimum level H.R. 7997 (to Amend the SS Act to establish a floor in MA benchmark rates for regions with low Medicare fee-for-service penetration and to make the Medicare Savings Program available in all jurisdictions) H.R. 2217 (Territory Federal Matching Requirement Equity Act of 2021) H.R. 1825 (A Bill to Remove the Matching Requirement for Medicare Part D Drugs) H.R. 1826 (Fairness in Medicare Part B Enrollment Act) S. 3778 (Territories Medicare Prescription Drug Assistance Equity Act of 2022). H.R.5376 - Build Back Better Act Medicaid eligibility and redeterminations H.R. 5376 - Inflation Reduction Act of 2022 Medicare Advantage Supplemental Benefits
Client expense: $1,590,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, White House Office
2022 · third_quarter · Medicare/Medicaid
COVID-19 Response, including COVID-19 bills legislation implementation Medicare Advantage Policy and Reimbursement 2023 Medicare Advantage Advance Rate Notice CMS-4192-P 2023 Medicare Care Advantage Part D Proposed Rule Medicare Part D Issues Medicaid and Dual Eligible Issues Pharmacy Reimbursement Issues Medicare Home Health Issues Prescription Drug Rebate issues, including Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection for Certain Point-of-Sale Reductions in Price on Prescription Pharmaceuticals and Certain Pharmacy Benefit Manager Service Fees S. 150/H.R. 2166, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 H.R. 4074, A bill to expand the availability of supplemental benefits to certain Medicare Advantage enrollees Medicare Hospice Issues Medicare Vision, Dental & Hearing Inflation Reduction Act of 2022 (HR 5376) Public Law No. 117-169 CMS-1772-P CY 2023 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates CMS-1771-P Hospital Inpatient Prospective Payment System for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2023 Rates CMS-1770-P Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2023 S. 3018/H.R. 3173, Improving Seniors Timely Access to Care Act CMS-1766-P CY 2023 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Program Requirements; Home Health Value-Based Purchasing Expanded Model Requirements; and Home Infusion Therapy Services Requirements CMS-4203-NC Medicare Program; Request for Information on Medicare
Client expense: $1,220,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office
2022 · second_quarter · Medicare/Medicaid
Medicare Advantage (risk adjustment, coding intensity, encounter data, dual-eligible members, star ratings, extreme and uncontrollable circumstances policy, normalization factors, stars contract consolidation, ESRD, audio-only telehealth H.R. 4074 -To amend title XVIII of the Social Security Act Medicare RAD-V Mental health and substance use (42 CFR Part 2) Medicaid (IMD Exclusion) Medicaid expansion Medicaid reform (block grants, per capita caps) Medicaid and CHIP reauthorization Medicaid actuarial soundness Long-term services and supports Social Determents of Health (SDOH) Medicare Part D prescription drug program and Medicare Part D coverage gap (donut hole) Opioid addiction issues and response (prescription drug monitoring programs) Medicaid medical loss ratio remittance Medicare Advantage Pilot Program in TRICARE Pharmacy Benefit Manager (PBM) operations and practices, Spread pricing Against Direct and Indirect Remuneration (DIR) reforms in the FY 2023 Medicare Part D Notice H.R.6833 - Affordable Insulin Now Act Maternal health (Medicaid postpartum coverage extension, H.R.959 Black Maternal Health Momnibus Act of 2021) Helping MOMS Act of 2021 CMS Extreme & Uncontrollable Circumstances Policy Medicare Sequester (H.R.315, S.748) Medicare Audio-Only Telehealth (H.R.2166, S.150) Continuing Resolution (CR)FY 2022 Medicaid Funding for Puerto Rico Medicaid Funding for Puerto Rico including discussions on the FMAP, ESRD, and LTSS. Medicare Advantage issues such as rates, benchmarks, providers payments, and disparities in funding for territories. Medicare Advantage asks regarding the underfunding and disparity for Puerto Rico H.R.5376 - Build Back Better Act Medicaid eligibility Health Equity/Health Disparities
Client expense: $1,570,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Treasury, Dept of
2022 · third_quarter · Medicare/Medicaid
HR 366 Authorize HHS Secretary to waive or modify application of Medicare requirements with respect to telehealth services during any emergency period. HR 955 and S 285 To allow for medical assistance under Medicaid for inmates during 30-day period preceding release from a public institution. HR 1332 and S 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 1349 To provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program. S 834 To create an additional 14,000 Medicare-supported residency slots over seven years. HR 2166 To require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs. HR 3371 To improve access to home health care furnished by telehealth amid PHEs. HR 3589 Medicare AAP loan repayment delay HR 3746 To improve the benchmarking process for the Medicare Shared Savings Program. S. 368 Amends title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program related to the COVID-19 public health emergency. HR 4587 To direct HHS to revise certain regulations in relation to the Medicare shared savings program and other advanced alternative payment arrangements to encourage program participation. S. 2622 To provide for Medicaid coverage of comprehensive tobacco cessation services. HR 5514 To improve extended care services by providing Medicare beneficiaries with an option for cost effective home-based extended care. S 3018 To establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Oppose Medicare sequester. S. 3593 To extend certain telehealth services covered by Medicare and to evaluate the impact of telehealth services on Medicare beneficiaries HR 7573 To extend certain telehealth services covered by Medicare and to evaluate the impact of telehealth services on Medicare beneficiaries HR 4407/S 1568 To modify the methodology and application of Medicare Advantage nursing and allied health education payments for hospitals HR 4040 To extend telehealth flexibilities under the Medicare program HR 5370 To establish a CMS demo for medically tailored meals for Medicare beneficiaries HR 8487 To establish requirements with respect to the use of prior authorization under Medicare Advantage plans HR 8800 To extend certain increases in payments for physicians services under the Medicare program through 2023
