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Medicare Dental Benefit Act of 2021
Legislative Progress
Introduced
January 28, 2021
Latest Action
February 2, 2021
Primary Sponsor
Nanette Diaz BarragánDemocratic(CA)
Momentum (last 30 days)
0
score
0 actions · 0 new cosponsors · 0 votes
Speed vs cohort
64pct
5d open
vs 9,698 other HR bills in the 117th — cohort avg 63d
Medicare Dental Benefit Act of 2021 This bill provides for Medicare coverage of dental and oral health services, including routine diagnostic and preventive services, basic and major dental services, and emergency care; dental prostheses are also covered. Currently, such services are excluded from Medicare coverage.
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Filing registrants (10)
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Congress.gov source codes: 1000, Intro-H
Bills with similar content found using semantic analysis.
Sources: Congress.gov
2022 · fourth_quarter · Medicare/Medicaid
Lowering the Cost of Prescription Drugs, Drug Importation H.R. 832, S. 259), Adding Vision and Dental to Medicare (H.R. 502).
Client expense: Not reported · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
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 · Medicare/Medicaid
Center for Medicare & Medicaid Innovation demonstration for periodontal services for targeted, low-income Medicare beneficiaries and monitor Medicare dental benefit issues, including medically necessary dental coverage in Medicare, and related provisions in S. 97/H.R. 502, the Medicare Dental Benefit Act. Coronavirus response efforts, including S. 3799, the PREVENT Pandemics Act, and support for health care providers and patients, implementation of related provisions in H.R. 1319, the American Rescue Plan Act (P.L. 117-2), and support for dentists and COVID-19 vaccine prescriber continuing education and training.
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2021 (H.R. 3650 and S. 2048): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Drug Costs (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act. Drug Costs. Pharmaceutical Research and Transparency Act of 2022 (S. 4037): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Drug Costs. Discounted Drugs for Clinical Trials Act (S. 4026): Proposal to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer. Drug Costs. Generic Substitution Non-Interference Act (H.R. 7473): Proposal would block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. These campaigns increase drug spending by encouraging overuse of brand drugs when cheaper, equally effective generic alternative is available. Drug Costs. The Price Relief, Innovation and Competition for Essential Drugs (PRICED) Act, (S. 583): Proposal to reduce the period after Food and Drug Administration approval where a brand manufacturer could exclusively market their drug in the United States from 12 years to five years. This reduced exclusivity period would hasten the introduction of lower cost biosimilars to the market, helping bring down cost for consumers. Drug savings. Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 383): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. The Lowering Medicare Premiums and Prescription Drug Costs Act (S. 1844): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and raise the income threshold for the low-income subsidy. The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D. Medicare Reform. Assuring Medicares Promise Act (H.R. 8323): Proposal to close the loophole for wealthy individuals to bypass paying net investment income tax (NIIT) and would direct the revenue to the Hospital Insurance Fund, which pays for Medicare Part A that covers inpatient care in hospitals. Medicare Dental Coverage. Medicare Dental Benefit Act (S. 97 and H.R. 502): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 1118): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Part B of the Medicare program. Medicare premiums (No bill): Proposals to lower the cost of the 2022 Medicare Part B premium that was inappropriately raised to cover the overestimated cost of the Alzheimers drug Aduhelm. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with HHS/CMS. Public Health emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage. Seniors Timely Access to Care Act (H.R. 3173): Proposal to create transparency around Medicare Advantage plans use of prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. Medicare Advantage Consumer Protection and Transparency Act (H.R. 9019). Proposal to create transparency around Medicare Advantage plans use of prior authorization. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid. Inflation Reduction Act (Public Law No: 117-169): Proposals to expand Medicaid home and community-based services and the Medicare savings programs.
Client expense: $190,000 · Firm income: Not reported
Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · fourth_quarter · Medicare/Medicaid
Lowering the Cost of Prescription Drugs, Drug Importation H.R. 832, S. 259), Adding Vision and Dental to Medicare (H.R. 502).
Client expense: Not reported · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
Medicaid: HR 4439 - Medicaid Dental Benefit Act and S. 3166 the Medicaid Dental Benefits Act of 2021 regarding provisions to require state Medicaid programs to provide mandatory adult dental and oral health services Medicare: Medicare Dental Benefit Act of 2021 (HR 502/S. 97); Medicare Dental Coverage Act of 2021 (HR 4650); Medicare Dental, Vision, and Hearing Benefit Act of 2021 (HR 4311); Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 (S. 2618); Medicare Medically Necessary Dental Care Act of 2021 (HR 5110); and the Build Back Better Act (HR 5376) regarding Medicare coverage of dental and oral health services
Client expense: $70,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · fourth_quarter · Medicare/Medicaid
Regulations related to the 2023 Medicare Physician Fee Schedule Rule. S.97 & H.R.502 - Medicare Dental Benefit Act of 2021 H.R.1794 - Foster Youth Dental Act of 2021 H.R.4311 - Medicare Dental, Vision, and Hearing Benefit Act of 2021 H.R.4439 - Medicaid Dental Benefit Act H.R.4650 - Medicare Dental Coverage Act of 2021 H.R.5376 - Build Back Better Act S.560 - Oral Health for Moms Act H.R.5110 - Medicare Medically Necessary Dental Care Act of 2021 S.1180 - Choose Medicare Act S.3166 - Medicaid Dental Benefit Act of 2021 S.1279 - Medicare at 50 Act S.2618 - Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2022 · third_quarter · Medicare/Medicaid
Regulations related to the 2023 Medicare Physician Fee Schedule Rule. S.97 & H.R.502 - Medicare Dental Benefit Act of 2021 H.R.1794 - Foster Youth Dental Act of 2021 H.R.4311 - Medicare Dental, Vision, and Hearing Benefit Act of 2021 H.R.4439 - Medicaid Dental Benefit Act H.R.4650 - Medicare Dental Coverage Act of 2021 H.R.5376 - Build Back Better Act S.560 - Oral Health for Moms Act H.R.5110 - Medicare Medically Necessary Dental Care Act of 2021 S.1180 - Choose Medicare Act S.3166 - Medicaid Dental Benefit Act of 2021 S.1279 - Medicare at 50 Act S.2618 - Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
2022 · third_quarter · Medicare/Medicaid
Center for Medicare & Medicaid Innovation demonstration for periodontal services for targeted, low-income Medicare beneficiaries and monitor Medicare dental benefit issues, including medically necessary dental coverage in Medicare, and related provisions in S. 97/H.R. 502, the Medicare Dental Benefit Act. Coronavirus response efforts, including S. 3799, the PREVENT Pandemics Act, and support for health care providers and patients, implementation of related provisions in H.R. 1319, the American Rescue Plan Act (P.L. 117-2), and support for dentists and COVID-19 vaccine prescriber continuing education and training.
