Relating to the House procedures contained in section 803 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

See page 5 for Medicare/Medicaid issues Specific Medicare/Medicaid bills: H.R. 6331, the Medicare Improvements for Patients and Providers Act (MIPPA) H.R. 6091/S. 2785, the Save Medicare Act S. 3101/H.R. 6212/H.R. 6331, the Medicare Improvements for Patients and Providers Act H.R. 4935/H.R. 4778/S. 3091, the Medicare Wound Therapy Patient Protection Act H.R. 2520/S.1465 (relating to Medicare and medical mobility devices) H. Res. 1368, Medicare Funding Trigger

Client expense: $61,364 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

See page 5 for Medicare/Medicaid issues. Specific Medicare/Medicaid bills: H.R. 6331, the Medicare Improvements for Patients and Providers Act (MIPPA) H.R. 6091/S. 2785, the Save Medicare Act S. 3101/H.R. 6212/H.R. 6331, the Medicare Improvements for Patients and Providers Act H.R. 4935/H.R. 4778/S. 3091, the Medicare Wound Therapy Patient Protection Act H.R. 2520/S.1465 (relating to Medicare and medical mobility devices) H. Res. 1368, Medicare Funding Trigger

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

See page 5 for Medicare/Medicaid issues Specific Medicare/Medicaid bills: H.R. 6331, the Medicare Improvements for Patients and Providers Act (MIPPA) H.R. 6091/S. 2785, the Save Medicare Act S. 3101/H.R. 6212/H.R. 6331, the Medicare Improvements for Patients and Providers Act H.R. 4935/H.R. 4778/S. 3091, the Medicare Wound Therapy Patient Protection Act H.R. 2520/S.1465 (relating to Medicare and medical mobility devices) H. Res. 1368, Medicare Funding Trigger

Client expense: $97,022 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

Health Centers Renewal Act, H.R. 1343, Sect. 4 and Sect. 5 regarding liability protection for certain health care practitioners; H.Res. 1368, entire resolution, regarding the waiving of House rules requiring specific actions to address Medicare funding shortfalls

Client expense: $90,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage - HR 6331, Medicare Improvements for Patients and Providers Act of 2008; Proposed legislation re this issue. Medigap insurance market issues - Proposed legislation re these issues. Medicare/Medicaid issues - S 706, To amend title XVIII of the Social Security Act to repeal the MA Regional Plan Stabilization Fund; S 130, Medicare Cost Contract Extension and Refinement Act of 2007; HR 1990, Medicare Cost Contract Extension and Refinement Act of 2007; HR 4, Medicare Prescription Drug Price Negotiation Act of 2007; S 3, Medicare Prescription Drug Price Negotiation Act of 2007; S 1102, Part D Equity for Low-Income Seniors Act of 2007; S 1103, Helping Fill the Medicare Rx Gap Act of 2007; S 1107, Home and Community Services Copayment Equity Act of 2007; S 1108, Medicare Part D Outreach and Enrollment Enhancement Act of 2007; HR 2945, Medicare Advantage Truth in Advertising Act of 2007; S 799, Community Choice Act of 2007; S 1544, Medicare Quality Enhancement Act of 2007; S 1507, Access to Medicare Data Act of 2007; S 1827, Pharmacist Access and Recognition in Medicare (PhARM) Act of 2007; HR 3025, Medicare Prescription Drug Savings for Our Seniors (Medicare Prescription Drug SOS) Act of 2007; HR 3061, Medicare Part D Drug Class Protection Act of 2007; HR 3162, Children's Health and Medicare Protection Act of 2007; HR 976, Children's Health Insurance Program Reauthorization Act of 2007; S 1893, Children's Health Insurance Program Reauthorization Act of 2007; S 1954, Pharmacy Access Improvement (PhAIm) Act of 2007; HR 3963, Children's Health Insurance Program Reauthorization Act of 2007; S 2219, Medicare Prescription Drug Savings and Choice Act of 2007; HR 3932, Medicare Prescription Drug Savings and Choice Act of 2007; S 2408, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007; HR 4296, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007; S 1200, Indian Health Care Improvement Act Amendments of 2008; HR 5480, Medicare Funding Warning Response Act of 2008; S 2662, Medicare Funding Warning Response Act of 2008; HR 5268, To provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; HR 6388, Government Accountability Office Improvement Act of 2008; HR 5998, Fair and Justifiable Credit Card Interest Rate Act of 2008; S 2819, Economic Recovery in Health Care Act of 2008; HR 6359, Medicare Beneficiary Protection Act of 2008; HR 6365, Medicare Special Needs Plans Extension and Amendments Act of 2008; HR 5613, Protecting the Medicaid Safety Net Act of 2008; S 2620, To provide for a temporary increase of the Federal medical assistance percentage under the Medicaid program; S 3101, Medicare Improvements for Patients and Providers Act of 2008; HR 5683, Government Accountability Office Act of 2008; HR 7110, Job Creation and Unemployment Relief Act of 2008; S 3560, QI Program Supplemental Funding Act of 2008; HR 7077, QI Program Supplemental Funding Act of 2008; SJRes 44, blocking implementation of SCHIP; HRes 1368, Resolved, That section 803 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 shall not apply during the remainder of the 110th Congress; S 3604, Emergency Supplemental.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