Client expense: $200,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE
2022 · third_quarter · Medicare/Medicaid
Medicare; Prior Authorization; Medicare Advantage; Medicaid; Improving the Medicaid & CHIP Application Process; End of Year Package - Medicaid; Improving Access to Physical and Mental Healthcare for Children and Youth Under Medicaid and CHIP draft package; H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 Sponsor: Rep. Terri Sewell (D-AL-07) H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 Sponsor: Rep. Suzan DelBene (D-WA-01) S. 3018 - Improving Seniors Timely Access to Care Act of 2021 Sponsor: Sen. Roger Marshall (R-KS)
Client expense: $1,500,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
2022 · third_quarter · Medicare/Medicaid
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021- Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - Treatment in Place Act - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - Jack Reynolds Memory Medigap Expansion Act - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - KEEP Telehealth Options Act of 2021 - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - Stabilize Medicaid and CHIP Coverage Act - Rep. Dingell, Debbie - Medicaid and CHIP continuous enrollment H.R. 1784 - Medicaid REACH Act - Rep. Doggett, Lloyd - requirements for non-expansion H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - Immediate Coverage for Former Foster Youth Act - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - Foster Youth Dental Act of 2021 - Rep. Bass, Karen - Medicaid dental coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - Territories Medicare Prescription Drug Assistance Equality Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare Part D premium and cost-sharing subsidies H.R. 1826 - Fairness in Medicare Part B Enrollment Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - RUSH Protection Act of 2021 - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - Rural Hospital Support Act - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - Health Insurance Consumer Protection Act - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - CAHOOTS Act - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - Improving Access to Mental Health Act of 2021 - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - SAVE Act - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri - Medicare Advantage payments for audio-only diagnoses H.R. 2168 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 2170 - HAPI Act - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - Affordable Insulin for the COVID-19 Emergency Act - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicaid FMAP for Territories H.R. 2228 - Rural Behavioral Health Access Act of 2021 - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. - Medicare Advantage supplemental benefits H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd - Medigap policies H.R. 6833 - Affordable Insulin Now Act - Rep. Craig, Angie - Insulin prices and cost sharing S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - HAPI Act -Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - KEEP Telehealth Options Act of 2021 - Sen. Fischer, Deb - telehealth expansion S. 644 - Rural Hospital Closure Relief Act of 2021 - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - Stabilize Medicaid and CHIP Coverage Act of 2021 - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - COMP Act - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - Dosha Joi Immediate Coverage for Former Foster Youth Act - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne - Medicare payment sequestration S. 764 - CAHOOTS Act - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - Medicare Patient Empowerment Act of 2021 - Sen. Paul, Rand - Medicaid payment options S. 870 - Improving Access to Mental Health Act of 2021 - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - Save Rural Hospitals Act of 2021 - Sen. Warner, Mark - Medicare hospital 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 2023 policy and technical regulation for MA and Part D; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2023 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; issues related to specialty infant formula; issues related to the Inflation Reduction Act passage and implementation; contraceptive coverage and reproductive health; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; issues related to Managed Long Term Services and Supports (MLTSS); issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; 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 or legislation, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; 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 value based payment 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; 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; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); issues relating to potential Medicare mental health parity requirements; 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 Affordable Care Act (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; 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; 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. *Add MACPAC to Agency List.