Client expense: Not reported · Firm income: $60,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, 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.
2022 · third_quarter · Medicare/Medicaid
Medicaid: HR 4439 - Medicaid Dental Benefit Act and S. 3166 the Medicaid Dental Benefits Act of 2021 regarding provisions to require state Medicaid programs to provide mandatory adult dental and oral health services Medicare: Medicare Dental Benefit Act of 2021 (HR 502/S. 97); Medicare Dental Coverage Act of 2021 (HR 4650); Medicare Dental, Vision, and Hearing Benefit Act of 2021 (HR 4311); Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 (S. 2618); Medicare Medically Necessary Dental Care Act of 2021 (HR 5110); and the Build Back Better Act (HR 5376) regarding Medicare coverage of dental and oral health services
Client expense: $70,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · third_quarter · Medicare/Medicaid
Lowering the Cost of Prescription Drugs, Drug Importation H.R. 832, S. 259), Adding Vision and Dental to Medicare (H.R. 502).
Client expense: Not reported · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · third_quarter · Medicare/Medicaid
Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2021 (H.R. 3650 and S. 2048): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Drug Costs (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act. Drug Costs. Pharmaceutical Research and Transparency Act of 2022 (S. 4037): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Drug Costs. Discounted Drugs for Clinical Trials Act (S. 4026): Proposal to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer. Drug Costs. Generic Substitution Non-Interference Act (H.R. 7473): Proposal would block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. These campaigns increase drug spending by encouraging overuse of brand drugs when cheaper, equally effective generic alternative is available. Drug Costs. The Price Relief, Innovation and Competition for Essential Drugs (PRICED) Act, (S. 583): Proposal to reduce the period after Food and Drug Administration approval where a brand manufacturer could exclusively market their drug in the United States from 12 years to five years. This reduced exclusivity period would hasten the introduction of lower cost biosimilars to the market, helping bring down cost for consumers. Drug savings. Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 383): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. The Lowering Medicare Premiums and Prescription Drug Costs Act (S. 1844): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and raise the income threshold for the low-income subsidy. The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D. Medicare Reform. Assuring Medicares Promise Act (H.R. 8323): Proposal to close the loophole for wealthy individuals to bypass paying net investment income tax (NIIT) and would direct the revenue to the Hospital Insurance Fund, which pays for Medicare Part A that covers inpatient care in hospitals. Medicare Dental Coverage. Medicare Dental Benefit Act (S. 97 and H.R. 502): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 1118): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Part B of the Medicare program. Medicare premiums (No bill): Proposals to lower the cost of the 2022 Medicare Part B premium that was inappropriately raised to cover the overestimated cost of the Alzheimers drug Aduhelm. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with HHS/CMS. Public Health emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage. Seniors Timely Access to Care Act (H.R. 3173): Proposal to create transparency around Medicare Advantage plans use of prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. Medicare Advantage Consumer Protection and Transparency Act (H.R. 9019). Proposal to create transparency around Medicare Advantage plans use of prior authorization. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid. Inflation Reduction Act (Public Law No: 117-169): Proposals to expand Medicaid home and community-based services and the Medicare savings programs.
2022 · second_quarter · Medicare/Medicaid
S.97 & H.R.502 - Medicare Dental Benefit Act of 2021 H.R.1794 - Foster Youth Dental Act of 2021 H.R.4311 - Medicare Dental, Vision, and Hearing Benefit Act of 2021 H.R.4439 - Medicaid Dental Benefit Act H.R.4650 - Medicare Dental Coverage Act of 2021 H.R.5376 - Build Back Better Act S.560 - Oral Health for Moms Act H.R.5110 - Medicare Medically Necessary Dental Care Act of 2021 S.1180 - Choose Medicare Act S.3166 - Medicaid Dental Benefit Act of 2021 S.1279 - Medicare at 50 Act S.2618 - Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021
Client expense: Not reported · Firm income: $20,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · second_quarter · Medicare/Medicaid
Medicaid: HR 4439 - Medicaid Dental Benefit Act and S. 3166 the Medicaid Dental Benefits Act of 2021 regarding provisions to require state Medicaid programs to provide mandatory adult dental and oral health services Medicare: Medicare Dental Benefit Act of 2021 (HR 502/S. 97); Medicare Dental Coverage Act of 2021 (HR 4650); Medicare Dental, Vision, and Hearing Benefit Act of 2021 (HR 4311); Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 (S. 2618); Medicare Medically Necessary Dental Care Act of 2021 (HR 5110); and the Build Back Better Act (HR 5376) regarding Medicare coverage of dental and oral health services
Client expense: $110,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · second_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; Part D reform, out of pocket limits; 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; contraceptive coverage and reproductive health; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing, 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; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; 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.
