Medicare Value Purchasing Act of 2005

Health Information Technology H.R. 747, the "National Health Information Incentive Act" H.R. 4642, the "Wired for Healthcare Quality Act" (companion to S. 1418) H.R. 4157, the "Health Information Technology Promotion Act of 2006" H.R. 4641, the Assisting Doctors to Obtain Proficient and Transmissible Health Information Technology (ADOPT HIT) Act of 2005 S. 1418, the Wired for Healthcare Quality Act S. 1355, the Better Healthcare Through Information Technology S. 1227, the Health Information Technology Act of 2005 - CMS/OIG Stark and Anti-kickback statute protections for donating health information technology Expanding Health Insurance Coverage H.R. 1399, the HealthCARE Act of 2005 S. 1049, the Covering Kids Act, S. 2772, Health Partnership Act - Health insurance reform - Medicaid - Association Health Plans, Medical Savings Accounts - Tax credits and purchasing pools Medical liability reform H.R. 5, S.11, the HEALTH Act of 2005 S. 22, Medical Care Access Protection Act of 2006 - Medical liability demonstration projects Medicare Physician Payment/Medicare Reform H.R. 2356, the Preserving Patient Access to Physicians Act S. 1356, the Medicare Value Purchasing Act of 2005 H.R. 3617, the Medicare Value-Based Purchasing for Physician Services Act S. 40, the Geriatric and Chronic Care Management Act S. 2071, the Community and Rural Medical Residency Preservation Act of 2005' H.R. 4403, the Community and Rural Medical Residency Preservation Act of 2005 H.R. 5866, Medicare Physician Payment Reform and Quality Improvement Act of 2006 - Reform of SGR, Value-based purchasing, Pay-for-Performance - Patient Centered Medical Home, Care coordination - Primary care shortage - CMS proposed changes to work relative value units (RVUs) - Medically Unbelievable Edits program - CMS Request for Information (RFI) for Cycle 1 of the Medicare Administrative Contractor (MAC) - CMS Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates - Health Care Price Transparency FY 07 Appropriations H.R. 5647, FY 2007 appropriations for Labor/HHS/Education (including Title VII health professions and student loans) and VA healthcare and research; S. 3708, FY 2007 appropriations for Labor/HHS/Education (including Title VII health professions and student loans) and VA healthcare and research Public Health Issues - Healthcare disparities, anti-smoking, vaccines (e.g. smallpox, influenza) - CMS - Payment for the recently approved Herpes Zoster (Shingles) vaccine and its administration - DEA how e-prescribing systems can meet the Drug Enforcement Administrations (DEAs) prescription requirements under the Controlled Substances Act Student Loan Debt Relief H.R. 1338, College Loan Assistance Act H.R. 1380, Higher Education Affordability and Equity Act

Client expense: $584,100 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), President of the U.S., SENATE, UNDETERMINED, White House Office

H.R. 6133, S. 4056-Cytology Proficiency Improvement Act of 2006; S. 1355-Better Healthcare Through Information Technology Act; S. 1503-Healthy America Act of 2005; S. 1356-Medicare Value Purchasing Act of 2005; H.R. 3617-Medicare Value-Based Purchasing for Physician Sevices Act of 2005; H.R. 2234-21st Century Health Information Act of 2005; H.R. 4268; H.R. 4568-The Proficiency Testing Improvement Act of 2005; S. 3069, H.R. 4568-Physician Pathology Services Continuity Act of 2006

Client expense: $300,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE

S. 1081, H.R. 2356-Preserving Patient Access to Physician Act of 2005; S. 1932-Deficit Reduction Act of 2005; Contractual Joint Ventures (No Specific Bill); S. 1356-Medicare Value Purchasing Act of 2005; H.R. 3617-Medicare Value-Based Purchasing for Physician Services Act of 2005; S. 3069, H.R. 4568-Physician Pathology Services Continuity Act of 2006

Client expense: $300,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE

Dept. of Labor, HHS, Education related agencies Appropriations Act of 2002 Provisions related to White Collar Refor, S. 1116 Commerce/Justice/State Appropriations, HR. 4754 Bureau of Census Appropriations, S.2778 Labor/HHS Appropriations, HR. 3061, S. 1356, HRES 258

Client expense: $737,596 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6133, S. 4056-Cytology Proficiency Improvement Act of 2006; S. 1355-Better Healthcare Through Information Technology Act; S. 1503-Healthy America Act of 2005; S. 1356-Medicare Value Purchasing Act of 2005; H.R. 3617-Medicare Value-Based Purchasing for Physician Sevices Act of 2005; H.R. 2234-21st Century Health Information Act of 2005; H.R. 4268; H.R. 4568-The Proficiency Testing Improvement Act of 2005; S. 3069, H.R. 4568-Physician Pathology Services Continuity Act of 2006

Client expense: $300,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE

S. 1081, H.R. 2356-Preserving Patient Access to Physician Act of 2005; S. 1932-Deficit Reduction Act of 2005; Contractual Joint Ventures (No Specific Bill); S. 1356-Medicare Value Purchasing Act of 2005; H.R. 3617-Medicare Value-Based Purchasing for Physician Services Act of 2005; S. 3069, H.R. 4568-Physician Pathology Services Continuity Act of 2006

Client expense: $300,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE

Subtitle D: Additional Demonstrations, Studies, and Other Provisions - (Sec. 646) Amends SSA title XVIII to direct the Secretary to establish a 5-year demonstration program under which the Secretary is required to approve demonstration projects that examine health delivery factors that encourage the delivery of improved quality in patient care. (Sec. 649) Directs the Secretary to establish a pay-for-performance demonstration program with physicians to meet the needs of eligible beneficiaries through the adoption and use of health information technology and evidence-based outcomes measures Title IX: Subtitle E: Miscellaneous Provisions - (Sec. 953) Requires the Comptroller General to report to Congress on: (1) the appropriateness of the updates in the conversion factor including the appropriateness of the sustainable growth rate formula for 2002 and subsequently. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services. Medicare Advisory Committee review of the scientific evidence pertaining to vertebroplasty and kyphoplasty. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Oppose limits on the laboratory CPI update. Ambulatory Surgical Center Medicare Payment Modernization Act of 2005, H.R. 4042/S. 1884 Legislation introduced by Representative Wally Herger (R-CA) and Senator Mike Crapo (R-ID), would amend the law to reform the method for determining Medicare payment rates for ambulatory surgical centers (ASCs). This legislation would expand Medicare beneficiaries’ access to care in ASCs. Title III: Combating Waste, Fraud, and Abuse - (Sec. 303) requires the Secretary, beginning in 2004, to make adjustments in practice expense relative value units for certain drug administration services when establishing the physician fee schedule. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Directs the Comptroller General to conduct a study for a report to Congress on the differences in payment amounts under the Medicare physician fee schedule for physicians' services in different geographic areas. Title VI: Provisions Relating to Part B - Subtitle A: Provisions Relating to Physicians' Services (Sec. 605) Requires the Secretary to review and consider alternative data sources than those currently used to establish the geographic index for the practice expense component under the Medicare physician fee schedule no later than January 1, 2005. (Sec. 606) Directs the MEDPAC to submit to Congress: (1) a report on the effect of refinements to the practice expense component of payments for physicians' services after the transition to a full resource-based payment system in 2002; and (2) a report on the extent to which increases in the volume of physicians' services under Medicare part B are a result of care that improves the health and well-being of Medicare beneficiaries. Subtitle C: Other Provisions - (Sec. 626) Provides that in FY 2004, starting April 1, 2004, the ambulatory surgery center (ASC) update will be the Consumer Price Index for all urban consumers (U.S. city average) as estimated as of March 31, 2003, minus 3.0 percentage points. Provides that in FY 2005, the last quarter of calendar year 2005, and each of calendar years 2006 through 2009, the ASC update will be zero percent. (Sec. 628) Provides that there will be no updates to the clinical diagnostic laboratory test fee schedule for 2004 through 2008. HR 4157, the Health Information Technology Promotion Act, introduced by Rep. Nancy Johnson (R-CT) Rep. Nathan Deal establishes within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology. Payment Fairness for Practice Costs The formulas by which Medicare’s payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 – 1.501) in practice expense could be channeled into a narrower corridor of adjustment Payment Equity In MMA ‘03, Congress established a floor payment mechanism for the physician work component of Medicare payment for ‘04 – ‘06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. H.R.5118 Section 5, SEC. 5. Extension of Floor on Medicare Work Geographic Adjustment. Introduced by Rep. Greg Walden Medicare Part D Call Center Requirements CMS issued a February 2006 guidance (Attachment 1) requiring customer service call centers to be open 8 a.m. through 8 p.m. 7 days per week, including holidays. Pharmacy technical help desks are required to be open 24 hours/day 7 days per week if there are network pharmacies open for this period. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage - Subtitle B: Immediate Improvements - (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. (Sec. 238) Requires the Secretary to enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation (for the Secretary and Congress) of leading health care performance measures in the public and private sectors and options to implement policies that align performance with payment under the Medicare program. the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. Tax Relief and Health Care Act of 2006 (HR 6111) coupled a tax extenders and trade bill with a number of Medicare and Medicaid provisions including a physician fee freeze, a 1.5% bonus for physicians who report performance measures, extension of the Medicare physician work adjuster floor, and extension of the therapy services cap. Sustainable Growth Rate Medicare’s SGR mechanism unfairly links physician payment updates to factors unrelated to patients’ needs and the cost of providing patient care. If the SGR formula is not changed, Medicare program trustees predict that Medicare physician payments will be cut by 31% between 2006-2013. S.1081, by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI), the Preserving Patient Access to Physicians Act, would replace projected Medicare payment cuts with positive updates in each of the next two years. H.R. 2356. Reps. Clay Shaw (R-FL) and Ben Cardin (D-MD) A bill to amend title XVIII of the Social Security Act to reform the Medicare physician payment update system through repeal of the sustainable growth rate (SGR) payment update system. Pay-for Reporting and Performance S 1356, Introduced by Senators Chuck Grassley (R-IA) and Max Baucus (D-MT), the Medicare Value Purchasing Act, a bill that links physician payment to quality performance, increasing payment by 2% incrementally between 2008 and 2012, and funding the performance payments by drawing funds from physicians who do not report quality performance. HR 3617, the Medicare Value-Based Purchasing for Physician Services Act introduced by Rep. Nancy Johnson (R-CT) amends Part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act to provide for value-based purchasing in the payment for physicians' services under the Medicare program. On October 28, 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In the program CMS calls on physicians to report on a “Core Starter Set” of 16 evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). Information Technology S. 1418, the Wired for Health Care Quality Act introduced by Senator Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. Provisions of the President’s FY2007 Budget and related appropriations legislation (H Con Res 376, S Con Res 83) and the Deficit Reduction Act (S 1932, HR 4241) related to implementation of the Medicare Advantage and Prescription Drug Programs,