Client expense: $3,230,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2022 · third_quarter · Medicare/Medicaid
HR 5376 Inflation Reduction Act of 2022. Provisions related to health care coverage, Medicare, Medicaid, COVID funding and mental/behavioral health HR 4128 VALID Act HR 8487 - Improving Seniors' Timely Access to Care Act of 2022 S 3792 & HR 7053 Hospital Inpatient Services Modernization Act HR 959 Black Maternal Health Omnibus Act of 2021 HR 4074 Addressing Social Determinants in Medicare Advantage Act of 2021 HR 4911 Medicare Advantage Quality Payment Relief Act HR 5370 Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2021 HR 5376 Build Back Better Act, to provide for Budget Reconciliation HR 3 Elijah E. Cummings Lower Drug Costs Now Act HR 19 and S. 2164 Lower Costs, More Cures Act of 2021 HR 3063 Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (Mommies) Act HR 3172 Homes for Every Local Protector, Educator, and Responder (HELPER) Act of 2021 HR 2166 & S 150 Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 S 833 Empowering Medicare Seniors to Negotiate Drug Prices Act of 2021 S 908 Medicare Drug Price Negotiation Act HR 2139 Medicare Drug Price Negotiation Act
Client expense: $2,580,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · third_quarter · Medicare/Medicaid
H.R. 1332, Telehealth Modernization Act, all provisions S. 368, Telehealth Modernization Act, all provisions H.R. 3259, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, all provisions S. 586, NOPAIN Act, all provisions H.R. 2903, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, all provisions S. 1512, CONNECT for Health Act of 2021, all provisions H.R. 2256, Resident Physician Shortage Reduction Act of 2021, all provisions S. 834, Resident Physician Shortage Reduction Act of 2021, all provisions H.R. 7995, Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act of 2022, all provisions H.R. 3407, Mothers and Offspring Mortality and Morbidity Awareness (MOMMAs) Act, all provisions S. 411, MOMMAs Act, all provisions H.R. 3173, Improving Seniors Timely Access to Care Act of 2021, all provisions S. 3018, Improving Seniors Timely Access to Care Act of 2021, all provisions H.R. 8487, Improving Seniors Timely Access to Care Act of 2022, all provisions H.R. 4058, Telemental Health Care Access Act of 2021, all provisions S. 2061, Telemental Health Care Access Act of 2021, all provisions H.R. 3441, Substance Use Disorder Workforce Act, all provisions S. 1438, Substance Use Disorder Workforce Act, all provisions H.R. 955, Medicaid Reentry Act of 2021, all provisions S. 285, Medicaid Reentry Act of 2021, all provisions H.R. 2654, Chiropractic Medicare Coverage Modernization Act of 2021, provisions related to scope of practice H.R. 6020, Supporting Medicare Providers Act of 2021, all provisions S. 3314, Supporting Medicare Providers Act of 2021, all provisions H.R. 4587, Value in Health Care Act of 2021, all provisions S. 2938, Bipartisan Safer Communities Act, all provisions H.R. 8800, Supporting Medicare Providers Act of 2022, all provisions H.R. 4040, Advancing Telehealth Beyond COVID-19 Act of 2022, all provisions H.R. 8850, Fair Access In Residency (FAIR) Act, all provisions S. 2173, Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies (PREVENT DIABETES) Act, all provisions S. 4873, Improving Access to Advance Care Planning Act, all provisions H.R. 4014, Physician Shortage GME Cap Flex Act of 2021, all provisions S. 2094, Physician Shortage GME Cap Flex Act of 2021, all provisions H.R. 7213, Equitable Community Access to Pharmacist Services Act, all provisions H.R. 8594, Restore Protections for Dialysis Patients Act, all provisions S. 4750, Restore Protections for Dialysis Patients Act, all provisions H.R. 8188, Saving Access to Laboratory Services Act (SALSA), all provisions S. 4449, SALSA 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 2021, all provisions H.R. 1868, To prevent across-the-board direct spending cuts, and for other purposes, all provisions H.R. 315, Medicare Sequester COVID Moratorium Act, all provisions S. 610, Protecting Medicare and American Farmers from Sequester Cuts