Geriatric Assessment and Chronic Care Coordination Act of 2007

Education and support for population-based health programs, such as disease and care management in FFS Medicare and Medicare Advantage, including Special Needs Plans (specifically, the reauthorization of Chronic Care Special Needs Plans, or C-SNPs, the incorporation of reasonable process measures and standards for SNP evaluation, and recommendations for CMS' Chronic Conditions SNP Panel); Medicare pilots and demonstrations such as the Medicare Medical Home Demonstration, Senior Risk Reduction Dem- onstration, Medicare Physician Group Practice Demonstration, Medicare Electronic Health Records Demonstration, the Medicare Coordinated Care Demonstration (MCCD, as authorized under Section 4016 of the Balanced Budget Act of 1997), and Medicare Health Support (as authorized under Section 721 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA), which created the "Voluntary Chronic Care Improvement Program" now called Medicare Health Support) - specifically, the 18-month Report to Congress on Medicare Health Support. Provision of suggestions and recommendations for consideration of the broader inclusion of coordinated chronic care and health service stakeholder expertise in the feasibility study of a Medicare Chronic Care Practice Research Network demonstration program and in outcomes reporting for comparative effectiveness research (authorized in the Medicare Improvements for Patients and Providers Act of 2008). Analysis and discussions regarding the expanded hospital re-admission reporting requirements included in Final IPPS & OPPS Rules. Analysis of Congressional Budget Office reports on health care reform key issues and budget options, and promotion of successful outcomes in population health improvement programs as a component of national reform of care delivery, financing and design, particularly in public sector programs. Promotion of alternative modeling might more fully capture the true costs and savings associated with innovative prevention and treatment techniques in health care. Promotion of consideration of alternative models to assess and adjust risk scores related to the illnesses of beneficiaries in the Medicare program. Support for funding of prevention and wellness programs and initiatives as provided for in the American Recovery and Reinvestment Act of 2009 as passed by the House and Senate. Support for modifying provisions related to HIPAA Privacy rule and security for personal health information as established in the Health-e Information Technology Act (HITECH Act) as part of the American Recovery & Reinvestment Act (ARRA). Encouragement of efforts to preserve HIPAA provisions permitting exchange of protected health information for care coordination and disease management, efforts to advance health information technology deployment, particularly as it would affect individuals with chronic conditions, including e-prescribing, and the creation of interoperability standards and priority use cases and best practices for technology deployment and promotion in care coordination. Support for the exemption of disease management and care coordination efforts from economic stimulus provision that would have required the HHS Secretary to issue new health care operations rules. Analysis and submission of comments regarding the Genetic Information Nondiscrimination Act (GINA) and the creation of regulations by the EEOC defining the employer wellness program exception as provided for in GINA. Education regarding effectiveness of chronic condition care and its benefits to Medicaid and other populations via the sharing of published quality improvement studies that reported cost or utilization outcomes from the intervention and which are target clinical conditions relevant for Medicaid programs. Advocacy for priorities of all stakeholders providing services along the care continuum toward the goal of population health improvement in proposed and realized legislation, including S. 3613 & H.R. 7114, the Independence at Home Act of 2008; S. 631 & H.R. 5765, the Remote Monitoring Access Act of 2007; S. 334, the Healthy Americans Act; S. 1340, the Geriatric Assessment and Chronic Care Coordination Act of 2007; S. 1753, the Healthy Workforce Act of 2007; H.R. 3800, the Wired for Healthcare Quality Act; H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology PRO(TECH)T Act of 2008; H.R. 6898, the Health-e Information Technology Act of 2008 (HITECH Act); H.R. 5442, TRUST in Health Information Act of 2008; S. 3101, Medicare Improvements for Patients and Providers Act of 2008; S. 3118, Preserving Access to Medicare Act of 2008; H.R. 853, Wellness and Prevention Act of 2007; H.R.6331, Medicare Improvements for Patients and Providers Act of 2008; the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA); the American Recovery & Reinvestment Act (ARRA); initiatives pertaining to the treatment and prevention of obesity as a chronic disease generally and as a component of population health improvement approaches to addressing the obesity epidemic. Advocacy and support for expansion of Medicare-covered clinical preventive services as recommended by the U.S. Preventive Services Task Force and provided for in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Endorsement of the Healthy Workforce Act of 2009 and promotion of the legislation through the Healthy Workplace Alliance. General advocacy for population health improvement as a tool to improve the quality of health care and health care outcomes, and reduce preventable health care costs, and promotion of health promotion, wellness, and care coordination programs at the White House Regional Health Reform Summits.

Client expense: $135,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

H.R. 1, American Recovery and Reinvestment Act of 2009 (as enrolled and agreed to by both House and Senate) -- sections 3000 - 3018, 4301, and 5001; also made contact regarding potential inclusion of home health rural add-on as amendment S. 2181/H.R.3865: The Home Health Care Access Protection Act - All sections H.R. 2860, The Health Care Access and Rural Equity Act of 2007 -- sections 305 and 309 S. 457, Fostering Independence Through Technology Act of 2009 -- All sections S. 1605, Craig Thomas Rural Hospital and Provider Equity Act of 2007 -- sections 11, 14 and 18 S. 1678, Home Health Care Planning Improvement Act of 2007 -- All sections H.R. 6163, Medicare Telehealth Enhancement Act of 2008 -- sections 104, 105, and 106 S. 3613/H.R. 7114, The Independence at Home Act of 2008 -- All sections S. 1340, The Geriatric Assessment and Chronic Care Coordination Act of 2007 -- All sections S. 3484/H.R. 6873 -- The Medicare Hospice Protection Act of 2008 -- All sections S. 421 Hospice Protection Act (2008) -- All sections S. 631 -- The Patient Safety and Abuse Prevention Act of 2009 -- All sections

Client expense: $160,000 · Firm income: Not reported

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

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192, the Preserving Patient Access to Primary Care Act; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007. Health Coverage: Guarantee all Americans access to health coverage; create tax credits to subsidize coverage for low income persons to buy into the Federal Employees Health Benefits Plan (FEHBP); create new options for small businesses to buy into group coverage based on the FEHBP; expand Medicaid and SCHIP; support state experimentation. Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the SCHIP program with additional funding to assure adequate coverage of all eligible children; target increases in Medicare payments for primary care physicians; target incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home; provide subsidies for newly unemployed workers to obtain COBRA coverage; provide temporary Medicaid coverage to laid-off workers; increase funding for community health centers; provide substantial funds for the Prevention and Wellness Fund to fight preventable chronic diseases; support healthcare research and quality programs to compare the effectiveness of different medical treatments funded by Medicare, Medicaid and CHIP; support existing work being done by public and private sector partnerships on HIT policy, standards and certification; H.R. 1, the American Recovery and Reinvestment Act. Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula. Primary Care Workforce: Establish a primary care advisory committee to provide explicit planning at the federal level to increase the primary care workforce to meet anticipated health care needs of the nation. Medicare Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care; restore the 20/220 loan deferment pathway (S.646). Healthcare in the FY2010 Budget: Account for the costs of preventing Medicare physician pay cuts under the Sustainable Growth Rate formula; address the negative impact of Medicare payment cuts on small physician practices; support the concept of dedicating funding for health care reform; support funding for physicians to acquire health information technology (HIT) to be used in a meaningful way; note concerns about penalties that would reduce baseline payments to physicians not using certified HIT systems beginning in 2015; support a policy reserve fund for physician payment reform, as reported out of the House Committee on the Budget, including the language to ensure primary care receives appropriate compensation. Medicare Payment Advisory Commission (MedPAC): Provide support for an internal medicine physician, and member of the College, as a candidate for MedPAC in 2009; candidacy discussed with members of Congress and the Government Accountability Office (GAO). Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268, provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation.