2022 · second_quarter · Medicare/Medicaid
Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2021 (H.R. 3650 and S. 2048): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Drug Costs. Proposals to allow Medicare to negotiate drug prices, allow for the reimportation of drugs, require manufacturer rebates for drugs used under Medicare Parts B and D for the amount prices rise above the rate of inflation, restructure the benefit, and cap beneficiary out-of-pocket costs in Part D. Drug Costs. Pharmaceutical Research and Transparency Act of 2022 (S. 4037): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Drug Costs. Discounted Drugs for Clinical Trials Act (S. 4026): Proposal to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer. Drug Costs. Generic Substitution Non-Interference Act (H.R. 7473): Proposal would block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. These campaigns increase drug spending by encouraging overuse of brand drugs when cheaper, equally effective generic alternative is available. Drug Costs. The Price Relief, Innovation and Competition for Essential Drugs (PRICED) Act, (S. 583): Proposal to reduce the period after Food and Drug Administration approval where a brand manufacturer could exclusively market their drug in the United States from 12 years to five years. This reduced exclusivity period would hasten the introduction of lower cost biosimilars to the market, helping bring down cost for consumers. Drug savings. More Help for Seniors Act of 2021 (H.R. 2464): Proposal to expand eligibility for low-income subsidies under the Medicare prescription drug benefit by raising the maximum allowable income for beneficiaries to qualify from 150 percent to 200 percent of the federal poverty line. Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 383): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. The Lowering Medicare Premiums and Prescription Drug Costs Act (S. 1844): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3): Proposals to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D. Medicare Reform. Assuring Medicares Promise Act (H.R. 8323): Proposal to close the loophole for wealthy individuals to bypass paying net investment income tax (NIIT) and would direct the revenue to the Hospital Insurance Fund, which pays for Medicare Part A that covers inpatient care in hospitals. Medicare reform. Build Back Better Act (H.R. 5376): Proposals to add dental, hearing and vision and a total out-of-pocket cap to Medicare. Proposals to means test Medicare. Proposals to create vouchers for hearing, dental and vision benefits. Medicare Dental Coverage. Medicare Dental Benefit Act (S. 97 and H.R. 502): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 1118): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Part B of the Medicare program. Medicare premiums (No bill): Proposals to lower the cost of the 2022 Medicare Part B premium that was inappropriately raised to cover the overestimated cost of the Alzheimers drug Aduhelm. Medicaid. Build Back Better Act (H.R. 5376): Proposals to expand Medicaid home and community-based services and the Medicare savings programs. COVID funding (H.R. 7007): Proposal to enact COVID relief supplemental appropriations legislation to provide additional federal funding to develop and distribute COVID vaccines, test kits and treatments to keep seniors and other vulnerable populations safe. Public Health emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Privatization (No bill): Proposal to create transparency around Medicare Advantage plans use of prior authorization. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans.
2022 · second_quarter · Medicare/Medicaid
Center for Medicare & Medicaid Innovation demonstration for periodontal services for targeted, low-income Medicare beneficiaries and monitor Medicare dental benefit issues, including medically necessary dental coverage in Medicare, and related provisions in S. 97/H.R. 502, the Medicare Dental Benefit Act, and monitor H.R. 5376 the Build Back Better Act, and related amendments to H.R. 5376 posted by the Senate Finance Committee. Coronavirus response efforts, including S. 3799, the PREVENT Pandemics Act, and support for health care providers and patients, implementation of related provisions in H.R. 1319, the American Rescue Plan Act (P.L. 117-2).
Client expense: Not reported · Firm income: $30,000
2022 · second_quarter · Medicare/Medicaid
Medicaid: HR 4439 - Medicaid Dental Benefit Act and S. 3166 the Medicaid Dental Benefits Act of 2021 regarding provisions to require state Medicaid programs to provide mandatory adult dental and oral health services Medicare: Medicare Dental Benefit Act of 2021 (HR 502/S. 97); Medicare Dental Coverage Act of 2021 (HR 4650); Medicare Dental, Vision, and Hearing Benefit Act of 2021 (HR 4311); Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 (S. 2618); Medicare Medically Necessary Dental Care Act of 2021 (HR 5110); and the Build Back Better Act (HR 5376) regarding Medicare coverage of dental and oral health services
Client expense: $120,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · second_quarter · Medicare/Medicaid
Medicaid: HR 4439 - Medicaid Dental Benefit Act and S. 3166 the Medicaid Dental Benefits Act of 2021 regarding provisions to require state Medicaid programs to provide mandatory adult dental and oral health services Medicare: Medicare Dental Benefit Act of 2021 (HR 502/S. 97); Medicare Dental Coverage Act of 2021 (HR 4650); Medicare Dental, Vision, and Hearing Benefit Act of 2021 (HR 4311); Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 (S. 2618); Medicare Medically Necessary Dental Care Act of 2021 (HR 5110); and the Build Back Better Act (HR 5376) regarding Medicare coverage of dental and oral health services
Client expense: $120,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · second_quarter · Medicare/Medicaid
S. 97/H.R. 502 (117th Congress) The Medicare Dental Benefit Act. ISSUES: interaction with existing dental coverage and general issues related to inclusion of dental benefits under Medicare Part B
Client expense: $470,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · second_quarter · Medicare/Medicaid
Lowering the Cost of Prescription Drugs, Drug Importation H.R. 832, S. 259), Adding Vision and Dental to Medicare (H.R. 502).
Client expense: Not reported · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · first_quarter · Medicare/Medicaid
S.97 & H.R.502 - Medicare Dental Benefit Act of 2021 H.R.1794 - Foster Youth Dental Act of 2021 H.R.4311 - Medicare Dental, Vision, and Hearing Benefit Act of 2021 H.R.4439 - Medicaid Dental Benefit Act H.R.4650 - Medicare Dental Coverage Act of 2021 H.R.5376 - Build Back Better Act S.560 - Oral Health for Moms Act H.R.5110 - Medicare Medically Necessary Dental Care Act of 2021 S.1180 - Choose Medicare Act S.3166 - Medicaid Dental Benefit Act of 2021 S.1279 - Medicare at 50 Act S.2618 - Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021
Client expense: Not reported · Firm income: $20,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · first_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; Part D reform, out of pocket limits; 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; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing, 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, 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); 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; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; 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.
2022 · first_quarter · Medicare/Medicaid
S. 97/H.R. 502 (117th Congress) The Medicare Dental Benefit Act. ISSUES: interaction with existing dental coverage and general issues related to inclusion of dental benefits under Medicare Part B
Client expense: $470,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · first_quarter · Medicare/Medicaid
Center for Medicare & Medicaid Innovation demonstration for periodontal services for targeted, low-income Medicare beneficiaries and monitor Medicare dental benefit issues, including related provisions in S. 97/H.R. 502, the Medicare Dental Benefit Act, and monitor H.R. 5376 the Build Back Better Act, and related amendments to H.R. 5376 posted by the Senate Finance Committee. Coronavirus response efforts, including S. 3799, the PREVENT Pandemics Act, and support for health care providers and patients, implementation of related provisions in H.R. 1319, the American Rescue Plan Act (P.L. 117-2).