Client expense: $154,366 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, White House Office

H.R. 1872: Health Care for the Uninsured Act of 2005 H.R. 1902: Healthy Families Act H.R. 2355/S. 1015: Health Care CHOICE Act of 2005 H.R. 66: Health Care Cost Deductions H.R. 4157: Health Information Technology Promotion Act of 2005 H.R. 4511: Flex HSA Act H.R. 4262: Tax-Free Health Savings Accounts S. 354: Health Care Liability Reform S. 1227: Health Information Technology Quality Act S. 1355: Health Information Technology Quality & Improvelment Act of 2005 S. 1356: Medicare Value Purchasing Act of 2005 S. 3585: Health Savings Accounts Improvement & Expansin Act of 2006 S. 3488: Tax-Free Healthcare Savings, Access & Portability Act of 2006

Client expense: $800,000 · Firm income: Not reported

Government targets: Energy, Dept of, HOUSE OF REPRESENTATIVES, SENATE, U.S. Trade Representative (USTR), White House Office

S 1418. S 1356. S 1355. HR 4157, HR 3617, S 1227, HR 4641, HR 6111, HR 4859, S 3846, HR 6289

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

HR 525 Small Business Health Fairness Act of 2005 S. 1955 Small Business Health Insurance Marketplace Modernization and Affordability Act HR 4859 Federal Family Health Information Technology Act S. 22 Medicare Care Assess Protection Act S. 2563 Pharmacist Assess and Recognition in Medicare Act HR 5166 Independent Pharmacy Protection Act S. 2510 Small Employers Health Benefits Program HR 4157 Health Information Technology Promotion Act S. 1355 Health Information Technology and Improvement Act S. 1356 Medicare Value Purchasing Act HR 3205 Patient Safety and Quality Improvement Act

Client expense: $240,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Treasury, Dept of, White House Office

17. House(s) of Congress and Federal Agencies Contacted (Continued) General Accounting Office, health Resources and Services Administration, Office of Management and Budget, U.S. House of Representatives, U.S. Senate S.22 & S.23 - Medical Liability Reform S.1356 - Medicare Value Based Purchasing Act S.2020 - Tax Relief Act S.2071 - Community and Rural Medical Residency Preservation Act S.3708 - FY 2007 Labor/HHS/Ed Appropriations Bill Healthcare Group Purchasing P.L.109-171 - Deficit Reduction Act Value-Based Medicare Purchasing H.R.4157 - The Health Information Technology Promotion Act of 2006 H.R.4297 - Tax Relief Extension Reconciliation Act H.R.5171 - The Communities Building Access Act H.R.5647 - FY 2007 Labor/HHS/Ed Appropriations Bill

Client expense: $170,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

S.1002 Hospital Fair Competition Act HR709 Medicare Beneficiary Freedom to Contract Act Medicaid Funding Practice Expense Payment under Medicare Payment of Teaching Physicians under Medicare Payment of Graduate Medical Education under Medicare Stark II-Physician Ban on Self-Referral and other Fraud & Abuse HR3617 Medicare Value Based Purchasing for Physicians Services Act of 2005 HR5866 Medican Physician Payment Reform and Quality Improvement Act of 2006 S.647/HR1337 Medicare Patient Access to Physical Therapist S.1081/HR2356 Preserving Patient Access to Physicians Act S.1356 Medicare Value Purchasing Act S.1405/HR3773 Preserving Patient Access to Inpatient Rehabilitation Hospital Act

Client expense: $540,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicaid Reform (various proposals) -- Waiver and intergovernmental transfer issues Medicare and Medicaid Reimbursement (general legislation) Medicare Pay for Performance legislation (S. 1356, H.Q. 3617) Helping Fill the Medicare Rx Gap Act (S. 3650) Tax Relief and Health Care Act (H.Q. 6111) -- health care provisions Deficit Reduction Act of 2005 (S. 1932) -- Medicaid citizenship verification provisions Medicare Modernization Act (P.L. 108-173) -- Implementation issues related to Medicare Part D pharmacy provisions Medicaid Disproportionate Share Hospital Assistance Act (H.Q. 4606)

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

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

S.1356, A bill to amend title XVIII of the Social Security Act to provide incentives for the provision of high quality care under the medicare program, S.338, Bipartisan Commission on Medicaid Act of 2005, S.445, Medicare Prescription Drug Price Reduction Act of 2005, S.813, A bill to amend part D of title XVIII of the Social Security Act to authorize the Secretary of Health and Human Services to negotiate for lower prices for medicare prescription drugs, H.R.3588, Medicare Home Health Telehealth Access Act of 2005, S.1733, To establish pilot projects under the medicare program to provide incentives for home health agencies to utilize home monitoring and communications technologies, H.R.3617, Medicare Value-Based Purchasing for Physicians' Services Act of 2005, S.2664, Pharmacy Access Improvement (PhAIm) Act of 2006, S.2665, Medicare Prescription Drug Simplification Act of 2006, S.2282, Medicare Home Health Telehealth Access Act of 2006 Department of Health and Human Services Executive Office of the President

Client expense: $320,000 · Firm income: Not reported

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

S.1223, Information Technology for Health Care Quality Act, S.1227, Health Information Techonology Act of 2005, S.1262, Health Technology to Enhance Quality Act of 2005 S.1355, A bill to enhance the adoption of health information technology and to improve the quality and reduce the costs of healthcare in the United States, S.1356, A bill to amend title XVIII of the Social Security Act to provide incentives for the provision of high quality care under the medicare program, S.40, Geriatric and Chronic Care Management Act of 2005, H.R.2234, 21st Century Health Information Act of 2005, H.R.4641, Assisting Doctors to Obtain Proficient and Transmissible Health Information Technology (ADOPT HIT) Act of 2005, S.1418, Wired for Health Care Quality Act, S.544, Patient Safety and Quality Improvement Act of 2005, H.R.3588, Medicare Home Health Telehealth Access Act of 2005, S.1733, To establish pilot projects under the medicare program to provide incentives for home health agencies to utilize home monitoring and communications technologies, H.R.4859, Federal Family Health Information Technology Act of 2006, H.R.5438, Public Health and Medical Emergency Coordination Act of 2006, S.3042, All-Hazards Public Health Emergency and Bioterrorism Preparedness and Response Act, H.R.5524, Rural Veterans Health Care Act of 2006, H.R.5533, Biodefense and Pandemic Vaccine and Drug Development Act of 2006, H.R.4726, Wired for Health Care Quality Act, H.R.4832, Electronic Health Information Technology Act of 2006 H.R.2807, Medicare Telehealth Ehancement Act of 2005, H.R.747, National Health Information Incentive Act of 2005, H.R.4157, Better Health Information Systems Act