Client expense: $283,059 · 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

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192, the Preserving Patient Access to Primary Care Act; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007. Health Coverage: Guarantee all Americans access to health coverage; create tax credits to subsidize coverage for low income persons to buy into the Federal Employees Health Benefits Plan (FEHBP); create new options for small businesses to buy into group coverage based on the FEHBP; expand Medicaid and SCHIP; support state experimentation. Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the SCHIP program with additional funding to assure adequate coverage of all eligible children; target increases in Medicare payments for primary care physicians; target incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home; provide subsidies for newly unemployed workers to obtain COBRA coverage; provide temporary Medicaid coverage to laid-off workers; increase funding for community health centers; provide substantial funds for the Prevention and Wellness Fund to fight preventable chronic diseases; support healthcare research and quality programs to compare the effectiveness of different medical treatments funded by Medicare, Medicaid and CHIP; support existing work being done by public and private sector partnerships on HIT policy, standards and certification; H.R. 1, the American Recovery and Reinvestment Act. Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula. Primary Care Workforce: Establish a primary care advisory committee to provide explicit planning at the federal level to increase the primary care workforce to meet anticipated health care needs of the nation. Medicare Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care; restore the 20/220 loan deferment pathway (S.646). Healthcare in the FY2010 Budget: Account for the costs of preventing Medicare physician pay cuts under the Sustainable Growth Rate formula; address the negative impact of Medicare payment cuts on small physician practices; support the concept of dedicating funding for health care reform; support funding for physicians to acquire health information technology (HIT) to be used in a meaningful way; note concerns about penalties that would reduce baseline payments to physicians not using certified HIT systems beginning in 2015; support a policy reserve fund for physician payment reform, as reported out of the House Committee on the Budget, including the language to ensure primary care receives appropriate compensation. Medicare Payment Advisory Commission (MedPAC): Provide support for an internal medicine physician, and member of the College, as a candidate for MedPAC in 2009; candidacy discussed with members of Congress and the Government Accountability Office (GAO). Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268, provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation.

Client expense: $148,372 · 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

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: 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. 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 Medicaid/Targeted Case Management (continued). Reduction Act.

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

Government targets: HOUSE OF REPRESENTATIVES, 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

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: 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. 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. 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: $440,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, 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, S. 137, S. 250, S. 450, S. 706, S. 1887, S. 2089, S. 2115, S. 2219: 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, Medicare Secondary Payer clarification, 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. 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. 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: $480,000 · Firm income: Not reported

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

Aging, health and Medicare, including S.1340 and H.R. 2244.

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Education and support for population-based health programs, such as disease and care management in FFS Medicare and Medicare Advantage, including Special Needs Plans (specifically, the reauthorization of Chronic Care Special Needs Plans, or C-SNPs, the incorporation of reasonable process measures and standards for SNP evaluation, and recommendations for CMS' Chronic Conditions SNP Panel); Medicare pilots and demonstrations such as the Medicare Medical Home Demonstration, Senior Risk Reduction Dem- onstration, Medicare Physician Group Practice Demonstration, Medicare Electronic Health Records Demonstration, the Medicare Coordinated Care Demonstration (MCCD, as authorized under Section 4016 of the Balanced Budget Act of 1997), and Medicare Health Support (as authorized under Section 721 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA), which created the "Voluntary Chronic Care Improvement Program" now called Medicare Health Support). Provision of suggestions and recommendations for consideration of the broader inclusion of coordinated chronic care and health service stakeholder expertise in the feasibility study of a Medicare Chronic Care Practice Research Network demonstration program and in outcomes reporting for comparative effectiveness research (authorized in the Medicare Improvements for Patients and Providers Act of 2008). Analysis and discussions regarding the expanded hospital re-admission reporting requirements included in Final IPPS & OPPS Rules and participation in the listening session for development of transition to a Medicare Value Based Purchasing Program for physician & other professional services. Analysis of Congressional Budget Office reports on health care reform key issues and budget options, and promotion of successful outcomes in population health improvement programs as a component of national reform of care delivery, financing and design, particularly in public sector programs. Encouragement of efforts to preserve HIPAA provisions permitting exchange of protected health information for care coordination and disease management, efforts to advance health information technology deployment, particularly as it would affect individuals with chronic conditions, including e-prescribing, and the creation of interoperability standards and priority use cases and best practices for technology deployment and promotion in care coordination. Education regarding effectiveness of chronic condition care and its benefits to Medicaid and other populations via the sharing of published quality improvement studies that reported cost or utilization outcomes from the intervention and which are target clinical conditions relevant for Medicaid programs. Advocacy for priorities of all stakeholders providing services along the care continuum toward the goal of population health improvement in proposed and realized legislation, including S. 3613 & H.R. 7114, the Independence at Home Act of 2008; S. 631 & H.R. 5765, the Remote Monitoring Access Act of 2007; S. 334, the Healthy Americans Act; S. 1340, the Geriatric Assessment and Chronic Care Coordination Act of 2007; S. 1753, the Healthy Workforce Act of 2007; H.R. 3800, the Wired for Healthcare Quality Act; H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology PRO(TECH)T Act of 2008; H.R. 6898, the Health-e Information Technology Act of 2008; H.R. 5442, TRUST in Health Information Act of 2008; S. 3101, Medicare Improvements for Patients and Providers Act of 2008; S. 3118, Preserving Access to Medicare Act of 2008; H.R. 853, Wellness and Prevention Act of 2007; H.R.6331, Medicare Improvements for Patients and Providers Act of 2008; initiatives pertaining to the treatment and prevention of obesity as a chronic disease generally and specifically as related to Medicare Part D coverage of pharmacotherapy as a component of population health improvement approaches to addressing the obesity epidemic. Advocacy and support for expansion of Medicare-covered clinical preventive services as recommended by the U.S. Preventive Services Task Force and provided for in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Endorsement of the Office of the National Nurse initiative, efforts to rename the Chief Nurse Officer of the U.S. Public Health Services as the "National Nurse". General advocacy for population health improvement as a tool to improve the quality of health care and health care outcomes, and reduce preventable health care costs.

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

S1340/HR2244/HR467, The Geriatric Assessment and Chronic Care Coordination Act of 2007, all provisions relating to Medicare Part B Coverage of geriatric assessment and chrnoic care management services for eligible beneficiaries and process measures and outcomes for Medicare Beneficiaries with multiple chronic illnesses, including dementia. S1758, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program. S2708, Caring for An Aging America Act, all provisions relating to training of health care professionals and direct care workers S264, Nursing Home Transparency and Improvement Act of 2008, all provisions relating to improving the transparency of information about skilled nursing facilities and providing dementia management training. S245 - Retooling for an Aging America, Building the Heatlhcare workforce. All provisions relating to expanding education and training opportunities in geriatric and long-term care for licensed health professionls, direct care workers, and family caregivers.

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

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

S. 1340, Geriatric Assessment and Chronic Care Management Act

Client expense: Not reported · Firm income: Not reported

Government targets: 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: 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. 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 Medicaid/Targeted Case Management (continued). Reduction Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2860, The Health Care Access and Rural Equity Act of 2007 -- sections 305 and 309 S. 321, Fostering Independence Through Technology Act of 2007 -- All sections S. 1605, Craig Thomas Rural Hospital and Provider Equity Act of 2007 -- sections 14 and 18 S. 1678, Home Health Care Planning Improvement Act of 2007 -- All sections S. 2181/H.R. 3865, The Fair Home Health Care Act -- All sections H.R. 6331, Medicare Improvements for Patients and Providers Act of 2008 -- effort to include home health rural add-on as amendment S. 3101, Medicare Improvements for Patients and Providers Act of 2008 --effort to include home health rural add-on as amendment S. 3118, Preserving Access to Medicare Act of 2008 -- section 112 H.R. 5613/S. 2819, Protecting the Medicaid Safety Net Act of 2008 -- All sections H.R. 2642, Supplemental Appropriations Act, 2008 -- Title VII Medicaid H.R. 6163, Medicare Telehealth Enhancement Act of 2008 -- sections 104, 105, and 106 S. 3613/H.R. 7114, The Independence at Home Act -- All sections S. 1340, The Geriatric Assessment and Chronic Care Coordination Act of 2007 -- All sections S. 3484/H.R. 6873 -- The Medicare Hospice Protection Act -- All sections S. 1628/H.R. 6826 -- The Home Health Care Planning Improvement Act -- All sections S. 1577/H.R. 3078 -- The Patient Safety and Abuse Prevention Act -- All sections

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

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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007; H.R. 6357, the Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act of 2008. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506/S.325, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; S. 1169, the State-Based Health Care Reform Act; H.R. 2351, the Health Care Act of 2007. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, 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. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking (S.625/H.R. 1108, the Family Smoking Prevention and Tobacco Control Act), 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. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; Include expansion of the medical home as well as transformation grants for the medical home in SCHIP re-authorizing legislation Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007. Economic Stimulus Package: Increase the federal matching rate under the Medicaid program, re-authorize the SCHIP program with additional funding to assure adequate coverage of all eligible children, targeted increases in Medicare payments for primary care physicians, targeted incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home.