Client expense: Not reported · Firm income: $30,000
2022 · first_quarter · Medicare/Medicaid
Medicaid: HR 4439 - Medicaid Dental Benefit Act and S. 3166 the Medicaid Dental Benefits Act of 2021 regarding provisions to require state Medicaid programs to provide mandatory adult dental and oral health services Medicare: Medicare Dental Benefit Act of 2021 (HR 502/S. 97); Medicare Dental Coverage Act of 2021 (HR 4650); Medicare Dental, Vision, and Hearing Benefit Act of 2021 (HR 4311); Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 (S. 2618); Medicare Medically Necessary Dental Care Act of 2021 (HR 5110); and the Build Back Better Act (HR 5376) regarding Medicare coverage of dental and oral health services
Client expense: $90,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2022 · first_quarter · Medicare/Medicaid
Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2021 (H.R. 3650 and S. 2048): Proposals to count time spent in hospital observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Drug Costs. The Build Back Better Act (H.R. 5376): Proposals to allow Medicare to negotiate drug prices, allow for the reimportation of drugs, require manufacturer rebates for drugs used under Medicare Parts B and D for the amount prices rise above the rate of inflation, restructure the benefit, and cap beneficiary out-of-pocket costs in Part D. Medicare reform. The Build Back Better Act (H.R. 5376): Proposals to add dental, hearing and vision and a total out-of-pocket cap to Medicare. Proposal to create temporary dental voucher. Proposals to means test Medicare. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 97 and H.R. 502): Proposal to add a dental benefit to Medicare. Drug savings. The More Help for Seniors Act of 2021 (H.R. 2464) and the Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 3831): Proposals to expand eligibility for low-income subsidies under the Medicare prescription drug benefit by raising the maximum allowable income for beneficiaries to qualify from 150 percent to 200 percent of the federal poverty line. Medicare Part B Premium Increase (No bill): Proposals to mitigate the 2022 Medicare Part B premium increase, including the Centers for Medicare and Medicaid Services decision on whether to cover Aduhelm under Part B, and to reinstate the reasonable prescription drug pricing clause that was established by the National Institutes of Health in 1989. Medicare Prescription Drugs. The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3): Proposals to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 1118): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Part B of the Medicare program. Shoring up Medicare Act. Proposal to close loopholes in the Net Investment Income Tax and redirect the revenue into the Medicare Trust Fund. Medicaid. The Build Back Better Act (H.R. 5376) and the Better Care Better Jobs Act (S. 2210 and H.R. 4131): Proposals to expand home- and community- based services and the Medicare savings programs. Medicaid. Public Health Emergency (No bill): Proposals to require four months of notice prior to ending the public health emergency.
2022 · first_quarter · Medicare/Medicaid
Lowering the Cost of Prescription Drugs, Drug Importation H.R. 832, S. 259), Adding Vision and Dental to Medicare (H.R. 502).
Client expense: Not reported · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2021 · fourth_quarter · Medicare/Medicaid
S.97 & H.R.502 - Medicare Dental Benefit Act of 2021 H.R.1794 - Foster Youth Dental Act of 2021 H.R.4311 - Medicare Dental, Vision, and Hearing Benefit Act of 2021 H.R.4439 - Medicaid Dental Benefit Act H.R.4650 - Medicare Dental Coverage Act of 2021 H.R.5376 - Build Back Better Act S.560 - Oral Health for Moms Act H.R.5110 - Medicare Medically Necessary Dental Care Act of 2021 S.1180 - Choose Medicare Act S.3166 - Medicaid Dental Benefit Act of 2021 S.1279 - Medicare at 50 Act S.2618 - Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, Treasury, Dept of, White House Office
2021 · fourth_quarter · Medicare/Medicaid
Medicaid: HR 4439 - Medicaid Dental Benefit Act and S. 3166 the Medicaid Dental Benefits Act of 2021 regarding provisions to require state Medicaid programs to provide mandatory adult dental and oral health services Medicare: Medicare Dental Benefit Act of 2021 (HR 502/S. 97); Medicare Dental Coverage Act of 2021 (HR 4650); Medicare Dental, Vision, and Hearing Benefit Act of 2021 (HR 4311); Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 (S. 2618); Medicare Medically Necessary Dental Care Act of 2021 (HR 5110); and the Build Back Better Act (HR 5376) regarding Medicare coverage of dental and oral health services
Client expense: $240,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2021 · fourth_quarter · Medicare/Medicaid
Analyzing the Duration of Remote Monitoring Services Act of 2021 (H.R.4347) CONNECT for Health Act of 2021 (H.R.2903 / S.1512) Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021 (S.1986) Medicare Dental Benefit Act of 2021 (S.97 / H.R. 502) SOS: Sustaining Outpatient Services Act (H.R.3348) Medicaid Waivers National Coverage Determination for Self-Measured Blood Pressure Telehealth Extension Act of 2021 (H.R. 6202) The Telehealth Modernization Act (S.368) 2023 Notice of Benefit and Payment Parameters
Client expense: $120,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Reserve System, Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Transportation, Dept of (DOT), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office
2021 · fourth_quarter · Medicare/Medicaid
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - Jim Ramstad Legacy of Recovery Act - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - Expanded Coverage for Former Foster Youth Act - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - Medicare for All Act of 2021 - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - Protecting Seniors Through Immunization Act of 2021 - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - Protect Seniors and Cut Waste Act - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - Permanency for Audio-Only Telehealth Act - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - CARING for Social Determinants Act of 2021- Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - COVER Now Act - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 Advancing Telehealth Beyond COVID-19 Act of 2021- Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - Ensuring Patient Access to Critical Breakthrough Products Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - Insulin Access for All Act of 