Client expense: $320,000 · Firm income: Not reported

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

SGR issues Pay for Performance Legislation (H.R. 3617; S. 1356) H.R. 4042/ S. 1884 - Ambulatory Surgical Center Medicare Payment Modernization Act of 2005 P.L. 109-432: Tax Relief and Health Care Act of 2006 H.R. 1632/S. 1010 - Colon Cancer Screen for Life Act of 2005 P.L. 109-171: Deficit Reduction Act of 2005 CMS-1321-P: CY2007 Physician Fee Schedule Proposed Rule P.L. 108-173: Medicare Prescription Drug Improvement and Modernization Act of 2003

Client expense: $230,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

SGR issues Pay for Performance Legislation (H.R. 3617; S. 1356) H.R. 4042/ S. 1884 - Ambulatory Surgical Center Medicare Payment Modernization Act of 2005 P.L. 109-432: Tax Relief and Health Care Act of 2006 H.R. 1632/S. 1010 - Colon Cancer Screen for Life Act of 2005 P.L. 109-171: Deficit Reduction Act of 2005 P.L. 108-173: Medicare Prescription Drug Improvement and Modernization Act of 2003

Client expense: $230,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

Medicare, Prescription Drug, and Medicaid issues - H.R. 6111 Tax Relief and Health Care Act of 2006 Issues related to Medicare Advantage funding/implementation of the Medicare Modernization Act (MMA) H.R. 5399/S. 2810, Medicare Drug Benefit Enrollment Fairness Act H.R. 3617/S. 1356, Medicare Value Based Purchasing See Next Page

Client expense: $260,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

S. 3701: A bill to determine successful methods to provide protection from catastrophic health expenses for individuals who have exceeded health insurance coverage for uninsured individuals, and for other purposes. S. 3900: A bill to amend title XVIII of the Social Security Act to improve the quality and efficiency of health care, to provide the public with information on provider and supplier performance, and to enhance the education and awareness of consumers for evaluating health care services through the development and release of reports based on Medicare enrollment, claims, survey, and assessment data. Other Matters: Department of Health and Human Services - Centers for Medicare and Medicaid Services, relating to guidance clarifying reimbursement for drugs that can be covered under Parts B and D of Medicare. S.4—Title: A bill to reduce healthcare costs, expand access to affordable healthcare coverage, and improve healthcare and strengthen the healthcare safety net, and for other purposes. S.16—Title: A bill to reduce to the cost of quality health care coverage and improve the availability of health care coverage for all Americans. S.309—Title: A bill to amend the Internal Revenue Code of 1986 to provide for the disposition of unused health benefits in cafeteria plans and flexible spending arrangements. S.544—Title: A bill to amend title IX of the Public Health Service Act to provide for the improvement of patient safety and to reduce the incidence of events that adversely effect patient safety. S.637—Title: A bill to establish a national health program administered by the Office of Personnel Management to offer health benefits plans to individuals who are not Federal employees, and for other purposes. S.1015—Title: A bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce. S.1286—Title: A bill to require States to report data on Medicaid beneficiaries who are employed. S.1356—Title: A bill to amend title XVIII of the Social Security Act to provide incentives for the provision of high quality care under the Medicare program. S.1418—A bill to enhance the adoption of a nationwide inter operable health information technology system and to improve the quality and reduce the costs of health care in the United States. S.1932—An original bill to provide for reconciliation pursuant to section 202(a) of the concurrent resolution on the budget for fiscal year 2006, including provisions to include value based purchasing in Medicare. S.1955—A bill to amend title I of the Employee Retirement Security Act of 1974 and the Public Health Service Act to expand health care access and reduce costs through the creation of small business health plans and through modernization of the health insurance marketplace. S.2229—A bill to provide quality, affordable health care for all Americans. S.2510—A bill to establish a national health program administered by the Office of Personnel Management to offer health benefits plans to individuals who are not Federal employees, and for other purposes. S.2772—A bill to provide for innovation in health care through State initiatives that expand coverage and access and improve quality and efficiency in the health care system. S.3701—A bill to determine successful methods to provide protection from catastrophic health expenses for individuals who have exceeded health insurance coverage for uninsured individuals, and for other purposes. S.3585—A bill to amend the Internal Revenue Code of 1986 to improve and expand the availability of health savings accounts, and for other purposes. H.R.1872—To amend the Internal Revenue Code of 1986 to provide tax incentives for the purchase of qualified health insurance, and for other purposes. H.R.2073—To amend the Internal Revenue Code of 1986 to provide tax subsidies to encourage small employers to offer affordable health coverage to their employees through qualified health pooling arrangements, to encourage the establishment and operation of these arrangements, and for other purposes. H.R.2203—To amend the Internal Revenue Code of 1986 to allow individuals a refundable and advanceable credit against income tax for health insurance costs, to allow employees who elect not to participate in employer subsidized health plans an exclusion from gross income for employer payments in lieu of such participation, and for other purposes. H.R.2234—To authorize the Secretary of Health and Human Services to make health information technology grants, and for other purposes. H.R.2355—To amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce. H.R. 4157: To promote a better health information system. H.R.4511—To amend the Internal Revenue Code of 1986 to allow the use of flexible spending and health reimbursement arrangements in combination with health savings accounts, and for other purposes. H.R. 4859: To amend chapter 89 of title 5, United States Code, to provide for the implementation of a system of electronic health records under the Federal Employees Health Benefits Program. H.R.4832—To amend the Social Security Act to establish an Office of Health Information Technology for the purpose of creating a national interoperable health information infrastructure, to provide loans to health care entities seeking to implement such infrastructure, and to provide exceptions to certain health anti-kickback laws to encourage the dissemination of health information technology. H.R.5262—To amend the Internal Revenue Code of 1986 to provide tax incentives for the payment of premiums for high deductible health plans, and for other purposes. H.R.5586—To amend the Internal Revenue Code of 1986 to allow distributions from health savings accounts to be used for the purchase of non-group coverage under high deductible health insurance. H.R. 5743: To amend the Internal Revenue Code of 1986 to improve and expand the availability of health savings accounts, and for other purposes. H.R. 5864: To provide for innovation in health care through State initiatives that expand coverage and access. H.R. 5886: To amend the Social Security Act and the Internal Revenue Code of 1986 to provide for a AmeriCare that assures the provision of health insurance coverage to all residents, and for other purposes. H.R. 6134: To amend the Internal Revenue Code of 1986 to expand health coverage through the use of high deductible health plans and to encourage the use of health savings accounts. H.R.525--To amend Title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees.

Client expense: Not reported · Firm income: $60,000

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

SGR issues Pay for Performance Legislation (H.R. 3617; S. 1356) H.R. 4042/ S. 1884 - Ambulatory Surgical Center Medicare Payment Modernization Act of 2005 P.L. 109-432: Tax Relief and Health Care Act of 2006 H.R. 1632/S. 1010 - Colon Cancer Screen for Life Act of 2005 P.L. 109-171: Deficit Reduction Act of 2005 CMS-1321-P: CY2007 Physician Fee Schedule Proposed Rule P.L. 108-173: Medicare Prescription Drug Improvement and Modernization Act of 2003

Client expense: Not reported · Firm income: $120,000

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

SGR issues Pay for Performance Legislation (H.R. 3617; S. 1356) H.R. 4042/ S. 1884 - Ambulatory Surgical Center Medicare Payment Modernization Act of 2005 P.L. 109-432: Tax Relief and Health Care Act of 2006 H.R. 1632/S. 1010 - Colon Cancer Screen for Life Act of 2005 P.L. 109-171: Deficit Reduction Act of 2005 P.L. 108-173: Medicare Prescription Drug Improvement and Modernization Act of 2003