H.R. 6331/ S. 3101 - Medicare Improvements for Patients and Providers Act of 2008 (P.L. 110-275) Sections on Medicaid AMP, Medicare Part D prompt payment, DME Competitive Bidding, Prescription Drug pricing, and e-prescribing H.Res. 1368 - Relating to the House procedures contained in section 803 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 H.R. 4296/ S. 2408 - Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 H.R. 3700/ S. 1951 - Fair Medicaid Drug Payment Act of 2007 H.R. 3140 - Saving Our Community Pharmacies Act of 2007 H.R. 6252/S. 3144 - Medicare DMEPOS Competitive Acquisition Reform Act of 2008 H.R. 5780 - Medicare Clinical Practitioner Services Coverage Act of 2008 H.R. 5613 - Medicaid Safety Net Act of 2008 H.R. 2408/ S. 2408 - Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 H.R. 971 - Community Pharmacy Fairness Act S. 1827 - Pharmacist Access and Recognition in Medicare (PhARM) of 2007 S. 1474 - Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2007 H.R. 3025 - Medicare Prescription Drug Savings for Our Seniors Act of 2007 S. 1954 Pharmacy Access Improvement Act (PhAIM) of 2007 (Docket Number: CMS-4121-F) CMS Final Rule on Prohibiting Midyear Changes to Medicare Advantage Plans (Docket Number: CMS 4131-P) CMS Proposed Changes to Medicare Program; Revisions to the Medicare Advantage and Prescription Drug Benefits Programs (Docket Number: CMS 4131F) CMS Final Rule on Medicare Program; Medicare Advantage and Prescription Drug Benefit Programs: Final Marketing Provisions (Docket Number: CMS-1403-P) CMS Amendment on Medicare Program; Revisions to Amendment of the E-Prescribing Exemption for Computer-Generated Facsimiles (Docket Number: CMS-1405-N) CMS Notice on Medicare Provider Feedback Group Town Hall Meeting (Docket Number: CMS-7011-N) CMS Notice on Medicare Program: Request for Cosponsors for E-prescribing Educational Conference (Public Law 110-28 and Public Law 110-90) Medicaid's Tamper-Resistance Prescription Pad Requirement (Public Law 109-171) Deficit Reduction Act of 2005 Section on Average Manufacturers Price (AMP)

Client expense: $196,642 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, White House Office