2021 - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - Medicare Vision Act of 2021 - Rep. Schrier, Kim [D-WA - Medicare vision coverage H.R. 4263 - Patient Parity Protection Act of 2021 - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services H.R. 4311 - Medicare Dental, Vision, and Hearing Benefit Act of 2021 - Rep. Doggett, Lloyd [D-TX-35] - Medicare dental, vision, and hearing benefits H.R. 4406 - Supporting Medicaid in the U.S. Territories Act of 2021 - Rep. Soto, Darren [D-FL-9] - Medicaid support in U.S. territories H.R. 4439 - Medicaid Dental Benefit Act - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicaid dental benefit H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd [D-TX-35] - Medicare supplemental health insurance policies H.R. 4650 - Medicare Dental Coverage Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - Medicare dental benefit H.R. 4941 - PACE Part D Choice Act of 2021 - Rep. Blumenauer, Earl [D-OR-3] - prescription drug plans in the Medicare-only PACE program H.R. 4942 - BETTER Kidney Care Act - Rep. Blumenauer, Earl [D-OR-3] - demonstration program for Medicare enrollees with ESRD H.R. 4974 - State Public Option Act - Rep. Schrier, Kim [D-WA-8] - Medicaid public option H.R. 5099 - Lowering Medicare Premiums and Prescription Drug Costs Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare cost-sharing benefits H.R. 5110 - Medicare Medically Necessary Dental Care Act of 2021 - Rep. Cohen, Steve [D-TN-9] - Medicare dental benefits H.R. 5165 - Improving Medicare Coverage Act - Rep. Jayapal, Pramila [D-WA-7] - Medicare eligibility age H.R. 5414 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2021 - Rep. Bilirakis, Gus M. [R-FL-12] - Medicaid coverage for children in foster care H.R. 5425 - Protecting Rural Telehealth Access Act - Rep. O'Halleran, Tom [D-AZ-1] - Medicare telehealth services H.R. 5576 - Fair Drug Prices for Kids Act - Rep. Wild, Susan [D-PA-7] - Medicaid Drug Rebate Program under CHIP H.R. 5632 - Long-Term Care Pharmacy Definition Act of 2021 - Rep. Schrader, Kurt [D-OR-5] - Medicare long term care pharmacy H.R. 5674 - Medicare Mental Health Inpatient Equity Act of 2021 - Rep. Tonko, Paul [D-NY-20] - inpatient psychiatric hospital services under Medicare H.R. 6101 - Drug Price Transparency in Medicaid Act of 2021 - Rep. Carter, Earl L. "Buddy" [R-GA-1] - drug pricing in Medicaid S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - COMP Act - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - Audio-Only Telehealth for Emergencies Act - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - EASE Behavioral Health Services Act - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - Rural and Frontier Telehealth Expansion Act - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - Better Care Better Jobs Act - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - Expanding Health Care Options for Early Retirees Act - Sen. Brown, Sherrod [D-OH] - Medicare buy-in S. 2315 - Medicaid Saves Lives Act - Sen. Warnock, Raphael [D-GA] - Medicaid expansion S. 2618 - Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 - Sen. Casey, Bob [D-PA] - Medicaid dental, vision, and hearing benefits S. 2639 - State Public Option Act - Sen. Schatz, Brian [D-HI] - Medicaid public option S. 2689 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2021 - Sen. Burr, Richard [R-NC] - Medicaid-eligibility for children in foster care S. 3018 - Improving Seniors Timely Access to Care Act of 2021 - Sen. Marshall, Roger [R-KS] - prior authorization under MA S. 3061 - Medicare Mental Health Inpatient Equity Act of 2021 - Sen. Collins, Susan M. [R-ME] - inpatient psychiatric hospital services under Medicare S. 3193 - Expanded Telehealth Access Act - Sen. Daines, Steve [R-MT] - Medicare telehealth service providers S. 3332 - Let States Innovate Under Medicaid Act - Sen. Braun, Mike [R-IN] - Medicaid program promotion 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 2022 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 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; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; 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, 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); 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; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; 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.
2021 · fourth_quarter · Medicare/Medicaid
S. 97/H.R. 502 (117th Congress) The Medicare Dental Benefit Act. ISSUES: interaction with existing dental coverage and general issues related to inclusion of dental benefits under Medicare Part B HR 5376 - Build Back Better Act: New Medicare benefits; issues related to dental, hearing, and vision.
Client expense: $460,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2021 · third_quarter · Medicare/Medicaid
Center for Medicare & Medicaid Innovation demonstration for periodontal services for targeted, low-income Medicare beneficiaries and monitor Medicare dental benefit issues, including related provisions in S. 97/H.R. 502, the Medicare Dental Benefit Act, and the Build Back Better Act, Budget Reconciliation Legislative Recommendations Related to Medicare - Medicare Dental and Oral Health, Part D, Energy and Commerce, and Part 4 of Subtitle E, Ways and Means. Coronavirus response efforts, including support for health care providers and patients, implementation of related provisions in H.R. 1319, the American Rescue Plan Act (P.L. 117-2), and support for dentists and COVID-19 vaccine prescriber continuing education and training.
Client expense: Not reported · Firm income: $30,000
2021 · fourth_quarter · Medicare/Medicaid
Center for Medicare & Medicaid Innovation demonstration for periodontal services for targeted, low-income Medicare beneficiaries and monitor Medicare dental benefit issues, including related provisions in S. 97/H.R. 502, the Medicare Dental Benefit Act, and monitor H.R. 5376 the Build Back Better Act, and related amendments to H.R. 5376 posted by the Senate Finance Committee. Coronavirus response efforts, including support for health care providers and patients, implementation of related provisions in H.R. 1319, the American Rescue Plan Act (P.L. 117-2).
Client expense: Not reported · Firm income: $30,000
2021 · fourth_quarter · Medicare/Medicaid
Build Back Better Act (H.R. 5376), policies related to the provision of dental benefits under the Medicare program; the Medicare Dental Benefit Act of 2021 (HR 502/S 97), the Medicaid Dental Benefits Act (S. 3166), the Medicaid Dental Benefit Act (H.R. 4439).