Client expense: Not reported · Firm income: $120,000

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

S.354/H.R.534 Medicaid Liability Reform S.473/H.R.215 Allied Health Professions Reinvestment Act of 2005 Act S.544 Patient Safety and Quality Improvement Act of 2005 S.681 Umbilical Cord Blood Stem Cell Research S.898/H.R.1812 Patient Navigator Outreach & Chronic Disease Prevention Act of 2005 S.933/H.R.2350 Rural Community Hospital Assistance Act S.1049 Covering Kids Act of 2005 S.1262/H.R.2234 Health Technology to Enhance Quality Act of 2005 & the 21st Century Health Information Act S.1355 & S.1262 Better Healthcare Through Information Technology Act S.1356/H.R.3617 Medicare Value Purchasing Act of 2005 S.1418 Wired for Health Care Quality Act S.1784 National Medical Error Disclosure & Compensation Act of 2005 S.1955 Health Insurance Marketplace Modernization & Affordability Act of 2005 S.3042 All-Hazards Public Health Emergency and Bioterrorism Preparedness and Response Act H.R.139 Health Improvement and Professionals Act of 2005 H.R.534 Rural Health Equity Act H.R.880 Rural Health Equity Act H.R.3173 Nurse Faculty Higher Education Act H.R.3373/S.1405 Preserving Patient Access to Inpatient Rehabilitation Hospitals Act H.R.3607 The Future of Health Care-Granting Access to Innovation in America Act H.R.4157 Health Information Technology Promotion Act of 2005/Hospital Pricing Transparency H.R.5647/S.3708 Labor-Health and Human Services Educaiton Bill FFY 2007 Budget and Budget Resolutions 2007 Medicare Inpatient Hospital PPS Rules 2007 Medicare Inpatient Psychiatric Facility PPS Rules 2007 Medicare Inpatient Rehabilitation Facility PPS and “75% Rule”, Rules 2007 Medicare Outpatient PPS Rules 2007 Medicare Skilled Nursing Facility PPS Rules 2007 Medicare Home Health Agency PPS Rules 2007 Medicare Physician Fee Schedule Update “Stark” and physician self-referral regulations Hospital pricing transparency Not-for-profit hospital tax-exempt status Medicaid regulations affecting states’ Medicaid financing mechanisms Pay for Performance Health information technology Hospital charity care/financial aid Coverage for undocumented immigrants Associated health plans Coverage for the uninsured Health savings accounts and high-deductible health plans Emergency preparedness Immigration Medicare Wage Index Community Benefit Reporting Mental health parity Limited service hospitals HUD Federal Housing Assistance mortgage program for hospitals Defined benefit pension plans National Institute of Health funding Health care workforce recruiting and training funding Hospital infection reporting Medical error reporting; hospital performance measure reporting S.4 Health Technology to Enance Quality Act of 2005 S.22 Medical Care Access Protection Act of 2006 S.23 Healthy Mothers and Healthy Babies Access S.338/H.R.985 bipartisan Medicaid Commission

Client expense: $420,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE

S.2229—A bill to provide quality, affordable health care for all Americans. S.2510—A bill to establish a national health program administered by the Office of Personnel Management to offer health benefits plans to individuals who are not Federal employees, and for other purposes. S.2772—A bill to provide for innovation in health care through State initiatives that expand coverage and access and improve quality and efficiency in the health care system. S.3701—A bill to determine successful methods to provide protection from catastrophic health expenses for individuals who have exceeded health insurance coverage for uninsured individuals, and for other purposes. S.3585—A bill to amend the Internal Revenue Code of 1986 to improve and expand the availability of health savings accounts, and for other purposes. S. 3701: A bill to determine successful methods to provide protection from catastrophic health expenses for individuals who have exceeded health insurance coverage for uninsured individuals, and for other purposes. S. 3900: A bill to amend title XVIII of the Social Security Act to improve the quality and efficiency of health care, to provide the public with information on provider and supplier performance, and to enhance the education and awareness of consumers for evaluating health care services through the development and release of reports based on Medicare enrollment, claims, survey, and assessment data. H.R. 5864: To provide for innovation in health care through State initiatives that expand coverage and access. H.R. 5886: To amend the Social Security Act and the Internal Revenue Code of 1986 to provide for a AmeriCare that assures the provision of health insurance coverage to all residents, and for other purposes. H.R. 6134: To amend the Internal Revenue Code of 1986 to expand health coverage through the use of high deductible health plans and to encourage the use of health savings accounts. S.4—Title: A bill to reduce healthcare costs, expand access to affordable healthcare coverage, and improve healthcare and strengthen the healthcare safety net, and for other purposes. S.16—Title: A bill to reduce to the cost of quality health care coverage and improve the availability of health care coverage for all Americans. S.306—Title: A bill to prohibit discrimination on the basis of genetic information with respect to health insurance and employment. S.309—Title: A bill to amend the Internal Revenue Code of 1986 to provide for the disposition of unused health benefits in cafeteria plans and flexible spending arrangements. S.544—Title: A bill to amend title IX of the Public Health Service Act to provide for the improvement of patient safety and to reduce the incidence of events that adversely effect patient safety. S.637—Title: A bill to establish a national health program administered by the Office of Personnel Management to offer health benefits plans to individuals who are not Federal employees, and for other purposes. S.1015—Title: A bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce. S. 1085: A bill to provide for paid sick leave to ensure that Americans can address their own health needs and the health needs of their families. S.1286—Title: A bill to require States to report data on Medicaid beneficiaries who are employed. S.1356—Title: A bill to amend title XVIII of the Social Security Act to provide incentives for the provision of high quality care under the Medicare program. S.1418—A bill to enhance the adoption of a nationwide inter operable health information technology system and to improve the quality and reduce the costs of health care in the United States. S.1932—An original bill to provide for reconciliation pursuant to section 202(a) of the concurrent resolution on the budget for fiscal year 2006, including provisions to include value based purchasing in Medicare. S.1955—A bill to amend title I of the Employee Retirement Security Act of 1974 and the Public Health Service Act to expand health care access and reduce costs through the creation of small business health plans and through modernization of the health insurance marketplace. entrepreneurs with small businesses with respect to medical care for their employees. H.R.1227—To prohibit discrimination on the basis of genetic information with respect to health insurance and employment. H.R.1872—To amend the Internal Revenue Code of 1986 to provide tax incentives for the purchase of qualified health insurance, and for other purposes. H.R. 1902: To provide for paid sick leave to ensure that Americans can address their own health needs and the health needs of their families. H.R.2071—To amend titles XIX and XXI of the Social Security Act to provide for FamilyCare coverage for parents of enrolled children, and for other purposes. H.R.2073—To amend the Internal Revenue Code of 1986 to provide tax subsidies to encourage small employers to offer affordable health coverage to their employees through qualified health pooling arrangements, to encourage the establishment and operation of these arrangements, and for other purposes. H.R.2203—To amend the Internal Revenue Code of 1986 to allow individuals a refundable and advanceable credit against income tax for health insurance costs, to allow employees who elect not to participate in employer subsidized health plans an exclusion from gross income for employer payments in lieu of such participation, and for other purposes. H.R.2234—To authorize the Secretary of Health and Human Services to make health information technology grants, and for other purposes. H.R.2355—To amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce. H.R. 4157: To promote a better health information system. H.R.4511—To amend the Internal Revenue Code of 1986 to allow the use of flexible spending and health reimbursement arrangements in combination with health savings accounts, and for other purposes. H.R. 4859: To amend chapter 89 of title 5, United States Code, to provide for the implementation of a system of electronic health records under the Federal Employees Health Benefits Program. H.R.4832—To amend the Social Security Act to establish an Office of Health Information Technology for the purpose of creating a national interoperable health information infrastructure, to provide loans to health care entities seeking to implement such infrastructure, and to provide exceptions to certain health anti-kickback laws to encourage the dissemination of health information technology. H.R.5262—To amend the Internal Revenue Code of 1986 to provide tax incentives for the payment of premiums for high deductible health plans, and for other purposes. H.R.5586—To amend the Internal Revenue Code of 1986 to allow distributions from health savings accounts to be used for the purchase of non-group coverage under high deductible health insurance. H.R. 5743: To amend the Internal Revenue Code of 1986 to improve and expand the availability of health savings accounts, and for other purposes. H.R.66—To amend the Internal Revenue Code of 1986 to improve health care choice by providing for the tax deductibility of medical expenses by individuals. H.R.525—To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for

Client expense: Not reported · Firm income: $320,996

Government targets: Equal Employment Opportunity Commission (EEOC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), SENATE, Treasury, Dept of, White House Office

HR. 6111, Tax Relief and Health Care Act of 2006. ***, no specific bill(s), Medicare Reimbursement, Inpatient Prospective Payment System, Gainsharing. HR. 5369. Medicare Clinical Laboratory Fee Schedule Improvement Act of 2006. HR. 3559, Medicare Durable Medical Equipment Access Act of 2005. S. 2022, Remote Monitoring Access Act of 2005. S. 3900, Medicare Quality Enhancement Act of 2006. HR. 5866, Medicare Physician Payment Reform and Quality Improvement Act of 2006. HR. 3617, Medicare Value-Based Purchasing for Physicians' Services. S. 1356, Medicare Value Purchasing Act. S. 3795, Access to Medicare Imaging Act. Please see attached addendum page.