MMM (Legislative Issues): H.R. 4: Medicare Prescription Drug Price Negotiation Act (Dingell); H.R. 976: Childrens Health Insurance Program Reauthorization Act (Rangel) (continued) H.R. 1990: Medicare Cost Contract Extension and Refinement Act (Pomeroy); H.R. 2945: Medicare Advantage Truth in Advertising Act (Stark); H.R. 3025: Medicare Prescription Drug Savings for Our Seniors Act (Doggett); H.R. 3061: Medicare Part D Drug Class Protection Act (Doggett); H.R. 3162: Childrens Health and Medicare Protection Act (Dingell); H.R. 3932: Medicare Prescription Drug Savings and Choice Act (Berry); H.R. 3963: Childrens Health Insurance Program Reauthorization Act (Dingell); H.R. 4296: Medicare Electronic Medication and Safety Protection Act (Schwartz); H.R. 5268: Medicaid FMAP (Pallone); H.R. 5480: Medicare Funding Warning Response Act (Hoyer-Boehner); H.R. 5613: Protecting the Medicaid Safety Net Act (Dingell); H.R. 5683: GAO Act (provisions relating to access to Medicare part C/part D data) (Davis); H.R. 5998: Protecting Children's Health Coverage Act (Pallone); H.R. 6331: Medicare Improvements for Patients and Providers Act (provisions relating to Medicare Advantage, Medicare Part D, Medigap, Medicaid, health care disparities, and electronic prescribing) (Rangel-Dingell); H.R. 6388: GAO Improvement Act (provisions relating to access to Medicare part C/part D data) (Waxman); H.R. 6359: Medicare Beneficiary Protection Act (Biggert); H.R. 6365: Medicare Special Needs Plans Extension and Amendments Act (Kind); H.R. 7077: QI Program Supplemental Funding Act (Dingell) (provisions relating to cost sharing assistance for low-income Medicare beneficiaries); H.Res. 1368 (provisions relating to Medicare Funding Warning); S. 3: Medicare Prescription Drug Price Negotiation Act (Reid); S. 130: Medicare Cost Contract Extension and Refinement Act (Allard); S. 706: Medicare Advantage Stabilization Fund (Feingold); S. 799: Community Choice Act (Harkin); S. 1102: Part D Equity for Low-Income Seniors Act (Bingaman); S. 1103: Helping Fill the Medicare Rx Gap Act (Bingaman); S. 1107: Home and Community Services Copayment Equity Act (Smith); S. 1108: Medicare Part D Outreach and Enrollment Enhancement Act (Smith); S. 1200: Indian Health Care Improvement Act (includes Medicaid/MA provisions); S. 1507: Access to Medicare Data Act (Grassley); S. 1544: Medicare Quality Enhancement Act (Gregg); S. 1827: Pharmacist Access and Recognition in Medicare Act (Cochran); S. 1893: Childrens Health Insurance Program Reauthorization Act (Baucus); S. 1954: Pharmacy Access Improvement Act (Baucus); S. 2219: Medicare Prescription Drug Savings and Choice Act (Durbin); S. 2408: Medicare Electronic Medication and Safety Protection Act (Kerry); S. 2620: Medicaid FMAP (Rockefeller); S. 2662: Medicare Funding Warning Response Act (Baucus-Gregg); S. 2795: Small Business Health Options Program Act (Durbin-Snowe); S. 2819: Economic Recovery in Health Care Act (provisions relating to Medicaid funding) (Rockefeller); S. 3101: Medicare Improvements for Patients and Providers Act (provisions relating to Medicare Advantage, Medicare Part D, Medigap, Medicaid, health care disparities, electronic prescribing) (Baucus); S. 3560: QI Program Supplemental Funding Act (Baucus) (provisions relating to cost sharing assistance for low-income Medicare beneficiaries); S. 3604: Emergency Supplemental Appropriations Act (provisions relating to Medicaid FMAP); and S.J.Res. 44 (provisions relating to blocking implementation of SCHIP requirements). MMM (Regulatory Issues) Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology and data issues, (including audit and encounter data issues) bidding and payment issues (including MA coding intensity, Part D reinsurance, low income subsidies, application process, and audits), application process, and audits, benefit design rules, SSA and CMS premium withhold processing issues, systems issues affecting enrollment and disenrollment processing, enrollment rules, 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); grievance and appeals processes, compliance/fraud and abuse training, and Medicare/Medicaid integration issues for Special Needs Plans (SNPs); Federal premption of State authority over MA and Part D plans, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education program; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval, systems issues affecting enrollment and disenrollment processing, payment and other operational issues; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting inititiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, grievance and appeals processes, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost/rebate issues affecting Medicaid health plans; health plan-related State Childrens Health Insurance Program (SCHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including documentation of citizenship requirements, state benefit flexibility options, and Medicaid managed care organization provider tax issues; standards for electronic prescribing; and health information technology standards and policies.

Client expense: $1,630,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

H.Res. 1368, Medicare Trigger legislation including savings generated from medical liability reforms to lower Medicare spending Herb Kuhn, Deputy Administrator, Centers for Medicare & Medicaid Services - delaying implementation of hospital acquired conditions payment policy for certain elective surgical procedures

Client expense: $50,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

H.Res. 1368, Medicare Trigger legislation including savings generated from medical liability reforms to lower Medicare spending Herb Kuhn, Deputy Administrator, Centers for Medicare & Medicaid Services - delaying implementation of hospital acquired conditions payment policy for certain elective surgical procedures

Client expense: $50,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

HR 3162, Children's Health & Medicare Protection Act of 2007 (Medicare Payment/Reimbursement Reform); S.1218/HR 2034, Medicare for All Act (Medicare "buy-in"); S. 130/HR 1990, Medicare Cost Contract Extension & Retirement Act of 2007 (private sector role in Medicare); S 3/HR 4, Medicare Prescription Drug Price Negotiation Act of 2007 (Government Negotiation of Medicare Drug Prices); S 1102, Part D Equity for Low Income Seniors Act of 2007 (Special benefits for low income seniors); HR 1663, Medicare Mental Health Modernization Act of 2007 (Medicare Mental Health Parity); HR 976, Children's Health Insurance Program Reauthorization Act of 2007 (SHIP Extension and Expansion); HR 2184, Enhanced Health Care Value for All Act of 2007 (Comparative Effectiveness Research Institute; HR 971, Community Pharmacy Fairness Act of 2007 (Medicare Pharmacist Antitrust Exemption), HR 4327, Medicare Chronic Care Practice Network (Establish a Medicare Chronic Care Practice Research Network to develop and evaluate evidence based chronic care management for Medicare beneficiaries); HR 1193, Kidney Care Quality and Education Act of 2007 (Modernize and improve the Medicare ESRD program); HR 6331, Electronic Prescription in Medicare; HR 6331, Medicare Improvements Act of 2008 (dealing with physician reimbursements and Medicare Advantage funding cuts); H. Res. 1368, Medicare "trigger" to warn against funding problem.