Act, all provisions H.R. 6048, Medicare Stability for Patients and Providers Act, all provisions H.R. 3434, Territories Health Equity Act of 2021, all provisions H.R. 4406, Supporting Medicaid in the U.S. Territories Act of 2021, all provisions S. 801, Connected Maternal Online Monitoring Act, all provisions S. 346, Black Maternal Health Momnibus Act of 2021, all provisions H.R. 1738, Stabilize Medicaid and CHIP Coverage Act, all provisions H.R. 1025, Kids Access to Primary Care Act of 2021, all provisions H.R. 66, Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act, all provisions S. 748, Medicare Sequester Relief Act, all provisions H.R. 6000, Cures 2.0 Act, all provisions H.R. 4043, Ensuring Patient Access to Critical Breakthrough Products Act of 2021, all provisions S. 2416, New Opportunities for Value that Extend Lives (NOVEL) Act of 2021, all provisions H.R. 7666, Restoring Hope for Mental Health and Well-Being Act of 2022, all provisions H.R. 3746, Accountable Care in Rural America Act, all provisions H.R. 4755, Seniors Chronic Care Management Improvement Act of 2021, all provisions H.R. 6308, ACO Assignment Improvement Act of 2021, all provisions H.R. 366, Protecting Access to Post-COVID-19 Telehealth Act of 2021, all provisions H.R. 2166, Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021, all provisions H.R. 2228, Rural Behavioral Health Access Act of 2021, all provisions H.R. 3447, Permanency for Audio-Only Telehealth Act, all provisions H.R. 7051, Access to Prescription Digital Therapeutics Act of 2022, all provisions S. 3791, Access to Prescription Digital Therapeutics Act of 2022, all provisions H.R. 7573, Telehealth Extension and Evaluation Act, all provisions S. 3593, Telehealth Extension and Evaluation Act, all provisions H.R. 7878, Kidney Health Connect Act of 2022, all provisions S. 4307, Kidney Health Connect Act of 2022, all provisions H.R. 6202, Telehealth Extension Act of 2021, all provisions H.R. 7053, Hospital Inpatient Services Modernization Act, all provisions S. 3792, Hospital Inpatient Services Modernization Act, all provisions H.R. 7116, 9-8-8 Implementation Act of 2022, all provisions H.R. 8879, Inpatient Psychiatric Facility Improvement Act, all provisions H.R. 8878, To amend title XVIII of the Social Security Act to ensure adequate coverage of outpatient mental health services under the Medicare program, all provisions H.R. 432, Mental Health Access Improvement Act of 2021, all provisions H.R. 8910, Behavioral Health Integration Awareness Act of 2022, all provisions H.R. 8884, To direct the Secretary of Health and Human Services to provide outreach and reporting on opioid use disorder treatment services furnished by opioid treatment programs under the Medicare program, all provisions S. 987, CARA 3.0 Act of 2021, all provisions H.R. 925, Data to Save Moms Act, all provisions H.R. 7475, Mamas First Act, all provisions H.R. 5067, Preserving Patient Access to Home Infusion Act, all provisions S. 2652, Preserving Patient Access to Home Infusion Act, all provisions H.R. 8812, To amend titles XVIII and XIX of the Social Security Act and the Bipartisan Budget Act of 2018 to increase access to services provided by advanced practice registered nurses under the Medicare and Medicaid programs, and for other purposes, provisions related to scope of practice Medicare program: 21st Century Cures Act/implementation Medicare program: EHR Certification Medicare program: Medicare and CHIP Reauthorization Act (MACRA) Reform Medicare program: MACRA implementation Medicare program: Laboratory testing/Diagnostics/PAMA Medicare program: Merit-based Incentive Payment System (MIPS) quality/cost/improvement activities/promoting interoperability Medicare program: Merit-based Value Pathway Medicare program: Physician Fee Schedule (PFS) inflation updates/budget neutrality rules Medicare program: 2023 Medicare Physician Fee Schedule/4.5% cut Medicare program: Accountable specialty care/payments Medicare program: Alternative Payment Models/incentive payments Medicare program: Telehealth/COVID flexibilities Medicare program: Health IT burdens Medicare program: Self-measured blood