Client expense: Not reported · Firm income: $120,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), White House Office

Health Care Information Technology, general issues HR 5647 and S 3709 Labor/HHS/Education Appropriation, Health IT Reserve Fund HR 247 National Health Information Incentive Act HR 2234 21st Century Health Information Act (continued on addendum) Specific Lobbying Issues continued: HR 4157 Health IT Promotion Act HR 3617 Medicare Value Based Priorities S 1223 Information Technology for Health Care Quality HR 4331 MAPIT S 4 Healthy America Act of 2005 S 1227 Health Information Technology Act of 2005 S 1262 Health Technology to Enhance Quality S 1418 Wired for Health Care Quality 2006 S 1355 Better Health Care through Information Technology S 1356 Medicare Value Purchasing Act HR 4157 Health Information Technology Promotion Act of 2006 HR 5647 and S 2708 Departments of Labor/HHS/Education and Related Agencies Act 2007 H Congressional Resolution 376 and S Congressional Resolution 83 House/Senate Budge Resolution - Health IT Reserve Fund

Client expense: $1,654,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Commerce, Dept of (DOC), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

Specific Lobbying Issues continued: S 3708 Departments of Labor, HHS, and Education Appropriations 2007 S 1418 Wired for Healthcare Act HR3617 Medicare Value-based purchasing for Physicians' Services Act of 2005, general issues, HR4331 Medicare Access Project through Information Technology Act of 2005, general issues HR5647 Labor HHS Education Appropriations, 2007, S1356 Medicare Value Purchasing Act, general issues

Client expense: $1,654,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Commerce, Dept of (DOC), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Trade Commission (FTC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

S.1356, A bill to amend title XVIII of the Social Security Act to provide incentives for the provision of high quality care under the medicare program, S.338, Bipartisan Commission on Medicaid Act of 2005, S.445, Medicare Prescription Drug Price Reduction Act of 2005, S.813, A bill to amend part D of title XVIII of the Social Security Act to authorize the Secretary of Health and Human Services to negotiate for lower prices for medicare prescription drugs, H.R.3588, Medicare Home Health Telehealth Access Act of 2005, S.1733, To establish pilot projects under the medicare program to provide incentives for home health agencies to utilize home monitoring and communications technologies, H.R.3617, Medicare Value-Based Purchasing for Physicians' Services Act of 2005, S.2664, Pharmacy Access Improvement (PhAIm) Act of 2006, S.2665, Medicare Prescription Drug Simplification Act of 2006, S.2282, Medicare Home Health Telehealth Access Act of 2006 H.R.376, Medicare's Equitable Drugs for Seniors Act of 2005, H.R.752, Medicare Prescription Drug Savings and Choice Act of 2005, H.R.985, Bipartisan Commission on Medicaid Act of 2005,

Client expense: Not reported · Firm income: $40,000

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

S.1223, Information Technology for Health Care Quality Act, S.1227, Health Information Techonology Act of 2005, S.1262, Health Technology to Enhance Quality Act of 2005 S.1355, A bill to enhance the adoption of health information technology and to improve the quality and reduce the costs of healthcare in the United States, S.1356, A bill to amend title XVIII of the Social Security Act to provide incentives for the provision of high quality care under the medicare program, S.40, Geriatric and Chronic Care Management Act of 2005, H.R.2234, 21st Century Health Information Act of 2005, H.R.4641, Assisting Doctors to Obtain Proficient and Transmissible Health Information Technology (ADOPT HIT) Act of 2005, S.1418, Wired for Health Care Quality Act, S.544, Patient Safety and Quality Improvement Act of 2005, H.R.3588, Medicare Home Health Telehealth Access Act of 2005, S.1733, To establish pilot projects under the medicare program to provide incentives for home health agencies to utilize home monitoring and communications technologies, H.R.4859, Federal Family Health Information Technology Act of 2006, H.R.5438, Public Health and Medical Emergency Coordination Act of 2006, S.3042, All-Hazards Public Health Emergency and Bioterrorism Preparedness and Response Act, H.R.5524, Rural Veterans Health Care Act of 2006, H.R.5533, Biodefense and Pandemic Vaccine and Drug Development Act of 2006, H.R.4726, Wired for Health Care Quality Act, H.R.4832, Electronic Health Information Technology Act of 2006 H.R.2807, Medicare Telehealth Ehancement Act of 2005, H.R.747, National Health Information Incentive Act of 2005, H.R.4157, Better Health Information Systems Act

Client expense: Not reported · Firm income: $40,000

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

HR 709 (Medicare Beneficiary Freedom To Contract Act of 2005) -- impact on podiatrists HR 916, S 438 (Medicare Access to Rehabilitation Services Act of 2005) -- podiatric medical benefits HR 6111 (Tax Relief and Health Care Act of 2006) -- reimbursement for podiatrists HR 6408 (Tax Relief and Health Care Act of 2006) -- impact on practicing podiatric medicine S 1356 (Medicare Value Purchasing Act of 2005) -- impact on practicing podiatric medicine HR 699, S 440 -- patient access to podiatrists Competitive acquisition of durable medical equipment, prosthetics, orthotics, and supplies as required by Public Law No. 108-173 (Medicare Modernization Act of 2003) -- impact on practicing podiatric medicine

Client expense: $220,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

S 1356 Medicare Value Purchasing Act of 2005; S 1262 Health Technology to Enhance Quality Act of 2005; S 1355 Better Healthcare Through Information Technology Act; HR 2234 21st Century Health Information Act of 2005; HR 6408, Tax Relief and HealthCare Act of 2006

Client expense: $530,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 183 & HR 1443, Family Opportunity Act of 2005; HR 4331, Medicaid Access Project through Information Technology (MAP IT) Act of 2005. HR 4241 & S.1932, An original bill to provide for reconciliation pursuant to section 202(a) of the concurrent resolution on the budget for fiscal year 2007, Medicare and Medicaid provisions; S. 1356 & HR 3617, Medicare Value Based Purchasing Act;

Client expense: Not reported · Firm income: $80,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 309 To amend the Internal Revenue Code of 1986 to provide for the disposition of unused health benefits in cafeteria plans and flexible spending arrangements. S. 334 Pharmaceutical Market Access and Drug Safety Act of 2005 S. 354 Help Efficient, Accessible, Low-Cost, Timely Healthcare Act of 2005 or the `HEALTH Act of 2005 S. 406 Small Business Health Fairness Act of 2005 S. 544 Patient Safety and Quality Improvement Act of 2005 S. 577 HIPAA Recreational Injury Technical Correction Act S. 772 Workforce Health Improvement Program Act of 2005 S. 978 Healthcare Tax Relief for the Uninsured Act of 2005 S. 1015 Health Care Choice Act of 2005 S. 1244 Long-Term Care and Retirement Security Act of 2005 S. 1356 Medicare Value Purchasing Act of 2005 S. 1418 Wired for Health Care Quality Act S. 1447 Tax Technical Corrections Act of 2005 S. 1932 Deficit Reduction Act of 2005 S. 3585 HSA Improvement and Expansion Act of 2006 HR 5 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2005 HR 525 Small Business Health Fairness Act of 2005 HR 700 Pharmaceutical Market Access and Drug Safety Act of 2005 HR 1227 Genetic Information Nondiscrimination Act of 2005 HR 1402 Paul Wellstone Mental Health Equitable Treatment Act of 2005 HR 1634 Workforce Health Improvement Program Act of 2005 HR 1872 Health Coverage for the Uninsured Act of 2005 HR 1998 To amend the Internal Revenue Code of 1986 to provide for the disposition of unused benefits in health flexible spending arrangements. HR 2234 21st Century Health Information Act of 2005 HR 2355 Health Care Choice Act of 2005 HR 2682 Long-Term Care and Retirement Security Act of 2005 HR 2793 HIPAA Recreational Injury Technical Correction Act HR 2830 Pension Protection Act of 2005 HR 3204 State High Risk Pool Funding Extension Act of 2005 HR 3205 Patient Safety and Quality Improvement Act of 2005 HR 3376 Tax Technical Corrections Act of 2005 HR 4157 Health Information Technology Promotion Act of 2006 HR 4241 Deficit Reduction Act of 2005 HR 4262 Tax-Free Health Savings Act of 2006 HR 4511 Health Flex Act HR 5586 HSA Premium Affordability Act of 2006 HR 5743 HSA Improvement and Expansion Act of 2006 HR 6111 The Tax Relief and Health Care Act of 2006 HR 6134 Health Opportunity and Patient Empowerment Act of 2006 HR 5262 Tax Free Health Savings Act of 2006 S. 4 Healthy America Act of 2005 S. 16 Affordable Health Care Act S. 288 State High Risk Pool Funding Extension Act of 2005 S. 306 Genetic Information Nondiscrimination Act of 2005

Client expense: $120,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

S. 124 - Repeal of the Medicare Advantage Stabilization Fund; S. 1356 - Medicare Value Purchasing Act; S. 2255 - Medicare Drug Formulary Protection Act; S. 2260 - Medicare Advantage Funding; S. 3900 - The Medicare Quality Enhancement Act of 2006 HR 3617 - Medicare Value-Based Purchasing for Physicians' Services Act; HR 4297 - Tax Relief Extension Reconciliation Act; HR 4719 - Medicare Advantage Funding; HR 5399 - Medicare Drug Benefit Enrollment Fairness Act;