Client expense: $269,132 · 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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007; H.R. 6357, the Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act of 2008. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506/S.325, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; S. 1169, the State-Based Health Care Reform Act; H.R. 2351, the Health Care Act of 2007. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, 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. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking (S.625/H.R. 1108, the Family Smoking Prevention and Tobacco Control Act), 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. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; Include expansion of the medical home as well as transformation grants for the medical home in SCHIP re-authorizing legislation. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007. Economic Stimulus Package: Increase the federal matching rate under the Medicaid program, re-authorize the SCHIP program with additional funding to assure adequate coverage of all eligible children, targeted increases in Medicare payments for primary care physicians, targeted incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home.

Client expense: $142,652 · 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

Education and support for population-based health programs, such as disease and care management in FFS Medicare and Medicare Advantage, including Special Needs Plans (specifically, the reauthorization of Chronic Care Special Needs Plans, or C-SNPs, the incorporation of reasonable process measures and standards for SNP evaluation, and recommendations for CMS' Chronic Conditions SNP Panel); Medicare pilots and demonstrations such as the Medicare Medical Home Demonstration, Senior Risk Reduction Dem- onstration, Medicare Physician Group Practice Demonstration, Medicare Electronic Health Records Demonstration, the Medicare Coordinated Care Demonstration (MCCD, as authorized under Section 4016 of the Balanced Budget Act of 1997), and Medicare Health Support (as authorized under Section 721 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA), which created the "Voluntary Chronic Care Improvement Program" now called Medicare Health Support). Provision of suggestions and recommendations for consideration of the broader inclusion of coordinated chronic care and health service stakeholder expertise in the feasibility study of a Medicare Chronic Care Practice Research Network demonstration program and in outcomes reporting for comparative effectiveness research (authorized in the Medicare Improvements for Patients and Providers Act of 2008). Provision of comments on the CMS-proposed rule for the Physician Fee Schedule for CY2009, specifically regarding expansion of the Physician Quality Reporting Initiative (PQRI). Encouragement of efforts to preserve HIPAA provisions permitting exchange of protected health information for care coordination and disease management, efforts to advance HIT deployment, particularly as it would effect individuals with chronic conditions, including e-prescribing, and the creation of interoperability standards and priority use cases and best practices for technologies that merge classical medical devices and telecommunications (American Health Information Community Chronic Care Workgroup initiatives). Education regarding effectiveness of chronic condition care and its benefits to Medicaid and other populations via the sharing of published quality improvement studies that reported cost or utilization outcomes from the intervention and which are target clinical conditions relevant for Medicaid programs. Advocacy for priorities of all stakeholders providing services along the care continuum toward the goal of population health improvement in proposed and realized legislation, including S. 3613 & H.R. 7114, the Independence at Home Act of 2008; S. 631 & H.R. 5765, the Remote Monitoring Access Act of 2007; S. 334, the Healthy Americans Act; S. 1340, the Geriatric Assessment and Chronic Care Coordination Act of 2007; S. 1753, the Healthy Workforce Act of 2007; H.R. 3800, the Wired for Healthcare Quality Act; H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology PRO(TECH)T Act of 2008; H.R. 6898, the Health-e Information Technology Act of 2008; H.R. 5442, TRUST in Health Information Act of 2008; S. 3101, Medicare Improvements for Patients and Providers Act of 2008; S. 3118, Preserving Access to Medicare Act of 2008; H.R. 853, Wellness and Prevention Act of 2007; H.R.6331, Medicare Improvements for Patients and Providers Act of 2008; initiatives pertaining to the treatment and prevention of obesity as a chronic disease generally and specifically as related to Medicare Part D coverage of pharmacotherapy as a component of population health improvement approaches to addressing the obesity epidemic. Education and coordination of briefings for congressional staff and agency representatives regarding the value for employers and employees of wellness programs and preventive health services as made available in the workplace. General advocacy for population health improvement as a tool to improve the quality of health care and health care outcomes, and reduce preventable health care costs.

Client expense: $95,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE

Alzheimer's Disease Demonstrataion Grants to States Program, Program Implementation S1340/HR2244/HR467, The Geriatric Assessment and Chronic Care Coordination Act of 2007, all provisions relating to Medicare Part B Coverage of geriatric assessment and chrnoic care management services for eligible beneficiaries and process measures and outcomes for Medicare Beneficiaires with multiple chronic illnesses, including dementia. S1758, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program. S897 Alzheimer's Family Assistance Act of 2007, all provisions relating to long term care tax credits, treatment of premiums or qualified long-term care insurance contracts and tax credits for caregivers. S2708, Caring for An Aging America Act, all provisions relating to training of health care professionals and direct care workers S264, Nursing Home Transparency and Improvement Act of 2008, all provisions relating to improving the transparency of information about skilled nursing facilities and providing dementia management training. HR1032, Alzheimer's Treatment and Caregiver Support Act, all provisions relating to grants for the expansion of treatment services to individuals with Alzheimer's and training and support services for families and caregivers

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

Government targets: Administration on Aging, Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE

S. 59/H.R. 2066 Med. Adv. Practice Nurse and Phys. Assist Act; Physician reimbursement rates; quality report initiative; home health reimbursement rates; S. 1340/H.R. 2244 Geriatric Asses. Chronic Care Coord Act; S. 1678 Home Health Care Plan. Improv. Act; S. 54/Nursing School Clinics Act; S. 2499 Medicare, Medicaid and SCHIP Extension Act; Medicare Medical Homes Issues; H.R. 6331, the Medicare Improvement for Patients and Providers Act.

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007; H.R. 6357, the Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act of 2008. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506/S.325, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; S. 1169, the State-Based Health Care Reform Act; H.R. 2351, the Health Care Act of 2007. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, 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. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking (S.625/H.R. 1108, the Family Smoking Prevention and Tobacco Control Act), 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. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007.

Client expense: $276,799 · 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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007; H.R. 6357, the Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act of 2008. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506/S.325, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; S. 1169, the State-Based Health Care Reform Act; H.R. 2351, the Health Care Act of 2007. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, 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. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: Healthcare disparities, anti-smoking (S.625/H.R. 1108, the Family Smoking Prevention and Tobacco Control Act), 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. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007.

Client expense: $167,205 · 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

Aging, health and Medicare, including S.1340 and H.R. 2244.

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, 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

H.R. 2860, The Health Care Access and Rural Equity Act of 2007 -- sections 305 and 309 S. 321, Fostering Independence Through Technology Act of 2007 -- All sections S. 1605, Craig Thomas Rural Hospital and Provider Equity Act of 2007 -- sections 14 and 18 S. 1678, Home Health Care Planning Improvement Act of 2007 -- All sections S. 2181/H.R. 3865, The Fair Home Health Care Act -- All sections H.R. 6331, Medicare Improvements for Patients and Providers Act of 2008 -- effort to include home health rural add-on as amendment S. 3101, Medicare Improvements for Patients and Providers Act of 2008 --effort to include home health rural add-on as amendment S. 3118, Preserving Access to Medicare Act of 2008 -- section 112 H.R. 5613/S. 2819, Protecting the Medicaid Safety Net Act of 2008 -- All sections H.R. 2642, Supplemental Appropriations Act, 2008 -- Title VII Medicaid H.R. 6163, Medicare Telehealth Enhancement Act of 2008 -- sections 104, 105, and 106 S. 3613/H.R. 7114, The Independence at Home Act -- All sections S. 1340, The Geriatric Assessment and Chronic Care Coordination Act of 2007 -- All sections S. 3484/H.R. 6873 -- The Medicare Hospice Protection Act -- All sections S. 1628/H.R. 6826 -- The Home Health Care Planning Improvement Act -- All sections S. 1577/H.R. 3078 -- The Patient Safety and Abuse Prevention Act -- All sections

Client expense: $92,550 · Firm income: Not reported

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

Medicare Access to Rehabilitation Services Act of 2007 (S. 450/H.R. 748) Geriatric Assessment and Chronic Care Coordination Act (S. 1340/H.R. 2244) State Children's Health Insurance Program (SCHIP) reauthorization (H.R. 976) (H.R. 3162) Medicare Imrpovements for Patients and Providers Act (S. 3101/H.R. 6331) Preserving Access to Medicare Act (S. 3118) Public Law No: 110-85 (H.R. 3580) Public Law 110-173 (S. 2499) CMS Hospotal Inpatient Prospective Payment System and Fiscal Year 2009 Rates (CMS-1390-P) CMS Evidenting Priorities for Medicare (CMS-3196-N)

Client expense: $453,031 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE

HR 3001/ S 1340 - Shared and discusssed actuarial analysis of the CLASS Act regarding creation of a public insurance program for long-term services. S 2337/HR 3363 - Discussion of and support for Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. S 1070 Elder Justice Act/S 1577 Patient Safety and Abuse Prevention Act of 2007 - Support for both pieces of legislation and strategy for how they might both move forward this year. S 1340 Geriatric Assessment and Chronic Care Coordination Act of 2007- Discussed a demonstration version of this Medicare chronic care coordination and geriatric assessment bill. S 2708 Caring for an Aging America Act of 2008 - Provisions related to increasing the number of professionals trained in geriatrics or gerontology, etc., providing input on legislation and encouraging offices to cosponsor the bill. Discussed draft legislation to make changes to Medicaid HCBS, including the Medicaid state plan option, spousal impoverishment, Medicaid Transformation Grants, etc. HR 1174 Healthy Hospitals Act of 2007- Discussed with sponsors' staff potential endorsement of this legislation to require hospitals to report infection rates. HR 5613 Protecting the Medicaid Safety Net Act of 2008 - Supported this legislation, particularly provisions related to placing a moratorium on seven harmful Medicaid regulations. Lobbied to adjust budget neutrality requirement in waivers to include costs in both Medicare and Medicaid. Medicaid Personal Assistance Services State Plan option- discussion of comment letter sending and receipt. Discussed need to strengthen low-income programs by raising asset limits and streamlining rules, and to keep premiums affordable for all beneficiaries. S 2480/HR 4296 Medicare Electronic Medication and Safety Protection (E-Meds) Act of 2007- Supported provisions related to requiring e-prescribing in Medicare Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. S 2641/ HR 5799 Nursing Home Quality and Transparency Legislation Act - To protect residents and support for the Nursing Home Transparency and Improvement Act. Discussion of provisions (civil monetary penalties and Special Focus Facilities) in nursing home transparency, accountability, and quality bill. Special Focus Facilities and disclosure of these facilities; criminal background checks for LTC employees; nursing home quality; poor performing nursing homes, family caregiving, nursing home compliance guidelines, Real Choice Systems Change Grants and family caregiver assessments, Home Health CAHPS, LTC Partnership Program (under Medicaid), Aging and Disability Resource Centers (AoA), health care and the uninsured - steps HHS is taking to address this, Medicare Medical Adult Day Care Demonstration. HR 5702 Advance Directive Promotion Act of 2008 - Negotiated provisions on portability of advance directives. HR 2642 - Lobbied for inclusion of Medicaid Regulation Moratoriam in Military Construction and Veterans Affairs Appropriations Act of 2008, and on supplemental appropriations bill. To build support for Medicaid Family Caregiver Assessment Demonstration proposal (no Bill). S 2838/HR 6126 - Input on draft legislation to make arbitration clauses between LTC facilities and their residents or representatives unenforceable; support for this legislation once it was introduced as the Fairness in Nursing Home Arbitration Act, including support letter. Discussion and input on legislation to improve the health/LTC workforce and support family caregivers. Advance directives and end-of-life care, education of the public about these issues, portability, and other issues relating to advance directives. S 1577/HR 3078 - Support for Patient Safety and Abuse Prevention Act (S 1577) and moving the issue forward; provided feedback and in testimony. S 2921 Caring for Wounded Warriors Act of 2008 - Services and supports for family caregivers of certain veterans. Feedback on draft legislation to provide chronic care coordination services to certain Medicare beneficiaries; approaches to improving chronic care for Medicare beneficiaries; discussion of chronic care and Special Needs Plans. S 1102 Part D Equity for Low-Income Seniors Act of 2007- Support for Medicare premium protection and modifications to Medicare Savings Programs/Part D Low-Income Subsidy. S 1758 - Long-term care financing proposals, including the CLASS Act, a public LTC financing program. S. 3164 - Lobbied on Medicare Fraud bill (Martinez and Cornyn) - All provisions related to protecting participants and the Medicare program from fraud and abuse. S. 3118 - Lobbied in opposition to Grassley-McConnell bill - All provisions related to beneficiary access and Medicare improvements, including e-prescribing. S 3101- Urged support of the Medicare Improvements for Patients and Providers Act of 2008 to help improve Medicare. Long Term Care/Reverse Mortgages - To protect consumers when reverse mortgages are used as a LTC financing tool. Green Houses and culture change in LTC facilities. HR 2642 - To keep moratorium on all seven Medicaid regulations in the supplemental appropriations bill. Lobbied on appeal notices for Medicare beneficiaries in Medicare Advantage plans. S 1102 - Lobbied for legislation to increase Medicare Part D LIS. HR 1536 - Lobbied for legislation to increase Medicare Part D LIS asset limits. S 3101/HR 6331 - (Medicare) Lobbied for legislation to protect part B premiums, increase LIS and MSP asset limits, and promote e-prescribing in Medicare. HR 2642 - (Medicaid) Lobbied for inclusion of Medicaid regulation moratorium in Iraq Supplemental.

Client expense: $6,480,000 · Firm income: Not reported

Government targets: Administration on Aging, Commerce, Dept of (DOC), Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office

Aging, health and Medicare, including S. 1340 and H.R. 2244.

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 59/H.R. 2066 Med. Adv. Practice Nurse and Phys. Assist Act; Physician reimbursement rates; quality report initiative; home health reimbursement rates; S. 1340/H.R. 2244 Geriatric Asses. Chronic Care Coord Act; S. 1678 Home Health Care Plan. Improv. Act; S. 54/Nursing School Clinics Act; S. 2499 Medicare, Medicaid and SCHIP Extension Act; Medicare Medical Homes Issues; H.R. 6331, the Medicare Improvement for Patients and Providers Act.

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Access to Rehabilitation Services Act of 2007 (S. 450/H.R. 748) Geriatric Assessment and Chronic Care Coordination Act (S. 1340/H.R. 2244) State Children's Health Insurance Program (SCHIP) reauthorization (H.R. 976) (H.R. 3162) Medicare Imrpovements for Patients and Providers Act (S. 3101/H.R. 6331) Preserving Access to Medicare Act (S. 3118) Public Law No: 110-85 (H.R. 3580) Public Law 110-173 (S. 2499) CMS Hospotal Inpatient Prospective Payment System and Fiscal Year 2009 Rates (CMS-1390-P) CMS Evidenting Priorities for Medicare (CMS-3196-N)

Client expense: $453,031 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE

Education and support for population-based health programs, including disease and care management in FFS Medicare and Medicare Advantage, including Special Needs Plans (specifically the reauthorization of Chronic Care Special Needs Plans, or C-SNPs and the incorporation of reasonable process measures and standards for SNP evaluation); Medicare pilots including Medicare Health Support (as authorized under Section 721 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA), which created the "Voluntary Chronic Care Improvement Program," now called Medicare Health Support (MHS)); and Medicare demonstrations, including the Medicare Coordinated Care Demonstration (MCCD, as authorized under Section 4016 of the Balanced Budget Act of 1997), and the Senior Risk Reduction Demonstration (SRRD). Provision of comments on CMS proposed and developed evaluations of care and disease management programs in Medicare Advantage. Advocacy for population health improvement as a tool to improve the quality of health care and health care outcomes, and reduce preventable health care costs. Encouragement of efforts to preserve HIPAA provisions permitting exchange of protected health information for care coordination and disease management, efforts to advance HIT deployment, particularly as it would effect individuals with chronic conditions, including e-prescribing, and the creation of interoperability standards and priority use cases and best practices for technologies that merge classical medical devices and telecommunications (American Health Information Community Chronic Care Workgroup initiatives). Education regarding effectiveness of chronic condition care and its benefits to Medicaid and other populations via the sharing of published quality improvement studies that reported cost or utilization outcomes from the intervention and which are target clinical conditions relevant for Medicaid programs. Advocacy around the CMS Medical Home Demonstration; S. 631 & H.R. 5765, the Remote Monitoring Access Act of 2007; S. 334, the Healthy Americans Act; S. 1340, the Geriatric Assessment and Chronic Care Coordination Act of 2007; S. 1753, the Health Workforce Act of 2007; H.R. 3800, the Wired for Healthcare Quality Act and discussion drafts of HIT & privacy legislation; H.R. 5442, TRUST in Health Information Act of 2008; S. 3101, Medicare Improvements for Patients and Providers Act of 2008; S. 3118, Preserving Access to Medicare Act of 2008; H.R. 853, Wellness and Prevention Act of 2007; H.R.6331, Medicare Improvements for Patients and Providers Act of 2008 and the broader inclusion of coordinated care stakeholder expertise in studies and proposals around a Medicare chronic care practice research network; initiatives pertaining to the treatment and prevention of obesity as a chronic disease generally and specifically as related to Medicare Part D coverage of pharmacotherapy as a component of population health improvement approaches to addressing the obesity epidemic.

Client expense: $125,000 · Firm income: Not reported

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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506 /S.325, Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; S. 1169, the State-Based Health Care Reform Act; H.R. 2351, the Health Care Act of 2007. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, 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. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: 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. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007.

Client expense: $334,690 · 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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506 Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; H.R. 2351, the Healthcare Act of 2007; S. 1169, the State-Based Health Care Reform Act. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, 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. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: 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. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R.. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007.

Client expense: $334,690 · 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

Health Information Technology (HIT); providing incentives for the successful adoption of HIT: S.1693, the Wired for Healthcare Quality Act; H.R. 3800, Promoting Health Information Technology Act; H.R. 1952, the National Health Information Incentive Act of 2007. Expanding health insurance coverage to ensure that more Americans will have access to affordable health insurance: H.R. 506 Health Partnership through Creative Federalism Act; Health insurance reform, Medicaid, Association Health Plans, Medical Savings Accounts, Tax credits and purchasing pools; H.R. 2351, the Healthcare Act of 2007; S. 1169, the State-Based Health Care Reform Act. Reforming the medical liability system in this country to ease existing financial burdens on practicing physicians and to ensure greater patient access to care: S. 243, the Medical Care Access Protection Act of 2007 (MCAP Act); H.R. 2580, the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2007. Medical liability demonstration projects. Reforming the Medicare physician reimbursement formula to provide for greater predictability and stability in payments: S. 40, the Geriatric and Chronic Care Management Act, Reform the Sustainable Growth Rate - S. 2785, Save Medicare Act of 2008, H. R. 5445; H.R. 5545 and S. 2729, the Ensuring the Future Physician Workforce Act of 2008, Pay-for-Performance, Patient Centered Medical Home H.R. 3162, the CHAMP Act, 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. H.R. 6331/S.3101, the Medicare Improvements for Patients and Providers Act. Ensure adequate funding for federal health programs in the FY08 and FY09 appropriations: Labor/HHS/Education Appropriations bill (including Title VII health professions and student loans) and VA healthcare and research). Address inadequacies in public health programs and funding: 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. Provide loan debt relief for medical students through enhancements to existing programs and the creation of new programs: H.R. 1093, Resident Physician Shortage Reduction Act of 2007; S. 588, Resident Physician Shortage Reduction Act of 2007; S. 1066, Medical Education Affordability Act; Reauthorization of the Higher Education Act, including the restoration of the 20/220 pathway; S. 2303/H.R. 4344, a bill to amend section 435 of the Higher Education Act of 1965 regarding the definition of economic hardship. Preserving the safety net function of federally-funded health care programs, such as SCHIP: H.R. 5268, providing for a temporary increase of the Federal medical assistance percentage under the Medicaid Program. Preserving access to primary care services: the impending shortage of primary care physicians, designation of primary care as a shortage profession, scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas, grants for medical school mentorship programs and primary care training in community health centers, increased Title VII funding for primary care health programs, Medicare payment reforms to support the Patient Centered Medical Home, regulatory relief, studies on primary care; S. 1340/H.R. 2244, the Geriatric Assessment and Chronic Care Coordination Act of 2007.

Client expense: $173,509 · 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

Alzheimer's Disease Demonstration Grants to States Program, Program Implementation S1340/HR2244/HR467, The Geriatric Assessment and Chronic Care Coordination Act of 2007, all provisions relating to Medicare Part B Coverage of geriatric assessment and chrnoic care management services for eligible beneficiaries and process measures and outcomes for Medicare Beneficiaires with multiple chronic illnesses, including dementia. S1758, the Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program. S1628 Nurse Faculty and Physical Therapist Education Act of 2007 all provisions relating to geriatric faculty fellowships H con Res 133 supproting the goals and ideals of Long Term Care Awareness week, all provisions relating to Long Term Care Awareness week. S897 Alzheimer's Family Assistance Act of 2007, all provisions relating to long term care tax credits, treatment of premiums or qualified long-term care insurance contracts and tax credits for caregivers. S2708, caring for An Aging America Act, all provisions relating to training of health care professionals and direct care workers S264, Nursing Home Transparency and Improvement Act of 2008, all provisions relating to improving the transparency of information about skilled nursing facilities and providing dementia management training. HR1032, Alzheimer's Treatment and Caregiver Support Act, all provisions relating to grants for the expansion of treatment services to individuals with Alzheimer's and training and support services for families and caregivers

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

Government targets: Administration on Aging, Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE

S. 1340, Geriatric Assessment and Chronic Care Coordination Act

Client expense: Not reported · Firm income: Not reported

Government targets: 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: 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. 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. 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: $440,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3001/ S 1340 - Shared and discusssed actuarial analysis of the CLASS Act regarding creation of a public insurance program for long-term services. S 2337/HR 3363 - Discussion of and support for Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. S 1070/S 1577 - Support for both pieces of legislation and strategy for how they might both move forward this year. S 1340 - Discussed a demonstration version of this Medicare chronic care coordination and geriatric assessment bill. S 2708 - Provisions related to increasing the number of professionals trained in geriatrics or gerontology, etc., providing input on legislation and encouraging offices to cosponsor the bill. Discussed draft legislation to make changes to Medicaid HCBS, including the Medicaid state plan option, spousal impoverishment, Medicaid Transformation Grants, etc. HR 1174/S 1174 - Discussed with sponsors' staff potential endorsement of this legislation to require hospitals to report infection rates. HR 5140- Supported provisions providing rebates to older Americans who do not file income taxes, and potential for adding provisions to temporarily increase federal funding to state Medicaid programs. HR 5613- Supported this legislation, particularly provisions related to placing a moratorium on harmful Medicaid regulations. Lobbied to adjust budget neutrality requirement in waivers to include costs in both Medicare and Medicaid. Filed comment letters with HHS on proposed regulations involving cost sharing and flexibility in benefit packages. Medicaid Personal Assistance Services State Plan option- discussion of comment letter sending and receipt. Advocated for part B premium protection and asset test improvement. Discussed need to strengthen low-income programs by raising asset limits and streamlining rules, and to keep premiums affordable for all beneficiaries. S 2480/HR 4296- Supported provisions related to requiring e-prescribing in Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. S 2641/ HR 5799 Nursing home quality; discussion of provisions (civil monetary penalties and Special Focus Facilities) in nursing home transparency, accountability, and quality bill. Advance directives and end-of-life care: discussed efforts to educate Medicare beneficiaries about advance directives; discussed, negotiated, and provided input on legislation regarding advance directives under Medicare and Medicaid;portability of advance directives, and public education around advance directives. Special Focus Facilities and disclosure of these facilities; criminal background checks for LTC employees; nursing home quality; poor performing nursing homes, family caregiving, nursing home compliance guidelines, Real Choice Systems Change Grants and family caregiver assessments, Home Health CAHPS, LTC Partnership Program (under Medicaid), Aging and Disability Resource Centers (AoA), health care and the uninsured - steps HHS is taking to address this, Medicare Medical Adult Day Care Demonstration.

Client expense: $7,220,000 · Firm income: Not reported

Geriatric and Chronic Care Management Act, S. 1340 Geriatric and Chronic Care Management Act, H.R. 2244

Client expense: Not reported · Firm income: Not reported

S. 59/H.R. 2066 Med. Adv. Practice Nurse and Phys. Assist Act; Physician reimbursement rates; quality report initiative; home health reimbursement rates; S. 1340/H.R. 2244 Geriatric Asses. Chronic Care Coord Act; S. 1678 Home Health Care Plan. Improv. Act; S. 54/Nursing School Clinics Act; S. 2499 Medicare, Medicaid and SCHIP Extension Act; Medicare Medical Homes Issues.

Client expense: Not reported · Firm income: $20,000

Nursing home quality; discussion of provisions (civil monetary penalties and Special Focus Facilities) in nursing home transparency, accountability, and quality bill (Senate). Advance directives and end-of-life care: discussed efforts to educate Medicare beneficiaries about advance directives; discussed, negotiated, and provided input on legislation regarding advance directives under Medicare and Medicaid; portability of advance directives, and public education around advance directives. Special Focus Facilities and disclosure of these facilities; criminal background checks for LTC employees; nursing home quality; poor performing nursing homes, family caregiving, nursing home compliance guidelines, Real Choice Systems Change Grants and family caregiver assessments, Home Health CAHPS, LTC Partnership Program (under Medicaid), Aging and Disability Resource Centers (AoA), health care and the uninsured - steps HHS is taking to address this, Medicare Medical Adult Day Care Demonstration. HR 3001 - Shared and discusssed actuarial analysis of the CLASS Act. S 2337/HR 3363 - Discusssed support for Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. S 1070.S 1577 - Support for both pieces of legislation and strategy for how they might both move forward this year. S 1340 - Discussed a demonstration version of this Medicare chronic care coordination and geriatric assessment bill. HR 1758 - Discussions on bill, including actuarial analysis, provisions and strategy on the bill. S 2708 - Increase the number of professionals trained in geriatrics or gerontology, etc., providing input on legislation and encouraging offices to cosponsor the bill. Discussed draft legislation to make changes to Medicaid HCBS, including the Medicaid state plan option, spousal impoverishment, Medicaid Transformation Grants, etc. HR 1174/S 1174 - Discussed with sponsors' staff potential endorsement of this legislation to require hospitals to report infection rates.

Client expense: $7,220,000 · Firm income: Not reported

Government targets: Administration on Aging, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