pressure devices/benefit category Medicare program: Coding Medicare program: Primary Care First models Medicare program: Appropriate Use Criteria Medicare program: Opioids Medicare program: Medicare Shared Savings Program (MSSP) Medicare program: Dental benefits Medicaid program: Uninsured and healthcare coverage/COVID-19 Medicare program: Provider Enrollment, Chain, and Ownership System (PECOS)/revalidation Medicare program: Open Payments Medicaid program: Special Enrollment Period Medicaid program: Sickle Cell Disease Medicaid program: Improving Access to Physical and Mental Health Care for Children and Youth Under Medicaid and CHIP/draft Medicare program: Provider compliance and regulatory relief Medicare program: Medicare Administrative Contractors (MACs)/Downcoding Medicare and Medicaid programs: Health Equity Medicare and Medicaid programs: Modifier 25, Impossible Day Medicare and Medicaid programs: Connected health technologies Medicare and Medicaid programs: Diabetes
Client expense: $4,360,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · third_quarter · Medicare/Medicaid
H.R. 4911, Medicare Advantage Quality Payment Relief Act; S. 150/H.R. 2166 Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021; CY 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Programs H.R. 3173/S. 3018, Improving Seniors Timely Access to Care Act
Client expense: Not reported · Firm income: $30,000
Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · third_quarter · Health Issues
H.R. 4911, Medicare Advantage Quality Payment Relief Act; S. 150/H.R. 2166 Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021; CY 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Programs H.R. 3173/S. 3018, Improving Seniors Timely Access to Care Act
Client expense: Not reported · Firm income: $30,000
Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · third_quarter · Medicare/Medicaid
H.R. 4911, Medicare Advantage Quality Payment Relief Act; S. 150/H.R. 2166 Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021; S. 2411/ H.R. 533 Stop COVID-19 Test Surprise Medical Bills Act of 2021; H.R. 5376 Build Back Better Act
Client expense: Not reported · Firm income: $40,000
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · third_quarter · Health Issues
H.R. 4911, Medicare Advantage Quality Payment Relief Act; S. 150/H.R. 2166 Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021; S. 2411/ H.R. 533 Stop COVID-19 Test Surprise Medical Bills Act of 2021; H.R. 5376 Build Back Better Act
Client expense: Not reported · Firm income: $40,000
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · third_quarter · Medicare/Medicaid
Sequestration relief (Protecting Medicare and American Farmers from Sequester Cuts Act - S. 610) Rural hospital policies [Rural Health Clinic payment - Rural and Underserved Small Hospital Protection Act/RUSH Act (H.R. 1885), Rural HELP Act - HR 1749; Rural Hospital Closure Relief Act (H.R. 1639/S.644)] Graduate Medical Education (GME) funding (Resident Physician Shortage Reduction Act of 2021 - S. 834/H.R. 2256; Opioid Workforce Act, S. 1438)/ Substance Use Disorder Workforce Act, H.R. 3441) H.R. 1749 (study on potential disparities in incurred costs for rural and urban hospitals and authorizing appropriate payment adjustments) S. 439, Coronavirus Medicaid Response Act (addressing FMAP) Telehealth flexibilities and payment (TREAT Act - S. 168/H.R. 708; Telehealth Modernization Act -S. 368/H.R. 1332; TREATS Act - S. 340; CONNECT for Health Act S. 1512/H.R. 2903; Ensuring Parity in MA and PACE for Audio-Only Telehealth Act S. 150/H.R. 2166; Consolidated Appropriations Act of 2022, HR 2471) Resetting the Impact (TRIA) Act of 2021 (H.R. 2455) Prior Authorization reform - Improving Seniors Timely Access to Care Act of 2021 (H.R. 3173/S.3018) S.586 / H.R. 3259 - Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act Annual Prospective Payment System Rules Accelerated and Advance Payment Program repayment flexibility (H.R. 1349, The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021; H.R. 2407, Better Way for Providers to Repay Act of 2021) S. 408, Supporting Best Practices for Healthy Moms Act (to reduce maternal mortality) Nursing and allied health education (NAHE) program funding Technical Reset to Advance the Instruction of Nurses (TRAIN) Act (S. 1568 / HR 4407) - Nursing and allied health education payments Organ acquisition payment policies Clinical lab fee schedule False Claims Act amendments CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule Hospital Inpatient Services Modernization Act (H.R. 7053 /S. 3792) - to extend the hospital at home waiver program Medicare Mental Health Inpatient Equity Act (S. 3061/H.R. 5674) HR 4040: Advancing Telehealth Beyond COVID-19 Act HELP Act Inpatient Psychiatric Facility Improvement Act MIND Act
Client expense: $80,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · third_quarter · Medicare/Medicaid
Medicare; Prior Authorization; Medicare Advantage Reform; Medicaid; H.R. 2166-Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 Sponsor: Rep. Terri Sewell (D-AL-01)(Introduced 03/23/2021) H.R. 3173 Improving Seniors' Timely Access to Care Act of 2022 A bill that establishes several requirements and standards relating to prior authorization processes under Medicare Advantage (MA) plans. Sponsor: Rep. Suzan DelBene (D-WA-1) (Introduced 05/13/2021)
Client expense: $10,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · third_quarter · Health Issues
"ACA stabilization; Medicare Advantage; Medicaid, Issues related to COVID-19 relief Tricare telehealth issues General mental health policy Part D modernization Reconciliation H.R.2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021"
Client expense: Not reported · Firm income: $80,000
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2022 · third_quarter · Medicare/Medicaid
Medicare Advantage. Rebate Rule. Prescription Drug Pricing. Medicare expansions and Medicare for all. Medicare Part D reform. Medicaid expansion. Medicare for All Act of 2021. H.R.1868 - To prevent across-the-board direct spending cuts, and for other purposes. S.150 - Raise the Wage Act. H.R.2166/S.150 - Global Health Security Act of 2020 on audio-only telehealth parity. Medicare vision, dental, and hearing. Medicare sequestration, statutory pay-go applicability to providers and health plans. CY 2023 Medicare Advantage and Part D Proposed Rule (CMS-4192-P). Inflation Reduction Act (HR 5376) Public Law 117-169. H.R. 6833 - Continuing Resolution. H.R. 8885 - Better Healthcare Directories Act. H.R. 8886 - Promoting Clarity in Mental Health Substance Use Disorder Treatment Act. H.R.8892 - To direct the Secretary of Health and Human Services to conduct a public outreach campaign to inform individuals covered under a group health plan or group or individual health insurance coverage of Federal requirements relating to mental health and substance use disorder crisis services, and for other purposes. H.R.8881 - To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to disclose the percentage of in-network participation for certain provider types, and for other purposes. H.R.8889 - RICE Act.
Client expense: Not reported · Firm income: $90,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office
2022 · third_quarter · Medicare/Medicaid
Implementation of American Rescue Plan Act of 2021 (PL 117-2); Continued monitoring of Consolidated Appropriations Act, 2021 (PL 116-260); Extension of the Medicare Sequester; H.R. 1868, To prevent across-the-board direct spending cuts, and for other purposes; S. 748, Medicare Sequester Relief Act; Telehealth Expansion Act; Telehealth issues related to COVID-19; S. 150/H.R. 2166, Ensuring Parity in MA for Audio-Only Telehealth Act of 2021; Medicare Advantage flexibilities; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; CMS Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies; Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model; S. 4293, Pharmacy Benefit Manager Transparency Act of 2022; Issues related to the OIG, GAO, MedPAC reports on Medicare Advantage; S. 3018/H.R. 3173, Improving Seniors Timely Access to Care Act of 2021; CMS RFI on Medicare Advantage S. 4605/H.R. 8581, The Preserving Access to Home Health Act of 2022
Client expense: Not reported · Firm income: $90,000