Client expense: $1,800,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Treasury, Dept of

payment: H Con Res 95, S1356, S1932, H.CON.RES 376/S Con Res 83, HR 5574, HR 6053, S 3767; self referral, S 1002, S.3606, HR 5574; quality: S1356; rehabilitation hospitals, HR3373/S1405, S1932; rural hospitals, S933, HR1016/S2396, HR2350, S1932, HR 5118, S 3500, HR 880/S 2819, HR 4912, HR 6030; long term care hospitals: HR 6236 and Medicaid reform HR 985/S338, H Con Res. 95, and S1932. Medicare and Medicaid Reimbursement issues including workforce, HR 1222, HR 1285, S1550, H.R.4997/S 2425, HR 4997S2425; regulations including, but not limited to, provisions of PL 106-554, PL 108-173, PL 109-171

Client expense: $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

Medicaid Reform (various proposals) - Waiver and intergovernmental transfer issues Medicare and Medicaid Reimbursement (general legislation) Medicare Pay for Performance legislation (S. 1356, H.R. 3617) Helping Fill the Medicare Rx Gap (S. 3650) Tax Relief and Health Care Act (H.R. 6111) - health care provisions Deficit Reduction Act of 2005 (S. 1932) - Medicaid citizenship verification provisions Medicare Modernization Act (P.L. 108-173) - Implementation issues related to Medicare Part D pharmacy provisions Medicaid Disproportionate Share Hospital Assistance Act (H.R. 4606)

Client expense: $320,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, Veterans Affairs, Dept of (VA)

MMM (Regulatory Issues) Ongoing implementation issues for the Medicare Advantage and Medicare Part D prescription drug programs, including risk adjustment methodology and data issues, bidding and payment (including Part D reinsurance and low income subsidies), benefit design rules, SSA and CMS premium withhold processing issues, systems issues affecting enrollment and disenrollment processing, enrollment rules, marketing materials review and approval, measurement and oversight of plan performance, grievance and appeals processes, 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; 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, and other issues affecting Medicaid health plan operations; Medicaid prescription drug cost/rebate issues affecting Medicaid health plans; health plan-related State Children’s Health Insurance Program (SCHIP) issues, including eligibility and outreach issues; and 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 CMS RFI concerning health information technology. H.R. 4297: “Tax Relief Extension Reconciliation Act” (Thomas); H.R. 4719: Medicare Advantage Funding (Dingell); H.R. 5166: “Independent Pharmacy Protection Act” (Wicker); H.R. 5399: “Medicare Drug Benefit Enrollment Fairness Act" (Johnson); H.R. 4939: “Emergency Supplemental Appropriations Act” (Lewis); H.R. 5647: Labor-HHS-Education Appropriations Act (Regula); H.R. 5866 "Medicare Physician Payment Reform and Quality Improvement Act" (Burgess); H.R. 6077: SCHIP Funding (Norwood); H.R. 6098 "Keep Children Covered Act" (Barrow); H.R. 6111: Medicare and Medicaid Provisions; H.R. 6164: SCHIP Funding (Barton); H.Con.Res. 376: Budget Resolution (Nussle); S. 124: Repeal of the Medicare Advantage Stabilization Fund (Feingold); S. 1356: “Medicare Value Purchasing Act” (Grassley-Baucus); S. 1778: QI-1 Extension/Ban on Coverage of ED Drugs (Grassley); S. 1932: Budget Reconciliation Bill (Gregg); S. 2255: “Medicare Drug Formulary Protection Act” (Feinstein-Collins); S. 2260: Medicare Advantage Funding (Clinton); S. 2354: “Medicare Prescription Drug Gap Reduction Act” (Nelson-Collins); S. 2409: “Home and Community Services Copayment Equity Act” (Smith-Bingaman); S. 2563: “Pharmacist Access and Recognition in Medicare Act” (Cochran); S. 2664: “Pharmacy Access Improvement Act” (Baucus); S. 2665: “Medicare Prescription Drug Simplification Act” (Baucus); S. 2810: “Medicare Late Enrollment Assistance Act” (Grassley-Baucus); S. 3647: "Prescription For Fairness Act" (Dorgan); S. 3897: "Medicare Data Access and Research Act" (Grassley); S. 3900: "Medicare Quality Enhancement Act" (Gregg); S. 3193: "Keep Children Covered Act" (Rockefeller); S. 3972: "Fair-SCHIP Act" (Grassley); S.Con.Res. 83: Budget Resolution (Gregg). MMM (Legislative Issues): H.R. 3617: “Medicare Value-Based Purchasing for Physicians' Services Act” (Johnson); H.R. 4241: Budget Reconciliation Bill (Nussle) (continued)

Client expense: $3,700,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), 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), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

H.R.752.IH, Medicare Prescription Drug Savings and Choice Act of 2005 H.R.918.IH, Medicare Prescription Drug Cost Containment Act of 2005 H.R.2685.IH, Medicare Presciption Drug Price Negotiation Act S.18.IS, Meeting our Responsibility to Medicare Beneficiaries Act of 2005 S.40.IS, Geriatric and Chronic Care Management Act of 2005 S.222.IS, Keep the Promise of Medicare Act of 2005 S.345, Medicare Prescription Drug Savings and Choice Act of 2005 (Introduced in the Senate) S.345.IS, Medicare Prescription Drug Savings and Choice Act of 2005 S.445, Medicare Prescription Drug Price Reduction Act of 2005 (Introduced in the Senate) S.581.IS, Medicare Prescription Drug Cost Containment Act of 2005 S.873.PCS, Medicare Prescription Drug Savings and Choice Act of 2005 S.1356.IS, Medicare Value Purchasing Act of 2005 S.1403, Medicare Cost Contract Extension and Refinement Act of 2005 (Introduced in the Senate) S.1841, The Medicare Informed Choice Act of 2005 (Introduced in the Senate) S.1589, Affordability in Medicare Premiums Act of 2005 (Introduced in the Senate) S.1589,IS, Affordability in Medicare Premiums Act of 2005 S.2240, Medicare Part D Reform Act of 2006 S.2255-7, Medicare Drug Formulary Protection Act S.2354, Medicare Prescription Drug Gap Reduction Act of 2006 (Introduced in the Senate) S.2563, Pharmacist Access and Recognition in Medicare (PhARM) Act of 2006 (Introduced in the Senate) S.2665, Medicare Prescription Drug Simplification Act of 2006 S.2723, Pharmacists Medicare Relief Act of 2006 S.2759, Medicare Part D Outreach and Enrollment Enhancement Act of 2006 (Introduced in the Senate) S.3697, Medicare Health Savings Accounts Act of 2006 (Introduced in the Senate) See attached list.

Client expense: $440,000 · 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), Natl Economic Council (NEC), SENATE, Transportation, Dept of (DOT), White House Office

HR 2671, Healthcare Truth & Transparency Act S 2480, Contact Lens Consumer Protection Act HR 534/ S 354/ S 22, Medical Liability Reform HR 5, the HEALTH ACT CMS-1321 FC and CMS-1317 F: Medicare Program; Revisions to Payment Policies, Five Year Review of Work Relative Value Units, Changes to the Practice Expense Methodology Under the Physician Fee Schedule, and Other Changes to Payment Under Part B. CMS-1321-P (Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2007 and Other Changes to Payment Under Part B; Proposed Rule) CMS-1506-P; CMS-4125-P (Medicare Program; Hospital Outpatient Prospective Payment System and CY 2007 Payment Rates; Ambulatory Surgical Center List of Covered Procedures; Ambulatory Surgical Center Payments System and CY2008 Payment Rates CMS-1512-PN; Medicare Program; Five Year Review of Work Relative Value Units under the Physician Fee Schedule and Proposed Changes to the Practice Expense Methodology HR 2328/ HR2238/ S 3685 Children's Access to Vision Act; HR 6227/ S 3685 Kids Vision Care Act HR 2356/ HR 6111/ HR 5866/ S 1081, Medicare Fee Fix HR 3617/ S 1356, Pay for Performance HR 4042/ S 1884, ACS Payment Modernization

Client expense: $601,100 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicare Payment and operational issues. HR 1, S.1, HR2427, S.1225, PL108-173, HR4337, S.2413, HR4304, S.2343, S.2339/HR4195, S.2810, S.2354, HR5156, S.2255, HR3617, S.2664, S.2665, S.2300, S.2357, S.2234, S.2130, S.2053, S.2076, S.1995, HR3767, HR3711, S.2563, HJ Resolution 107, S.1356, HR1932