LONG TERM CARE (SENATE) - Senate, nursing home quality: discussion of provisions (civil monetary penalties and Special Focus Facilities) in nursing home transparency, accountability, and quality bill LONG TERM CARE (HOUSE) - Advance directives and end-of-life care: discussed efforts to educate Medicare beneficiaries about advance directives; discussed, negotiated and provided input on legislation regarding advance directives under Medicare and Medicaid, portability of advance directives, and public education around advance directives LONG TERM CARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Special Focus Facilities and disclosure of these facilities; criminal background checks for LTC employees; nursing home quality, poor performing nursing homes, family caregiving, nursing home compliance guidance, Real Choice Systems Change Grants and family caregiver assessments, Home Health CAHPS, LTC Partnership Program (under Medicaid), Aging and Disability Resource Centers (AoA), health care and the uninsured steps HHS is taking to address this, Medicare Medical Adult Day Care Demonstration LONG TERM CARE (SENATE) - Senate, nursing home quality: discussion of provisions (civil monetary penalties and Special Focus Facilities) in nursing home transparency, accountability, and quality bill LONG TERM CARE (HOUSE) - Advance directives and end-of-life care: discussed efforts to educate Medicare beneficiaries about advance directives; discussed, negotiated and provided input on legislation regarding advance directives under Medicare and Medicaid, portability of advance directives, and public education around advance directives LONG TERM CARE HR 3001 - CLASS Act shared and discussed actuarial analysis of the CLASS Act, a bill to create a public insurance program for long-term services and supports LONG TERM CARE HR 3363 - Discussed support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections; focused consumer protections LONG TERM CARE S 1070/S 1577 - Elder Justice Act (S. 1070) and Patient Safety and Abuse Prevention Act (S. 1577): support for both pieces of legislation and strategy for how they might both move forward this year LONG TERM CARE S 1340 - Geriatric Assessment and Chronic Care Coordination Act, discussed a demonstration version of this Medicare chronic care coordination and geriatric assessment bill LONG TERM CARE S 1758 - CLASS ACT - discussions on Class Act, including actuarial analysis, provisions and strategy on the bill. Bill would create a public long-term care financing program. LONG TERM CARE S 2337 - Discussion of and support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. LONG TERM CARE S 2337/HR 3363 (SENATE) - Discussion of and support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections LONG TERM CARE S 2708 - Caring for an Aging America Act, a health and long-term care workforce bill to increase the number of professionals trained in geriatrics or gerontology, etc., providing input on legislation and encouraging offices to cosponsor the bill LONG TERM CARE (HOUSE) - Advance directives and end-of-life care: discussed efforts to educate Medicare beneficiaries about advance directives; discussed, negotiated and provided input on legislation regarding advance directives under Medicare and Medicaid, portability of advance directives, and public education around advance directives LONG TERM CARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Special Focus Facilities and disclosure of these facilities; criminal background checks for LTC employees; nursing home quality, poor performing nursing homes, family caregiving, nursing home compliance guidance, Real Choice Systems Change Grants and family caregiver assessments, Home Health CAHPS, LTC Partnership Program (under Medicaid), Aging and Disability Resource Centers (AoA), health care and the uninsured steps HHS is taking to address this, Medicare Medical Adult Day Care Demonstration LONG TERM CARE HR 3001 - CLASS Act shared and discussed actuarial analysis of the CLASS Act, a bill to create a public insurance program for long-term services and supports LONG TERM CARE HR 3363 - Discussed support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections; focused consumer protections LONG TERM CARE S 1070/S 1577 - Elder Justice Act (S. 1070) and Patient Safety and Abuse Prevention Act (S. 1577): support for both pieces of legislation and strategy for how they might both move forward this year LONG TERM CARE S 1340 - Geriatric Assessment and Chronic Care Coordination Act, discussed a demonstration version of this Medicare chronic care coordination and geriatric assessment bill LONG TERM CARE S 1758 - CLASS ACT - discussions on Class Act, including actuarial analysis, provisions and strategy on the bill. Bill would create a public long-term care financing program. LONG TERM CARE S 2337 - Discussion of and support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. LONG TERM CARE S 2337/HR 3363 (SENATE) - Discussion of and support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections LONG TERM CARE S 2708 - Caring for an Aging America Act, a health and long-term care workforce bill to increase the number of professionals trained in geriatrics or gerontology, etc., providing input on legislation and encouraging offices to cosponsor the bill LONG TERM CARE (HOUSE) - Advance directives and end-of-life care: discussed efforts to educate Medicare beneficiaries about advance directives; discussed, negotiated and provided input on legislation regarding advance directives under Medicare and Medicaid, portability of advance directives, and public education around advance directives LONG TERM CARE (SENATE) - Senate, nursing home quality: discussion of provisions (civil monetary penalties and Special Focus Facilities) in nursing home transparency, accountability, and quality bill LONG TERM CARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Special Focus Facilities and disclosure of these facilities; criminal background checks for LTC employees; nursing home quality, poor performing nursing homes, family caregiving, nursing home compliance guidance, Real Choice Systems Change Grants and family caregiver assessments, Home Health CAHPS, LTC Partnership Program (under Medicaid), Aging and Disability Resource Centers (AoA), health care and the uninsured steps HHS is taking to address this, Medicare Medical Adult Day Care Demonstration LONG TERM CARE HR 3001 - CLASS Act shared and discussed actuarial analysis of the CLASS Act, a bill to create a public insurance program for long-term services and supports LONG TERM CARE HR 3363 - Discussed support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections; focused consumer protections LONG TERM CARE S 1070/S 1577 - Elder Justice Act (S. 1070) and Patient Safety and Abuse Prevention Act (S. 1577): support for both pieces of legislation and strategy for how they might both move forward this year LONG TERM CARE S 1758 - CLASS ACT - discussions on Class Act, including actuarial analysis, provisions and strategy on the bill. Bill would create a public long-term care financing program. LONG TERM CARE S 2337/HR 3363 (SENATE) - Discussion of and support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections LONG TERM CARE S 1340 - Geriatric Assessment and Chronic Care Coordination Act, discussed a demonstration version of this Medicare chronic care coordination and geriatric assessment bill LONG TERM CARE S 2337 - Discussion of and support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. LONG TERM CARE (HOUSE) - Advance directives and end-of-life care: discussed efforts to educate Medicare beneficiaries about advance directives; discussed, negotiated and provided input on legislation regarding advance directives under Medicare and Medicaid, portability of advance directives, and public education around advance directives LONG TERM CARE (SENATE) - Senate, nursing home quality: discussion of provisions (civil monetary penalties and Special Focus Facilities) in nursing home transparency, accountability, and quality bill LONG TERM CARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Special Focus Facilities and disclosure of these facilities; criminal background checks for LTC employees; nursing home quality, poor performing nursing homes, family caregiving, nursing home compliance guidance, Real Choice Systems Change Grants and family caregiver assessments, Home Health CAHPS, LTC Partnership Program (under Medicaid), Aging and Disability Resource Centers (AoA), health care and the uninsured steps HHS is taking to address this, Medicare Medical Adult Day Care Demonstration LONG TERM CARE HR 3001 - CLASS Act shared and discussed actuarial analysis of the CLASS Act, a bill to create a public insurance program for long-term services and supports LONG TERM CARE HR 3363 - Discussed support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections; focused consumer protections LONG TERM CARE S 1758 - CLASS ACT - discussions on Class Act, including actuarial analysis, provisions and strategy on the bill. Bill would create a public long-term care financing program. LONG TERM CARE S 2337/HR 3363 (SENATE) - Discussion of and support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections LONG TERM CARE S 1340 - Geriatric Assessment and Chronic Care Coordination Act, discussed a demonstration version of this Medicare chronic care coordination and geriatric assessment bill LONG TERM CARE S 2337 - Discussion of and support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. LONG TERM CARE S 2708 - Caring for an Aging America Act, a health and long-term care workforce bill to increase the number of professionals trained in geriatrics or gerontology, etc., providing input on legislation and encouraging offices to cosponsor the bill LONG TERM CARE S 1070/S 1577 - Elder Justice Act (S. 1070) and Patient Safety and Abuse Prevention Act (S. 1577): support for both pieces of legislation and strategy for how they might both move forward this year MEDICAID (HOUSE) - Lobbied to adjust budget neutrality requirement in waivers to include costs in both Medicare and Medicaid. MEDICAID (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Filed comment letters on proposed regulations involving cost sharing and flexibility in benefit packages. MEDICAID (SENATE) - Discussed draft legislation to make changes to Medicaid HCBS, including the Medicaid state plan option, spousal impoverishment, Medicaid Transformation Grants, etc. MEDICAID HR 1174 - S1174 Health Hospitals Act discussed with sponsors staff potential endorsement of this legislation to require hospitals to report infection rates. MEDICAID HR 5140 (SENATE) - Recovery Rebates and Economic Stimulus for the American People Act of 2008 supported provisions providing rebates to older Americans who do not file income taxes, and potential for adding provisions to temporarily increase federal funding to state Medicaid programs. MEDICAID HR 5613 - Protecting the Medicaid Safety Net Act support this legislation that places a moratorium on harmful Medicaid regulations. MEDICAID (HOUSE) - Lobbied to adjust budget neutrality requirement in waivers to include costs in both Medicare and Medicaid. MEDICAID (SENATE) - Discussed draft legislation to make changes to Medicaid HCBS, including the Medicaid state plan option, spousal impoverishment, Medicaid Transformation Grants, etc. MEDICAID (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Filed comment letters on proposed regulations involving cost sharing and flexibility in benefit packages. MEDICAID HR 1174 - S1174 Health Hospitals Act discussed with sponsors staff potential endorsement of this legislation to require hospitals to report infection rates. MEDICAID HR 5140 (SENATE) - Recovery Rebates and Economic Stimulus for the American People Act of 2008 supported provisions providing rebates to older Americans who do not file income taxes, and potential for adding provisions to temporarily increase federal funding to state Medicaid programs MEDICAID HR 5613 - Protecting the Medicaid Safety Net Act support this legislation that places a moratorium on harmful Medicaid regulations. MEDICAID (HOUSE) - Lobbied to adjust budget neutrality requirement in waivers to include costs in both Medicare and Medicaid. MEDICAID (SENATE) - Discussed draft legislation to make changes to Medicaid HCBS, including the Medicaid state plan option, spousal impoverishment, Medicaid Transformation Grants, etc. MEDICAID (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Filed comment letters on proposed regulations involving cost sharing and flexibility in benefit packages. MEDICAID HR 1174 - S1174 Health Hospitals Act discussed with sponsors staff potential endorsement of this legislation to require hospitals to report infection rates. MEDICAID HR 5140 (SENATE) - Recovery Rebates and Economic Stimulus for the American People Act of 2008 supported provisions providing rebates to older Americans who do not file income taxes, and potential for adding provisions to temporarily increase federal funding to state Medicaid programs MEDICAID HR 5613 - Protecting the Medicaid Safety Net Act support this legislation that places a moratorium on harmful Medicaid regulations. MEDICAID (HOUSE) - Lobbied to adjust budget neutrality requirement in waivers to include costs in both Medicare and Medicaid. MEDICAID (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Filed comment letters on proposed regulations involving cost sharing and flexibility in benefit packages MEDICAID HR 1174 - S1174 Health Hospitals Act discussed with sponsors staff potential endorsement of this legislation to require hospitals to report infection rates. MEDICAID HR 5140 (SENATE) - Recovery Rebates and Economic Stimulus for the American People Act of 2008 supported provisions providing rebates to older Americans who do not file income taxes, and potential for adding provisions to temporarily increase federal funding to state Medicaid programs MEDICAID HR 5613 - Protecting the Medicaid Safety Net Act support this legislation that places a moratorium on harmful Medicaid regulations. MEDICAID (SENATE) - Discussed draft legislation to make changes to Medicaid HCBS, including the Medicaid state plan option, spousal impoverishment, Medicaid Transformation Grants, etc. MEDICAID (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Medicaid Personal Assistance Services State Plan option discussion of comment letter sending and receipt MEDICARE (SENATE) - Senate Medicare package--AARP advocated for part B premium protection and asset test improvement. MEDICARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Discussed need to strengthen low-income programs by raising asset limits and streamlining rules, and to keep premiums affordable for all beneficiaries. MEDICARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) HR 3363 - Support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. MEDICARE S.2408 (HOUSE) - S. 2408/HR4296 - Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 support this legislation to require e-prescribing in Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. MEDICARE S.2408 (SENATE) - S. 2408/HR4296 - Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 support this legislation to require e-prescribing in Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. MEDICARE (SENATE) - Senate Medicare package--AARP advocated for part B premium protection and asset test improvement. MEDICARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) HR 3363 - Support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. MEDICARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) HR3363 - Support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. MEDICARE S.2408 (HOUSE) - S. 2408/HR4296 - Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 support this legislation to require e-prescribing in Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. MEDICARE S.2408 (SENATE) - S. 2408/HR4296 - Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 support this legislation to require e-prescribing in Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. MEDICARE (SENATE) - Senate Medicare package--AARP advocated for part B premium protection and asset test improvement. MEDICARE (SENATE) - Senate Medicare package--AARP advocated for part B premium protection and asset test improvement. MEDICARE (SENATE) - Senate Medicare package--AARP advocated for part B premium protection and asset test improvement. MEDICARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Discussed need to strengthen low-income programs by raising asset limits and streamlining rules, and to keep premiums affordable for all beneficiaries. MEDICARE (SENATE) - Senate Medicare package--AARP advocated for part B premium protection and asset test improvement. MEDICARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) HR 3363 - Support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. MEDICARE S.2408 (HOUSE) - S. 2408/HR4296 - Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 support this legislation to require e-prescribing in Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. MEDICARE S.2408 (SENATE) - S. 2408/HR4296 - Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 support this legislation to require e-prescribing in Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. MEDICARE (SENATE) - Senate Medicare package--AARP advocated for part B premium protection and asset test improvement. MEDICARE (SENATE) - Senate Medicare package--AARP advocated for part B premium protection and asset test improvement. MEDICARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) - Discussed need to strengthen low-income programs by raising asset limits and streamlining rules, and to keep premiums affordable for all beneficiaries. MEDICARE S.2408 (HOUSE) - S. 2408/HR4296 - Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 support this legislation to require e-prescribing in Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. MEDICARE S.2408 (SENATE) - S. 2408/HR4296 - Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 support this legislation to require e-prescribing in Part D, at first by providing incentive payments to providers who do and after 2011 lower payments to providers who do not. MEDICARE (DEPARTMENT OF HEALTH & HUMAN SERVICES) HR 3363 - Support for the Long-Term Care Affordability and Security Act that would make private long-term care insurance available through employer-sponsored flexible spending accounts and cafeteria plans and update and add consumer protections. MEDICARE (SENATE) - Senate Medicare package--AARP advocated for part B premium protection and asset test improvement.

Client expense: $7,220,000 · Firm income: Not reported

Alzheimer's Disease Demonstration Grants to States Program, program implementation S1340/HR2244/HR467, The Geriatric Assessment and Chronic Care Coordination Act of 2007, all provisions relating to Medicare Part B Coverage of geriatric assessment and chrnoic care management services for eligible beneficiaries and process measures and outcomes for Medicare Beneficiaires with multiple chronic illnesses, including dementia. S1758, the Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program. S1628 Nurse Faculty and Physical Therapist Education Act of 2007 all provisions relating to geriatric faculty fellowships H con Res 133 supproting the goals and ideals of Long Term Care Awareness week, all provisions relating to Long Term Care Awareness week. S897 Alzheimer's Family Assistance Act of 2007, all provisions relating to long term care tax credits, treatment of premiums or qualified long-term care insurance contracts and tax credits for caregivers. S2708, caring for An Aging America Act, all provisions relating to training of health care professionals and direct care workers S264, Nursing Home Transparency and Improvement Act of 2008, all provisions relating to improving the transparency of information about skilled nursing facilities and providing dementia management training. HR1032, Alzheimer's Treatment and Caregiver Support Act, all provisions relating to grants for the expansion of treatment services to individuals with Alzheimer's and training and support services for families and caregivers

Client expense: $115,000 · Firm income: Not reported

Education and support for population-based health programs, including disease and care management in FFS Medicare and Medicare Advantage, including Special Needs Plans (specifically the reauthorization of Chronic Care Special Needs Plans, or C-SNPs and the incorporation of reasonable process measures and standards for SNP evaluation); Medicare pilots including Medicare Health Support (as authorized under Section 721 of the Medicare Prescription Drug, Improvement and Modernization Act (MMA), which created the "Voluntary Chronic Care Improvement Program," now called Medicare Health Support (MHS)); and Medicare demonstrations, including the Medicare Coordinated Care Demonstration (MCCD, as authorized under Section 4016 of the Balanced Budget Act of 1997), and the Senior Risk Reduction Demonstration (SRRD). Provision of comments on CMS proposed and developed evaluations of care and disease management programs in Medicare Advantage. Advocacy for population health improvement as a tool to improve the quality of health care and health care outcomes, and reduce preventable health care costs. Encouragement of efforts to preserve HIPAA provisions permitting exchange of protected health information for care coordination and disease management, efforts to advance HIT deployment, particularly as it would effect individuals with chronic conditions, including e-prescribing, and the creation of interoperability standards and priority use cases and best practices for technologies that merge classical medical devices and telecommunications (American Health Information Community Chronic Care Workgroup initiatives). Education regarding effectiveness of chronic condition care and its benefits to Medicaid and other populations via the sharing of published quality improvement studies that reported cost or utilization outcomes from the intervention and which are target clinical conditions relevant for Medicaid programs. Advocacy around the CMS Medical Home Demonstration; S. 631, the Remote Monitoring Access Act of 2007; S. 334, the Healthy Americans Act; S. 1340, the Geriatric Assessment and Chronic Care Coordination Act of 2007; S. 1753, the Health Workforce Act of 2007; H.R. 3800, the Wired for Healthcare Quality Act; and H.R. 5442, TRUST in Health Information Act of 2008.

Client expense: $75,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

Medicare Access to Rehabilitation Services Act of 2007 (S. 450/H.R. 748) Geriatric Assessment and Chronic Care Coordination Act (S. 1340/H.R. 2244) State Children's Health Insurance Program (SCHIP) reauthorization (H.R. 976) (H.R. 3162) Public Law No: 110-85 (H.R. 3580) Public Law 110-173 (S. 2499) CMS National Coverage Determination for Computed Tomographic Angiography (CAG-00385N) CMS National Coverage Analysis for PTA of the Carotid Artery Concurrent with Stenting (CAG-00085RG)

Client expense: $157,992 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE

S. 59/H.R. 2066 Med. Adv. Practice Nurse and Phys. Assist Act; Physician reimbursement rates; quality report initiative; home health reimbursement rates; S. 1340/H.R. 2244 Geriatric Asses. Chronic Care Coord Act; S. 1678 Home Health Care Plan. Improv. Act; S. 54/Nursing School Clinics Act; S. 2499 Medicare, Medicaid and SCHIP Extension Act; Medicare Medical Homes Issues.

Client expense: Not reported · Firm income: $20,000

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