Client expense: Not reported · Firm income: $60,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2021 · fourth_quarter · Medicare/Medicaid
Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2021 (H.R. 3650 and S. 2048): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Drug Costs. Build Back Better Act (H.R. 5376): Proposals to allow Medicare to negotiate drug prices, allow for the reimportation of drugs, require manufacturer rebates for drugs used under Medicare Parts B and D for the amount prices rise above the rate of inflation, restructure the benefit, and cap beneficiary out-of-pocket costs in Part D. Medicare reform. Build Back Better Act (H.R. 5376): Proposals to add dental, hearing and vision and a total out-of-pocket cap to Medicare. Proposal to create temporary dental voucher. Proposals to means test Medicare. Medicare Dental Coverage. Medicare Dental Benefit Act (S. 97 and H.R. 502): Proposal to add a dental benefit to Medicare. Drug savings. More Help for Seniors Act of 2021 (H.R. 2464): Proposal to expand eligibility for low-income subsidies under the Medicare prescription drug benefit by raising the maximum allowable income for beneficiaries to qualify from 150 percent to 200 percent of the federal poverty line. Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 383): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. The Lowering Medicare Premiums and Prescription Drug Costs Act (S. 1844): Proposals to eliminate the asset test and raise the income eligibility levels to 200 percent of the Federal Poverty Level. Medicare Part B Premium Increase (No bill): Proposals to mitigate the 2022 Medicare Part B premium increase, including the Centers for Medicare and Medicaid Services decision on whether to cover Aduhelm under Part B, and to reinstate the reasonable prescription drug pricing clause that was established by the National Institutes of Health in 1989. Medicare Prescription Drugs. The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3): Proposals to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 1118): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Part B of the Medicare program. Medicaid. Build Back Better Act (H.R. 5376): Proposals to expand home- and community- based services and the Medicare savings programs.
2021 · fourth_quarter · Medicare/Medicaid
Medicare Part D Smoothing; Medicare Part D Out of Pocket Costs; Adding Dental, Vision, and Hearing benefits to Medicare; Vaccine co-pay parity for Medicare Part D and Part B; H.R. 502/S. 87 - Medicare Dental Benefit Act; Expanding eligibility for the Medicare Low-Income Subsidy/Extra Help program; H.R. 4311 - Medicare Dental Vision, and Hearing Benefit Act of 2021; H.R. 5376 - Part D cap and smoothing and Part D vaccine copay equity in the Build Back Better Act.
Client expense: Not reported · Firm income: $30,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES
2021 · third_quarter · Medicare/Medicaid
S.97 & H.R.502 - Medicare Dental Benefit Act of 2021 H.R.1794 - Foster Youth Dental Act of 2021 H.R.4311 - Medicare Dental, Vision, and Hearing Benefit Act of 2021 H.R.4439 - Medicaid Dental Benefit Act H.R.4650 - Medicare Dental Coverage Act of 2021 H.R.5376 - Build Back Better Act
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, Treasury, Dept of, White House Office
2021 · third_quarter · Medicare/Medicaid
Medicaid: HR 4439 - Medicaid Dental Benefit Act regarding provisions to require state Medicaid programs to provide mandatory adult dental and oral health services Medicare: Medicare Dental Benefit Act of 2021 (HR 502/S. 97); Medicare Dental Coverage Act of 2021 (HR 4650); Medicare Dental, Vision, and Hearing Benefit Act of 2021 (HR 4311); Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 (S. 2618); and Medicare Medically Necessary Dental Care Act of 2021 (HR 5110) regarding Medicare coverage of dental and oral health services
Client expense: $140,000 · 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
2021 · third_quarter · Medicare/Medicaid
Medicaid: HR 4439 - Medicaid Dental Benefit Act regarding provisions to require state Medicaid programs to provide mandatory adult dental and oral health services Medicare: Medicare Dental Benefit Act of 2021 (HR 502/S. 97); Medicare Dental Coverage Act of 2021 (HR 4650); Medicare Dental, Vision, and Hearing Benefit Act of 2021 (HR 4311); Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 (S. 2618); and Medicare Medically Necessary Dental Care Act of 2021 (HR 5110) regarding Medicare coverage of dental and oral health services
Client expense: $140,000 · 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
2021 · third_quarter · Medicare/Medicaid
H.R. 19 - Lower Costs, More Cures Act of 2021 - Rep. McMorris Rodgers, Cathy [R-WA-5] - Medicare and Medicaid reforms H.R. 56 - Patient Access to Medical Foods Act - Rep. Biggs, Andy [R-AZ-5] - coverage of medical foods H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern [R-FL-16] - CHIP extension H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare Sequester H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc A. [D-TX-33] - Medicaid expansion H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicare dental coverage H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie [D-MI-12] - HCBS H.R. 599 - Protecting Medicare Beneficiaries with Pre-Existing Conditions Act - Rep. Schneider, Bradley Scott [D-IL-10] - pre-existing conditions H.R. 722 - Ensuring Vaccination and Treatment Affordability Act - Rep. Pappas, Chris [D-NH-1] - cost-sharing for COVID-19 vaccines H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony [D-CA-29] - Medicaid & COVID-19 H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul [D-NY-20] - Medicaid coverage H.R. 975 - Ensuring Seniors Access to COVID Treatments Act - Rep. Casten, Sean [D-IL-6] - coverage of COVID-19 drugs H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio [D-NY-19] - Medicare-X H.R. 1495 - Jim Ramstad Legacy of Recovery Act - Rep. Emmer, Tom [R-MN-6] - Medicaid coverage for SUD H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred [R-MI-6] - HCBS and spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia M. [D-NY-7] - Medicaid for territories H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz [D-CA-44] - CHIP extension H.R. 1795 - Expanded Coverage for Former Foster Youth Act - Rep. Bass, Karen [D-CA-37] - coverage for foster youth H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie [D-MI-12] - Money Follows the Person extension H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - Medicare Advantage benchmark rates H.R. 1976 - Medicare for All Act of 2021 - Rep. Jayapal, Pramila [D-WA-7] - Medicare for All H.R. 1978 - Protecting Seniors Through Immunization Act of 2021 - Rep. Kuster, Ann M. [D-NH-2] - cost sharing for vaccines under Medicare part D H.R. 1999 - Protect Seniors and Cut Waste Act - Rep. Smith, Jason [R-MO-8] - sequester for Pay-As-You-Go H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri A. [D-AL-7] - Medicare coverage of telehealth H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer [R-PR-At Large] - FMAP for territories H.R. 2297 - MIND Act - Rep. Boyle, Brendan F. [D-PA-2] - Medicaid payment for services provided in institutions for mental diseases H.R. 2464 - More Help for Seniors Act of 2021 - Rep. Craig, Angie [D-MN-2] - Medicare prescription drug benefit H.R. 2881 - Medicare Buy-In and Health Care Stabilization Act of 2021 - Rep. Higgins, Brian [D-NY-26] - Medicare public insurance H.R. 3108 - Medical Nutrition Therapy Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - coverage of medical foods H.R. 3173 - Improving Seniors Timely Access to Care Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - prior authorization H.R. 3447 - Permanency for Audio-Only Telehealth Act - Rep. Smith, Jason [R-MO-8] - Medicare telehealth coverage H.R. 3450 - Medicaid Bump Act - Rep. Tonko, Paul [D-NY-20] - Medicaid funding and behavioral health H.R. 3894 - CARING for Social Determinants Act of 2021- Rep. Blunt Rochester, Lisa [D-DE-At Large] - Medicaid and SDOH H.R. 3961 - COVER Now Act - Rep. Doggett, Lloyd [D-TX-35] - Medicaid expansion H.R. 4040 Advancing Telehealth Beyond COVID-19 Act of 2021- Rep. Cheney, Liz [R-WY-At Large] - Medicare telehealth coverage H.R. 4043 - Ensuring Patient Access to Critical Breakthrough Products Act of 2021 - Rep. DelBene, Suzan K. [D-WA-1] - Medicare coverage of breakthrough devices H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. [R-FL-12] - Medicare Advantage supplemental benefits H.R. 4158 - Insulin Access for All Act of 2021 - Rep. Rush, Bobby L. [D-IL-1] - cost sharing for insulin H.R. 4187 - Medicare Vision Act of 2021 - Rep. Schrier, Kim [D-WA - Medicare vision coverage H.R. 4263 - Patient Parity Protection Act of 2021 - Rep. Gottheimer, Josh [D-NJ-5] - out-of-network services H.R. 4311 - Medicare Dental, Vision, and Hearing Benefit Act of 2021 - Rep. Doggett, Lloyd [D-TX-35] - Medicare dental, vision, and hearing benefits H.R. 4406 - Supporting Medicaid in the U.S. Territories Act of 2021 - Rep. Soto, Darren [D-FL-9] - Medicaid support in U.S. territories H.R. 4439 - Medicaid Dental Benefit Act - Rep. Barragan, Nanette Diaz [D-CA-44] - Medicaid dental benefit H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd [D-TX-35] - Medicare supplemental health insurance policies H.R. 4650 - Medicare Dental Coverage Act of 2021 - Rep. Kelly, Robin L. [D-IL-2] - Medicare dental benefit H.R. 4941 - PACE Part D Choice Act of 2021 - Rep. Blumenauer, Earl [D-OR-3] - prescription drug plans in the Medicare-only PACE program H.R. 4942 - BETTER Kidney Care Act - Rep. Blumenauer, Earl [D-OR-3] - demonstration program for Medicare enrollees with ESRD H.R. 4974 - State Public Option Act - Rep. Schrier, Kim [D-WA-8] - Medicaid public option H.R. 5099 - Lowering Medicare Premiums and Prescription Drug Costs Act - Rep. Schneider, Bradley Scott [D-IL-10] - Medicare cost-sharing benefits H.R. 5110 - Medicare Medically Necessary Dental Care Act of 2021 - Rep. Cohen, Steve [D-TN-9] - Medicare dental benefits H.R. 5165 - Improving Medicare Coverage Act - Rep. Jayapal, Pramila [D-WA-7] - Medicare eligibility age H.R. 5414 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2021 - Rep. Bilirakis, Gus M. [R-FL-12] - Medicaid coverage for children in foster care H.R. 5425 - Protecting Rural Telehealth Access Act - Rep. O'Halleran, Tom [D-AZ-1] - Medicare telehealth services S. 97 - Medicare Dental Benefit Act of 2021 - Sen. Cardin, Benjamin L. [D-MD] - Medicare dental coverage S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez Masto, Catherine [D-NV] - Medicaid telehealth coverage S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael F. [D-CO] - Medicaid & COVID-19 S. 340 - TREATS Act - Sen. Portman, Rob [R-OH] - telehealth - Medicare telehealth coverage S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael F. [D-CO] - Medicare-X S. 448 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Sen. Cardin, Benjamin L. [D-MD] - CHIP S. 653 - COMP Act - Sen. Portman, Rob [R-OH] - Medicare secondary payer rules S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne [D-NH] - Medicare sequestration S. 1180 - Choose Medicare Act - Sen. Merkley, Jeff [D-OR] - Medicare public insurance S. 1536 - Medical Nutrition Therapy Act of 2021 - Sen. Collins, Susan M. [R-ME] - coverage of medical foods S. 1727 - Medicaid Bump Act - Sen. Smith, Tina [D-MN] - Medicaid funding and behavioral health S. 1844 - Lowering Medicare Premiums and Prescription Drug Costs Act - Sen. Casey, Robert P., Jr. [D-PA] - Medicare premiums and drug costs S. 2111 - Audio-Only Telehealth for Emergencies Act - Sen. Kennedy, John [R-LA] - Medicare coverage of telehealth S. 2112 - EASE Behavioral Health Services Act - Sen. Kennedy, John [R-LA] - telehealth S. 2164 - Lower Costs, More Cures Act of 2021 - Sen. Crapo, Mike [R-ID] - Medicare and Medicaid reforms S. 2197 - Rural and Frontier Telehealth Expansion Act - Sen. Rosen, Jacky [D-NV] - FMAP & telehealth S. 2210 - Better Care Better Jobs Act - Sen. Casey, Robert P., Jr. [D-PA] - HCBS S. 2236 - Expanding Health Care Options for Early Retirees Act - Sen. Brown, Sherrod [D-OH] - Medicare buy-in S. 2315 - Medicaid Saves Lives Act - Sen. Warnock, Raphael [D-GA] - Medicaid expansion S. 2618 - Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2021 - Sen. Casey, Bob [D-PA] - Medicaid dental, vision, and hearing benefits S. 2639 - State Public Option Act - Sen. Schatz, Brian [D-HI] - Medicaid public option S. 2689 - Ensuring Medicaid Continuity for Children in Foster Care Act of 2021 - Sen. Burr, Richard [R-NC] - Medicaid-eligibility for children in foster care 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 2022 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2022 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; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing and vaccines; 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, 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); 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; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; 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.
2021 · third_quarter · Medicare/Medicaid
Access to Genetic Counselor Services Act (H.R. 2144) Analyzing the Duration of Remote Monitoring Services Act of 2021 (H.R.4347) CONNECT for Health Act of 2021 (H.R.2903 / S.1512) Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021 (S.1986) Medicare Dental Benefit Act of 2021 (S.97 / H.R. 502 SAME Act of 2021 (S.245) SOS: Sustaining Outpatient Services Act (H.R.3348) Medicaid Waivers National Coverage Determination for Self-Measured Blood Pressure Requirements Related to Surprise Billing Part I & Part II The Telehealth Modernization Act (S.368) 2022 Hospital Inpatient Prospective Payment System 2022 Hospital Outpatient Prospective Payment System 2022 Physician Fee Schedule
Client expense: $140,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Reserve System, Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Transportation, Dept of (DOT), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office
2021 · third_quarter · Medicare/Medicaid
S. 97/H.R. 502 (117th Congress) The Medicare Dental Benefit Act. ISSUES: interaction with existing dental coverage and general issues related to inclusion of dental benefits under Medicare Part B S.Con.Res.14 - ISSUE: New Medicare benefits
Client expense: $460,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2021 · third_quarter · Medicare/Medicaid
Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2021 (H.R. 3650 and S. 2048): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Drug Costs. Build Back Better Act (H.R. 5376): Proposals to allow Medicare to negotiate drug prices, allow for the reimportation of drugs, require manufacturer rebates for drugs used under Medicare Parts B and D for the amount prices rise above the rate of inflation, restructure the benefit, and cap beneficiary out-of-pocket costs in Part D. Medicare reform. Build Back Better Act (H.R. 5376): Proposals to add dental, hearing and vision and a total out-of-pocket cap to Medicare. Proposals to means test Medicare. Proposals to create vouchers for hearing, dental and vision benefits. Medicare Dental Coverage. Medicare Dental Benefit Act (S. 97 and H.R. 502): Proposal to add a dental benefit to Medicare. Drug savings. More Help for Seniors Act of 2021 (H.R. 2464): Proposal to expand eligibility for low-income subsidies under the Medicare prescription drug benefit by raising the maximum allowable income for beneficiaries to qualify from 150 percent to 200 percent of the federal poverty line. Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 383): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. The Lowering Medicare Premiums and Prescription Drug Costs Act (S. 1844): Proposals to eliminate the asset test and raise the income eligibility levels to 200 percent of the Federal Poverty Level. Medicare Prescription Drugs. The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3): Proposals to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 1118): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Part B of the Medicare program. Medicaid. Build Back Better Act (H.R. 5376): Proposals to expand home- and community- based services and the Medicare savings programs.
2021 · third_quarter · Medicare/Medicaid
Build Back Better Act (H.R. 5376), policies related to the provision of dental benefits under the Medicare program; the Medicare Dental Benefit Act of 2021 (HR 502/S 97).
Client expense: Not reported · Firm income: $60,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2021 · third_quarter · Medicare/Medicaid
Eliminating Out of Pocket Costs/cost-sharing in Medicare Parts A, B, C, and D for COVID-19 treatment services; Medicare Part D Smoothing; Medicare Part D Out of Pocket Costs; Adding Dental, Vision, and Hearing benefits to Medicare; Vaccine co-pay parity for Medicare Part D and Part B; H.R. 502/S. 87 - Medicare Dental Benefit Act; Expanding eligibility for the Medicare Low-Income Subsidy/Extra Help program; H.R. 4311 - Medicare Dental Vision, and Hearing Benefit Act of 2021.
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2021 · third_quarter · Medicare/Medicaid
Center for Medicare & Medicaid Innovation demonstration for periodontal services for targeted, low-income Medicare beneficiaries and monitor Medicare dental benefit issues, including related provisions in S. 97/H.R. 502, the Medicare Dental Benefit Act, and the Build Back Better Act, Budget Reconciliation Legislative Recommendations Related to Medicare - Medicare Dental and Oral Health, Part D, Energy and Commerce, and Part 4 of Subtitle E, Ways and Means. Coronavirus response efforts, including support for health care providers and patients, implementation of related provisions in H.R. 1319, the American Rescue Plan Act (P.L. 117-2), and support for dentists and COVID-19 vaccine prescriber continuing education and training.
Client expense: Not reported · Firm income: $30,000
2021 · second_quarter · Medicare/Medicaid
S.97 & H.R.502 - Medicare Dental Benefit Act of 2021 H.R.1794 - Foster Youth Dental Act of 2021 H.R.4311 - Medicare Dental, Vision, and Hearing Benefit Act of 2021 H.R.4439 - Medicaid Dental Benefit Act H.R.4650 - Medicare Dental Coverage Act of 2021
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, Treasury, Dept of, White House Office
| Democratic |
| CA |
| Robin L. Kelly | Democratic | IL |
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
Client expense: $210,000 · Firm income: Not reported
Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $2,890,000 · 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
Client expense: $230,000 · Firm income: Not reported
Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Client expense: $4,680,000 · 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
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Client expense: $250,000 · Firm income: Not reported
Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $2,630,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, SENATE
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Client expense: $260,000 · Firm income: Not reported
Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Treasury, Dept of
Client expense: $2,250,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
Client expense: $220,000 · Firm income: Not reported
Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Treasury, Dept of
Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, SENATE