Client expense: $1,323,170 · Firm income: Not reported

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

Provision and coverage of occupational therapy services • HR 1443, Family Opportunity Act of 2005 • S 183, Family Opportunity Act of 2005 Provisions related to parity and inclusion of occupational therapy • HR 1125, Medicare Mental Health Copayment Equity Act of 2005 • HR 1946, Medicare Mental Health Modernization Act of 2005 • S 1152, Medicare Mental Health Copayment Equity Act of • S 927, Medicare Mental Health Modernization Act of 2005 All provisions • HR 1333, Medicare Patient Access to Physical Therapists Act of 2003 • HR 2869, Ending the Medicare Disability Waiting Period Act of 2005 • HR 3373, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2005 • HR 3022, Medicare Occupational Therapy Coverage Eligibility Act of 2005 • HR 4223, Medicaid Preservation Act of 2005 • HR 916, Medicare Access to Rehabilitation Services Act of 2005 • S 1217, Ending the Medicare Disability Waiting Period Act of 2005 • S 1405, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2005 • S 1716, Emergency Health Care Relief Act of 2005 • HR 3952, Emergency Health Care Relief Act of 2005 • S 2181, Medicare State Reimbursement Act • S 1951, CLASS Act - Community Living Assistant Service and Supports Act • S 438, Medicare Access to Rehabilitation Services Act of • S 647, Medicare Patient Access to Physical Therapists Act of 2003' • S. 3912, Securing Effective and Necessary Individual Outpatient Rehabilitation Services Act of 2006 • HR 6132, Securing Effective and Necessary Individual Outpatient Rehabilitation Services Act of 2006 Provisions related to occupational therapy services • HR 1381, Medicare Nursing Facility Pay-for-Performance Act of 2005 • HR 2487, Preserving Medicare for All Act of 2005 • S 3963, Access to Physical Medicine & Rehabilitation Services Improvement Act of 2006 Inclusion of occupational therapy and rehabilitation services • HR 2629, Positive Aging Act of 2005 • S 1116, Positive Aging Act of 2005 • HR 2807, Medicare Telehealth Enhancement Act of 2005 • S 1225, Access to Affordable Health Care Act • S 1503, Healthy America Act of 2005 • S 4, Healthy America Act of 2005 Provisions related to Medicare coverage of occupational therapy services, training and education under Title VII of the Public Health Service Act, and funding for IDEA • HR 5647, Making Appropriations for Depts of Labor, Health and Human Svcs. And Education, and related agencies for year ending Sept. 30, 2007 • S 3708, Making Appropriations for Depts of Labor,Health and Human Svcs and Education and related agencies for year ending Sept 30 2007 Inclusion of occupational therapy practitioners • HR 3074, Quality Healthcare Coalition Act of 2005 Provisions related to reimbursement for occupational therapy services • HR 3617, Medicare Value Based Purchasing for Physician's Services Act of 2005 • HR 4520, Medicare Physician Payment Reform Act of 2005 Provisions related to occupational therapy and rehabilitation services • S 1356, Medicare Value Purchasing Act of 2005 • S 1440, Pulmonary and Cardiac Rehabilitation Act of 2005 • HR 4824, Pulmonary and Cardiac Rehabilitation Act of 2005 • S 1580, A bill to improve the health of minority individuals • HR 3561, A bill to improve the health of minority individuals • S 2022, Remote Monitoring Access Act of 2005 • S 1909, Medicare Telehealth Enhancement Act All provisions, especially as related to occupational therapy services • HR 898, Stroke Treatment and Ongoing Prevention Act • S 1064, Stroke Treatment and Ongoing Prevention Act Provisions related to extension of therapy caps exceptions process: • HR 6111, Tax Relief and Health Care Act of 2006 • S 3523, Tax Relief and Health Care Act of 2006 Issues regarding 5-year review and SGR fix - no bills related to this topic.

Client expense: $240,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

* "Pharmacy Access Improvement Act" - S 2664 A bill to amend Title XVIII of the Social Security Act to improve access to pharmacies under part D, issues relating to health plans. Sponsor: Senator Max Baucus "Bipartisan Commission on the Medicaid Act of 2005" - S 338 To provide for the establishment of a Bipartisan commission on Medicaid, issues relating to health plans. Sponsor: Senator Gordon Smith "Medicare Value Purchasing Act of 2005" - S 1356 To amend Title XVIII of the Social Security Act to provide incentives for the provision of high quality care under the Medicare program, issues relating to health plans. Sponsor: Senator Charles Grassley "Bipartisan Commission on Medicaid Act of 2005" - HR 985 To provide for the establishment of a Bipartisan Commission on Medicaid, issues relating to health plans. Sponsor: Congresswoman Heather Wilson "Medicare Cost Contract Extension and Refinement Act of 2005" - HR 4050 To amend title XVIII of the Social Security Act to extend reasonable cost contracts under Medicare, issues relating to health plan. Sponsor: Senator Ron Wyden "No Title – an amendment to the Deficit Reduction Act of 2005" - S 3590 To amend title XIX of the Social Security Act to delay the effective date of the amendments made by the Deficit Reduction Act of 2005 requiring documentation evidencing citizenship or nationality "Medicare Prescription Drug Simplification Act of 2006" - S 2665 A bill to amend Title XVIII of the Social Security Act to simplify and improve the Medicare prescription drug program, issues relating to health plans. Sponsor: Senator Max Baucus "Medicare Drug Benefit Enrollment Fairness Act of 2006" - HR 5399 To amend title XVIII of the Social Security Act to eliminate the Medicare prescription drug late enrollment penalty for months during 2006, and for other purposes, issues relating to health plans. Sponsor: Rep. Nancy Johnson for State Health Insurance Counseling Programs and area Agencies on Aging, and for other purposes, issues related to health plans. Sponsor(s) Sens. Charles Grassley and Max Baucus “Medicare Late Enrollment Assistance Act of 2006” – S 2810 To amend title XVIII of the Social Security Act to eliminate months in 2006 from the calculation of any late enrollment penalty under the Medicare Part D prescription drug program and to provide for additional funding as a condition for receipt of medical assistance under the Medicaid program, issues relating to health plans. Sponsor: Senator Daniel Akaka "Medicare Drug Formulary Protection Act of 2006" - S 2255 A bill to amend Title XVIII of the Social Security Act to prohibit removal of covered part D drugs from a prescription drug plan formulary during the plan year once an individual has enrolled in the plan, issues relating to health plans. Sponsor: Senator Diane Feinstein and organizations, and congressional support agencies, issues relating to health plans. Sponsor: Senator Ron Grassley “Federal Family Health Information Technology Act of 2006” – HR 4859 To establish electronic health records for federal workers, retirees, and their dependents, issues relating to health plans. Sponsor: Rep. Jon Porter "Medicare Data Access and Research Act" - S 3897 A bill to amend Titles XI and XVIII of the Social Security Act to provide for the sharing of certain data collected by the Centers for Medicare & Medicaid Services with certain agencies, research centers 1 2 3 4 5 6 7 8 9 10 11

Client expense: $240,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S 1932/HR 4241-Deficit Reduction Act of 2005 (Bills concerned with gainsharing and its implications on patient access to medical devices efficiency standards in pay-for-performance program) HR 5369-Medicare Clinical Laboratory Fee Schedule Improvement Act of 2006 (Bill to improve payments under the Medical clinical laboratory fee schedule) S. 3900-Medicare Quality Enhancement Act of 2006 (Bill to improve quality and efficiency of health care, to provide public with information on provider and supplier performance, and to enhance education and awareness of consumers for evaluating health care services through development and release of reports based on Medicare enrollments, claims, survey, and assessment data) HR 5866-Medicare Physician Payment Reform and Quality Improvement Act of 2006 (Bill to reform physician payment under the Medicare program) HR 3617-Medicare Value-Based Purchasing for Physicians’ Services Act of 2005 (Bill to provide for value-based purchasing in the payment for physicians’ services under the Medicare program) S 1356-Medicare Value Purchasing Act of 2005 (Bill to provide incentives for the provision of high quality care under the Medicare program) S 1002-Hospital Fair Competition Act of 2005 (Bill to make improvements in payments to hospitals under the Medicare program) HR 4297-Tax Relief Extension Reconciliation Act of 2005 S 2020-Tax Relief Act of 2005 (Bills to provide for reconciliation pursuant to section 202(b) of the concurrent resolution on the budget for fiscal year 2006) HR 6063-The Remote Monitoring Access Act of 2006 S 2022-Remote Monitoring Access Act of 2005 (Bills to provide for coverage of remote patient management services for chronic health care conditions under the Medicare program) S 3795/HR 5704-Access to Medicare Imaging Act of 2006 (Bills to provide for a budget-neutral two-year moratorium on certain Medicare physician payment reductions for imaging services) HR 3559-Medicare Durable Medical Equipment Access Act of 2005 (Bill to assure access to durable medical equipment under the Medicare Program) HR 4994-Medicare Access to Complex Rehabilitation and Assistive Technology Act of 2006 (Bill to exempt complex rehabilitation products and assistive technology products from the Medicare competitive acquisition program) S 3920-Medicare Durable Medicare Equipment Access Act of 2006 (Bill to assure access to durable medical equipment under the Medicare Program) HR 3196/S 470-Fair Access to Clinical Trials (FACT) Act (Bills to expand the scope of information required for the data bank on clinical trials) S 3822-Genomics and Personalized Medicine Act of 2006 (Bill to improve access and appropriate utilization of valid, reliable and accurate molecular genetic tests by all populations)