Client expense: $452,449 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Treasury, Dept of

H.R. 6819 Medicare Improvements for Patients And Providers Act of 2008 (MIPPA) H. Res. 1368 Relating to the House procedures contained in section 803 of the Medicare Prescriptions Drug, Improvement and Modernization Act of 2003 H.R. 6898 Health-e Information Technology Act

Client expense: $250,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicare/General. H.R. 205, H.R. 748, H.R. 1218, H.R. 1277, H.R. 1310, H.R. 1521, H.R. 2009, H.R. 2056, H.R. 2065, H.R. 2149, H.R. 3025, H.R. 3061, H.R. 3162, H.R. 3932, H.R. 6331, S. 137, S. 250, S. 450, S. 706, S. 1887, S. 2089, S. 2115, S. 2219, S. 3101: Medicare/General (continued). provisions relating to enrollment periods and the late enrollment penalty, physician reimbursement rates, creating a Medicare-operated prescription drug plan, drug price negotiations, Medicare beneficiary improvements, repealing cost containment mandates, Medicare Advantage payments, Medicare Advantage stabilization fund, and comparative cost adjustment demonstration projects under the Medicare Modernization Act, therapy caps, liberalizing asset test limits, reducing the Part D benefit gap and guaranteeing prescription drug benefits. Medicare/Prescription Drug Price Negotiation. H.R. 4, H.R. 118, H.R. 5317, S. 3, S. 273: provisions pertaining to the negotiation of prescription drug prices under Medicare Part D. Medicare/Medicare Advantage. H.R. 2945: provision to provide beneficiary protections against excessive cost-sharing under the Medicare Advantage Program. Medicare/Importation of Prescription Drugs. S. 242, H.R. 380, S.Amdt. 4299: provisions pertaining to the importation of prescription drugs. Medicare/Outpatient Psychiatric Services. H.R. 1571, H.R. 1663, H.R. 4897, S. 1715, S. 1854: provisions to eliminate discriminatory copayment rates for outpatient psychiatric services under Medicare Part B. Medicare/Geriatric Assessments. H.R. 2244, S. 1340: provisions to provide Medicare beneficiaries with access to geriatric assessments and chronic care coordination services. Medicare/Generic Drugs Market Exclusivity. H.R. 1432, H.R. 1902, S. 316, S. 1088: pertaining to market exclusivity for generic drugs. Medicare/Prescription Drug Benefits for Low Income Beneficiaries. H.R. 470, H.R. 932, H.R. 1536, H.R. 2058, H.R. 3127, S. 1102, S. 1103, S. 1107, S. 1108, S. 2101: provisions affecting prescription drug benefits for low-income beneficiaries under Medicare Parts B and D. Medicare/Part B Late Enrollment. H.R. 2591: provision limiting the penalty for late enrollment under Medicare Part B. Medicare/Marketing. H.R. 2307, H.R. 4790, S. 1883, S. 2687: provisions relating to the marketing of Medicare Advantage and Medicare Part D plans. Medicare/Health Care Vouchers. H.R. 749: provision to establish health care vouchers for seniors. Medicare/Medicare Savings Accounts. H.R. 2639, S. 173, S. 1019: provisions pertaining to Medicare Savings Accounts. Medicare/End-of-Life Planning. S. 464, S. 465, S. 466: pertaining to advance directives and end-of-life planning. Medicare/Means-testing. H.R. 4295, H.R. 4330, S. 2414, S.Amdt. 4240: pertaining to means-testing of Medicare Part D. Medicare/Presidents Funding Warning. H.R. 5480, S. 2662: proposals responding to the Presidents Medicare funding warning. H. Res. 1368, to suspend section 803 of the Medicare Modernization Act of 2003 (known as the Medicare trigger") for the remainder of the 110th Congress. Medicare/24-month Waiting Period. H.R.154, S. 2101: provisions phasing out the 24-month waiting period for disabled individuals to become eligible for Medicare benefits and eliminating the waiting period for individuals with life-threatening conditions. Medicare/Identity Theft Prevention. H.R. 6600, provisions related to removal of Social Security numbers from Medicare cards. Medicaid/Federal Match. H.R. 5140: provisions pertaining to temporary increases in the federal Medicaid match. Medicaid/Targeted Case Management. Targeted Case Management: interim final rule to implement Section 6052 of the Deficit Reduction Act.

Client expense: $280,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE