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Lowering Medicare Premiums and Prescription Drug Costs Act
Legislative Progress
Introduced
August 24, 2021
Latest Action
August 25, 2021
Primary Sponsor
Bradley Scott SchneiderDemocratic(IL)
Momentum (last 30 days)
0
score
0 actions · 0 new cosponsors · 0 votes
Speed vs cohort
43pct
1d open
vs 9,698 other HR bills in the 117th — cohort avg 63d
Lowering Medicare Premiums and Prescription Drug Costs Act This bill transfers certain programs that provide Medicare premium and cost-sharing assistance for low-income individuals from Medicaid to Medicare. Specifically, the bill establishes a program under Medicare to assist low-income Medicare beneficiaries with premiums, coinsurance, deductibles, and other costs. Currently, such assistance is provided through Medicare Savings Programs, which are administered by state Medicaid programs. The bill also establishes a related special enrollment period under Medicare, expands eligibility for assistance to beneficiaries with income up to 200% of the federal poverty line, and provides for joint eligibility determinations with respect to the bill's program and the low-income subsidy program under the Medicare prescription drug benefit.
These links require the bill number to appear in the filing's source-reported specific issue text. Client expenses and lobbying-firm income are separate disclosure fields.
Filing registrants (2)
2022 · third_quarter · Medicare/Medicaid
H.R. 2815, BIOSIM Act, support passage H.R. 2855, the STAR Rating for Biosimilars Act, support passage H.R. 2846- Ensuring Access to Lower-Cost Medicines for Seniors Act of 021 - support passage S.2210/H.R. 4131- Better Care Better Jobs Act - support passage S.2315- Medicaid Saves Lives Act, support passage S.2327- Seniors Prescription Drug Relief Act- support passage S.2562-Choose Home Care Act of 2021- support passage S.2612- Prevent Interruptions in Physical Therapy Act of 2021- support passage S. 2694- Nursing Home Improvement and Accountability Act of 2021 - support passage H.R. 5011- Choose Medicare Act, support passage H.R. 5099- Lowering Medicare Premiums and Prescription Drug Costs Act, support passage H.R. 5165 - Improving Medicare Coverage Act - support passage H.R. 5237 - "To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes." - monitor for position determination H.R. 5260 - Reduced Costs and Continued Cures Act - monitor for position determination H.R. 5536 - SMART Act - support passage H.R. 5514 Choose Home Care Act of 2021, support passage Senate Reconciliation/Senate Finance prescription drug pricing package - supporting provisions that allow Medicare to negotiate for a specific amount of drugs, implement a $2,000 out-of-pocket cap on drug costs in Medicare Part D and a smoothing mechanism so that people in Medicare can spread their costs over the course of the year, and limit drug price increases by implementing rebates if prescription drug prices rise faster than inflation. H.R. 5376, Inflation Reduction Act (support passage, particularly drug pricing provisions)
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
Client expense: $42,877 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Office of Administration, SENATE
2022 · fourth_quarter · Medicare/Medicaid
H.R. 2815, BIOSIM Act, support passage H.R. 2855, the STAR Rating for Biosimilars Act, support passage H.R. 2846- Ensuring Access to Lower-Cost Medicines for Seniors Act of 021 - support passage S.2210/H.R. 4131- Better Care Better Jobs Act - support passage S.2315- Medicaid Saves Lives Act, support passage S.2327- Seniors Prescription Drug Relief Act- support passage S.2562-Choose Home Care Act of 2021- support passage S.2612- Prevent Interruptions in Physical Therapy Act of 2021- support passage S. 2694- Nursing Home Improvement and Accountability Act of 2021 - support passage H.R. 5011- Choose Medicare Act, support passage H.R. 5099- Lowering Medicare Premiums and Prescription Drug Costs Act, support passage H.R. 5165 - Improving Medicare Coverage Act - support passage H.R. 5237 - "To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes." - monitor for position determination H.R. 5260 - Reduced Costs and Continued Cures Act - monitor for position determination H.R. 5536 - SMART Act - support passage H.R. 5514 Choose Home Care Act of 2021, support passage Senate Reconciliation/Senate Finance prescription drug pricing package - supporting provisions that allow Medicare to negotiate for a specific amount of drugs, implement a $2,000 out-of-pocket cap on drug costs in Medicare Part D and a smoothing mechanism so that people in Medicare can spread their costs over the course of the year, and limit drug price increases by implementing rebates if prescription drug prices rise faster than inflation. H.R. 7667- Food and Drug Amendments of 2022, support passage S.4248- Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act, support passage H.R. 5435- BRAIN Act of 2021, establishing a Neuroscience Center of Excellence at the Food and Drug Administration, support passage H.R.315 - Common Sense Cannabis Reform for Veterans, Small Business and Medical Professionals Act, monitor to support H.R. 6000 - Cures 2.0 Act, supporting the goals of Rep. Upton/DeGette's Cures 2.0 initiative aimed at accelerating medical research, patient access to novel therapeutics and authorizing the Administration's Advanced Research Projects Agency for Health (ARPA-H) proposal -support passage S. 3726- CARE for Long COVID Act- support passage S.4447 - Modernizing Accelerated Approval Act, support passage and inclusion in Senate FDASLA package. S. 3799 Prevent Pandemics Act - support passage Lisa Blunt Rochester- Long-COVID RECOVERY NOW Act, support passage (bill number forthcoming)
Client expense: $58,169 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Office of Administration, SENATE
2022 · fourth_quarter · Medicare/Medicaid
H.R. 2815, BIOSIM Act, support passage H.R. 2855, the STAR Rating for Biosimilars Act, support passage H.R. 2846- Ensuring Access to Lower-Cost Medicines for Seniors Act of 021 - support passage S.2210/H.R. 4131- Better Care Better Jobs Act - support passage S.2315- Medicaid Saves Lives Act, support passage S.2327- Seniors Prescription Drug Relief Act- support passage S.2562-Choose Home Care Act of 2021- support passage S.2612- Prevent Interruptions in Physical Therapy Act of 2021- support passage S. 2694- Nursing Home Improvement and Accountability Act of 2021 - support passage H.R. 5011- Choose Medicare Act, support passage H.R. 5099- Lowering Medicare Premiums and Prescription Drug Costs Act, support passage H.R. 5165 - Improving Medicare Coverage Act - support passage H.R. 5237 - "To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes." - monitor for position determination H.R. 5260 - Reduced Costs and Continued Cures Act - monitor for position determination H.R. 5536 - SMART Act - support passage H.R. 5514 Choose Home Care Act of 2021, support passage Senate Reconciliation/Senate Finance prescription drug pricing package - supporting provisions that allow Medicare to negotiate for a specific amount of drugs, implement a $2,000 out-of-pocket cap on drug costs in Medicare Part D and a smoothing mechanism so that people in Medicare can spread their costs over the course of the year, and limit drug price increases by implementing rebates if prescription drug prices rise faster than inflation. H.R. 7667- Food and Drug Amendments of 2022, support passage S.4248- Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act, support passage H.R. 5435- BRAIN Act of 2021, establishing a Neuroscience Center of Excellence at the Food and Drug Administration, support passage H.R.315 - Common Sense Cannabis Reform for Veterans, Small Business and Medical Professionals Act, monitor to support H.R. 6000 - Cures 2.0 Act, supporting the goals of Rep. Upton/DeGette's Cures 2.0 initiative aimed at accelerating medical research, patient access to novel therapeutics and authorizing the Administration's Advanced Research Projects Agency for Health (ARPA-H) proposal -support passage S. 3726- CARE for Long COVID Act- support passage S.4447 - Modernizing Accelerated Approval Act, support passage and inclusion in Senate FDASLA package. S. 3799 Prevent Pandemics Act - support passage Lisa Blunt Rochester- Long-COVID RECOVERY NOW Act, support passage (bill number forthcoming)
Client expense: $45,264 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Office of Administration, SENATE
2022 · third_quarter · Medicare/Medicaid
H.R. 2815, BIOSIM Act, support passage H.R. 2855, the STAR Rating for Biosimilars Act, support passage H.R. 2846- Ensuring Access to Lower-Cost Medicines for Seniors Act of 021 - support passage S.2210/H.R. 4131- Better Care Better Jobs Act - support passage S.2315- Medicaid Saves Lives Act, support passage S.2327- Seniors Prescription Drug Relief Act- support passage S.2562-Choose Home Care Act of 2021- support passage S.2612- Prevent Interruptions in Physical Therapy Act of 2021- support passage S. 2694- Nursing Home Improvement and Accountability Act of 2021 - support passage H.R. 5011- Choose Medicare Act, support passage H.R. 5099- Lowering Medicare Premiums and Prescription Drug Costs Act, support passage H.R. 5165 - Improving Medicare Coverage Act - support passage H.R. 5237 - "To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes." - monitor for position determination H.R. 5260 - Reduced Costs and Continued Cures Act - monitor for position determination H.R. 5536 - SMART Act - support passage H.R. 5514 Choose Home Care Act of 2021, support passage Senate Reconciliation/Senate Finance prescription drug pricing package - supporting provisions that allow Medicare to negotiate for a specific amount of drugs, implement a $2,000 out-of-pocket cap on drug costs in Medicare Part D and a smoothing mechanism so that people in Medicare can spread their costs over the course of the year, and limit drug price increases by implementing rebates if prescription drug prices rise faster than inflation. H.R. 5376, Inflation Reduction Act (support passage, particularly drug pricing provisions)
Client expense: $11,123 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Office of Administration, SENATE
2022 · third_quarter · Medicare/Medicaid
H.R. 2815, BIOSIM Act, support passage H.R. 2855, the STAR Rating for Biosimilars Act, support passage H.R. 2846- Ensuring Access to Lower-Cost Medicines for Seniors Act of 021 - support passage S.2210/H.R. 4131- Better Care Better Jobs Act - support passage S.2315- Medicaid Saves Lives Act, support passage S.2327- Seniors Prescription Drug Relief Act- support passage S.2562-Choose Home Care Act of 2021- support passage S.2612- Prevent Interruptions in Physical Therapy Act of 2021- support passage S. 2694- Nursing Home Improvement and Accountability Act of 2021 - support passage H.R. 5011- Choose Medicare Act, support passage H.R. 5099- Lowering Medicare Premiums and Prescription Drug Costs Act, support passage H.R. 5165 - Improving Medicare Coverage Act - support passage H.R. 5237 - "To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes." - monitor for position determination H.R. 5260 - Reduced Costs and Continued Cures Act - monitor for position determination H.R. 5536 - SMART Act - support passage H.R. 5514 Choose Home Care Act of 2021, support passage Senate Reconciliation/Senate Finance prescription drug pricing package - supporting provisions that allow Medicare to negotiate for a specific amount of drugs, implement a $2,000 out-of-pocket cap on drug costs in Medicare Part D and a smoothing mechanism so that people in Medicare can spread their costs over the course of the year, and limit drug price increases by implementing rebates if prescription drug prices rise faster than inflation. H.R. 5376, Inflation Reduction Act (support passage, particularly drug pricing provisions)
Client expense: $11,123 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Office of Administration, SENATE
2022 · third_quarter · Medicare/Medicaid
H.R. 2815, BIOSIM Act, support passage H.R. 2855, the STAR Rating for Biosimilars Act, support passage H.R. 2846- Ensuring Access to Lower-Cost Medicines for Seniors Act of 021 - support passage S.2210/H.R. 4131- Better Care Better Jobs Act - support passage S.2315- Medicaid Saves Lives Act, support passage S.2327- Seniors Prescription Drug Relief Act- support passage S.2562-Choose Home Care Act of 2021- support passage S.2612- Prevent Interruptions in Physical Therapy Act of 2021- support passage S. 2694- Nursing Home Improvement and Accountability Act of 2021 - support passage H.R. 5011- Choose Medicare Act, support passage H.R. 5099- Lowering Medicare Premiums and Prescription Drug Costs Act, support passage H.R. 5165 - Improving Medicare Coverage Act - support passage H.R. 5237 - "To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes." - monitor for position determination H.R. 5260 - Reduced Costs and Continued Cures Act - monitor for position determination H.R. 5536 - SMART Act - support passage H.R. 5514 Choose Home Care Act of 2021, support passage Senate Reconciliation/Senate Finance prescription drug pricing package - supporting provisions that allow Medicare to negotiate for a specific amount of drugs, implement a $2,000 out-of-pocket cap on drug costs in Medicare Part D and a smoothing mechanism so that people in Medicare can spread their costs over the course of the year, and limit drug price increases by implementing rebates if prescription drug prices rise faster than inflation. H.R. 5376, Inflation Reduction Act (support passage, particularly drug pricing provisions)
2022 · second_quarter · Medicare/Medicaid
H.R.3 - Elijah Cummings Lower Drug Costs Now, monitor legislation S.151- "COVID HCBS Relief Act of 2021"- support passage H.R. 4131- "To amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid, and for other purposes."- support passage H.R. 2455 - The Resetting the IMPACT Act (TRIA) of 2021." - support passage H.R. 1319- The American Rescue Plan Act of 2021, support passage H.R. 2815, BIOSIM Act, support passage H.R. 2855, the STAR Rating for Biosimilars Act, support passage H.R. 2846- Ensuring Access to Lower-Cost Medicines for Seniors Act of 021 - support passage S.2210/H.R. 4131- Better Care Better Jobs Act - support passage S.2315- Medicaid Saves Lives Act, support passage S.2327- Seniors Prescription Drug Relief Act- support passage S.2562-Choose Home Care Act of 2021- support passage S.2612- Prevent Interruptions in Physical Therapy Act of 2021- support passage S. 2694- Nursing Home Improvement and Accountability Act of 2021 - support passage H.R. 5011- Choose Medicare Act, support passage H.R. 5099- Lowering Medicare Premiums and Prescription Drug Costs Act, support passage H.R. 5165 - Improving Medicare Coverage Act - support passage H.R. 5237 - "To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes." - monitor for position determination H.R. 5260 - Reduced Costs and Continued Cures Act - monitor for position determination H.R. 5536 - SMART Act - support passage H.R. 5514 Choose Home Care Act of 2021, support passage Senate Reconciliation/Senate Finance prescription drug pricing package - supporting provisions that allow Medicare to negotiate for a specific amount of drugs, implement a $2,000 out-of-pocket cap on drug costs in Medicare Part D and a smoothing mechanism so that people in Medicare can spread their costs over the course of the year, and limit drug price increases by implementing rebates if prescription drug prices rise faster than inflation.
2022 · first_quarter · Medicare/Medicaid
H.R.3 - Elijah Cummings Lower Drug Costs Now, monitor legislation S.151- "COVID HCBS Relief Act of 2021"- support passage H.R. 4131- "To amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid, and for other purposes."- support passage H.R. 2455 - The Resetting the IMPACT Act (TRIA) of 2021." - support passage H.R. 1319- The American Rescue Plan Act of 2021, support passage H.R. 2815, BIOSIM Act, support passage H.R. 2855, the STAR Rating for Biosimilars Act, support passage H.R. 2846- Ensuring Access to Lower-Cost Medicines for Seniors Act of 021 - support passage S.2210/H.R. 4131- Better Care Better Jobs Act - support passage S.2315- Medicaid Saves Lives Act, support passage S.2327- Seniors Prescription Drug Relief Act- support passage S.2562-Choose Home Care Act of 2021- support passage S.2612- Prevent Interruptions in Physical Therapy Act of 2021- support passage S. 2694- Nursing Home Improvement and Accountability Act of 2021 - support passage H.R. 5011- Choose Medicare Act, support passage H.R. 5099- Lowering Medicare Premiums and Prescription Drug Costs Act, support passage H.R. 5165 - Improving Medicare Coverage Act - support passage H.R. 5237 - "To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes." - monitor for position determination H.R. 5260 - Reduced Costs and Continued Cures Act - monitor for position determination H.R. 5536 - SMART Act - support passage H.R. 5514 Choose Home Care Act of 2021, support passage
Client expense: $58,183 · Firm income: Not reported
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
H.R.3 - Elijah Cummings Lower Drug Costs Now, monitor legislation S.151- "COVID HCBS Relief Act of 2021"- support passage H.R. 4131- "To amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid, and for other purposes."- support passage H.R. 2455 - The Resetting the IMPACT Act (TRIA) of 2021." - support passage H.R. 1319- The American Rescue Plan Act of 2021, support passage H.R. 2815, BIOSIM Act, support passage H.R. 2855, the STAR Rating for Biosimilars Act, support passage H.R. 2846- Ensuring Access to Lower-Cost Medicines for Seniors Act of 021 - support passage S.2210/H.R. 4131- Better Care Better Jobs Act - support passage S.2315- Medicaid Saves Lives Act, support passage S.2327- Seniors Prescription Drug Relief Act- support passage S.2562-Choose Home Care Act of 2021- support passage S.2612- Prevent Interruptions in Physical Therapy Act of 2021- support passage S. 2694- Nursing Home Improvement and Accountability Act of 2021 - support passage H.R. 5011- Choose Medicare Act, support passage H.R. 5099- Lowering Medicare Premiums and Prescription Drug Costs Act, support passage H.R. 5165 - Improving Medicare Coverage Act - support passage H.R. 5237 - "To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes." - monitor for position determination H.R. 5260 - Reduced Costs and Continued Cures Act - monitor for position determination H.R. 5536 - SMART Act - support passage H.R. 5514 Choose Home Care Act of 2021, support passage
Client expense: $45,264 · Firm income: Not reported
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
H.R.3 - Elijah Cummings Lower Drug Costs Now, monitor legislation S.151- "COVID HCBS Relief Act of 2021"- support passage H.R. 4131- "To amend title XIX of the Social Security Act to expand access to home and community-based services (HCBS) under Medicaid, and for other purposes."- support passage H.R. 2455 - The Resetting the IMPACT Act (TRIA) of 2021." - support passage H.R. 1319- The American Rescue Plan Act of 2021, support passage H.R. 2815, BIOSIM Act, support passage H.R. 2855, the STAR Rating for Biosimilars Act, support passage H.R. 2846- Ensuring Access to Lower-Cost Medicines for Seniors Act of 021 - support passage S.2210/H.R. 4131- Better Care Better Jobs Act - support passage S.2315- Medicaid Saves Lives Act, support passage S.2327- Seniors Prescription Drug Relief Act- support passage S.2562-Choose Home Care Act of 2021- support passage S.2612- Prevent Interruptions in Physical Therapy Act of 2021- support passage S. 2694- Nursing Home Improvement and Accountability Act of 2021 - support passage H.R. 5011- Choose Medicare Act, support passage H.R. 5099- Lowering Medicare Premiums and Prescription Drug Costs Act, support passage H.R. 5165 - Improving Medicare Coverage Act - support passage H.R. 5237 - "To amend titles XI, XVIII, and XIX of the Social Security Act to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers, and for other purposes." - monitor for position determination H.R. 5260 - Reduced Costs and Continued Cures Act - monitor for position determination H.R. 5536 - SMART Act - support passage H.R. 5514 Choose Home Care Act of 2021, support passage
Client expense: $66,069 · Firm income: Not reported
| HR 5165 |
117th |
| Related bill |
Client expense: $42,877 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Office of Administration, SENATE
Client expense: $42,877 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, 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: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)
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
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)