Client expense: $1,404,102 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Allied health Professions Reinvestment Act of 2005 (S.473/H.R.215); Patient Safety and Quality Improvement Act of 2005 (S.544); Rural Community Hospital Assistance Act (S.933/H.R.2350); Health Technology to Enhance Quality Act of 2005 & 21st Century Health Information Act (S.1262/H.R.2234); Medicare Value Purchasing Act of 2005 (S.1356/H.R.3617); National Medical Error Disclosure & Compensation Act of 2005 (S.1784); Health Improvement and Professionals Act of 2005 (H.R.139); Rural Health Equity Act (H.R.534/H.R.880); Health Information Technology Promotion Act of 2005/Hospital Pricing Transparency (H.R.4157); FFY 2007 Budget and Budget Resolutions; FFY 2007 Medicare Inpatient Hospital PPS Rules; FFY 2007 Medicare Inpatient Rehabilitation Facility PPS and 75% Rule; CY 2007 Medicare Outpatient PPS Rules; Pay for Performance; Not for Profit Hospital Tax-Exempt Status; Medicaid Regulations Affection States' Medicaid Financing Mechanisms; Hospital Charity Care/Financial Aid; Emergency Preparedness; Medicare Wage Index; Health Care Workforce Recruiting and Training Funding; Medical Error Reporting Health Technology to Enhance Quality Act of 2005 (S.4); Medical Care Access Protection Act of 2006 (S.22); Bipartisan Medicaid Commission (S.338/H.R.985); Medicaid Liability Reform (S.354/H.R.534);

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1356: Medicare Value Purchasing Act of 2005 H.R. 1872: Health Care for the Uninsured Act of 2005 H.R. 1902/S. 932: Healthy Families Act H.R. 66: Health Care Cost Deductions H.R. 4157: Health Information Technology Promotion Act of 2005 H.R. 4511: Flex H.S.A. Account H.R. 5262: Tax-Free Health Savings Accounts S. 3585: Health Savings Accounts Improvement and Expansion Act of 2006 S. 3488: Tax-Free Healthcare Savings, Access, and Portability Act S. 354: Health Care Liability Reform H.R. 2355/S. 1015: Health Care CHOICE Act of 2005 S. 1227: Health Information Technology Quality Act S. 1335: Healthy Information Technology Quality & Improvement Act of 2005

Client expense: $380,000 · Firm income: Not reported

Government targets: Energy, Dept of, Federal Communications Commission (FCC), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

43. H.R. 1539, a bill to amend the Public Health Service Act with respect to the responsibilities of a pharmacy when a pharmacist employed by the pharmacy refuses to fill a valid prescription for a drug 44. S. 338, the Bipartisan Commission on Medicaid Act of 2005 45. H.R. 985, the Bipartisan Commission on Medicaid Act of 2005 46. S. Con.Res.18, Budget FY2006 Appropriations resolution 47. H. Con.Res.95, 18, Budget FY2006 Appropriations resolution 48. S. 1262, the Health Technology to Enhance Quality Act of 2005 49. S.3678, the Pandemic and All-Hazards Preparedness Act 50. S.2564, the Biodefense and Pandemic Vaccine and Drug Development Act of 2006 51. H.R. 5533, the Biodefense and Pandemic Vaccine and Drug Development Act 52. H.R. 5262, Tax Free Savings Act of 2006 53. S. 3546, the Dietary Supplement and Nonprescription Drug Consumer Protection Act 54. H.R. 4157, the Health Information Technology Promotion Act of 2006 55. S. 2766, the National Defense Authorization Act for Fiscal Year 2007 56. H.R.5122, the National Defense Authorization Act for Fiscal Year 2007 57. S.2810, the Medicare Late Enrollment Assistance Act of 2006 58. H.R.5399, the Medicare Drug Benefit Enrollment Fairness Act of 2006 59. H.R. 5182, the Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2006 60. S. 2563, the Pharmacist Access and Recognition in Medicare (PhARM) Act of 2006 61. S. 2664, the Pharmacy Access Improvement (PhAIm) Act of 2006 62. H.R. 4769, the Prescription Drug Elimination Act of 2006 63. S. 2300, the Lower Prices With Increased Competition and Efficient Development of Drugs Act (the Lower Priced Drugs Act) 64. H.R. 5166 – The Independent Pharmacy Protection Act of 2006 65. S. 2181, the Medicare State Reimbursement Act 66. S. 2183, the Requiring Emergency Pharmaceutical Access for Individual Relief (REPAIR) Act 67. H.R. 4297, the Tax Relief Extension Reconciliation Act 68. H.R. 5384, the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2007 69. H.R.5441, the Department of Homeland Security Appropriations Act, 2007 70. S. 2020, Tax Relief Act of 2005 71. HR 5122 - FY2007 National Defense Authorization Act (joint project with the National Community Pharmacists Association for Coalition for Community Pharmacy Action) 72. HR 5182 - Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2006 (joint project with the National Community Pharmacists Association for Coalition for Community Pharmacy Action) 73. S. 2563 - Pharmacist Access and Recognition in Medicare (PHARM) Act of 2006 (joint project with the National Community Pharmacists Association for Coalition for Community Pharmacy Action) 74. S. 1932 - Deficit Reduction Act (joint project with the National Community Pharmacists Association for Coalition for Community Pharmacy Action) 1. H.R. 4241, the Deficit Reduction Act of 2005 2. S. 1932, the Senate Deficit Reduction Act of 2005 3. H.R. 6111, the Tax Relief and Health Care Act of 2006 4. H.R. 5280, the Dextromethorphan Distribution Act of 2006 5. S.3807. the Enhancing Drug Safety and Innovation Act of 2006 6. H.R. 6257, the Access to Life-Saving Medicine Act 7. H.R. 5970, the Estate Tax and Extension of Tax Relief Act of 2006 8. S. 1716, Emergency Health Care Relief Act of 2005 9. H.R. 4297, the Tax Relief Extension Reconciliation Act 10. H.R. 3010, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2006 11. S. 544, the Patient Safety and Quality Improvement Act of 2005 12. H.R. 3205, the Patient Safety and Quality Improvement Act of 2005 13. H.R. 1132, the National All Schedules Prescription Electronic Reporting Act of 2005 14. S. 518, the National All Schedules Prescription Electronic Reporting Act of 2005 15. S. 1392, the Federal Trade Commission Reauthorization Act of 2005 16. S. 334, the Pharmaceutical Market Access and Drug Safety Act 17. H.R. 700, the Pharmaceutical Market Access and Drug Safety Act of 2005 18. S. 309, the Pharmaceutical Market Access Act 19. H.R. 328, the Pharmaceutical Market Access Act 20. H.R. 3010, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2006 21. H.R. 1808, the Safe Online Drug Act of 2005 22. S. 399, the Ryan Haight Internet Pharmacy Consumer Protection Act of 2005 23. H.R. 840, the Ryan Haight Internet Pharmacy Consumer Protection Act of 2005 24. S. 14, the Fair Wage, Competition, and Investment Act of 2005 25. S. 534, the Health Efficient, Accessible, Low-Cost, Timely Healthcare Act of 2005 26. H.R. 5, the Health Efficient, Accessible, Low-Cost, Timely Healthcare Act of 2005 27. H.R. 1669, the Pharmacy Benefit Manager Transparency Act of 2005 28. H.R. 1671, the Community Pharmacy Fairness Act of 2005 29. S. 103, the Combat Meth Act of 2005 30. H.R. 314, the Combat Meth Act of 2005 31. S. 102, the Exile Meth Act 32. H.R. 313, the Exile Meth Act 33. H.R. 3889, Meth Epidemic Elimination Act 34. H.R. 1378, the Ephedrine Alkaloids Regulation Act of 2005 35. H.R. 2829, the Office of National Drug Control Policy Reauthorization Act of 2005 36. H.R. 3617, the Medicare Value-Based Purchasing for Physicians' Services Act of 2005 37. S. 1356, the Medicare Value Purchasing Act of 2005 38. S. 1408, the Identity Theft Protection Act 39. S. 1332, the Personal Data Privacy and Security Act of 2005 40. S. 930, the Food and Drug Administration Safety Act of 2005 41. H.R. 1652, the Access to Legal Pharmaceuticals Act 42. S. 809, the Access to Legal Pharmaceuticals Act See addendum

Client expense: $300,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Consumer Product Safety Commission (CPSC), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Personnel Management (OPM), SENATE, White House Office