Critical Access Hospital Flexibility Act of 2007

Issues pertaining to coverage and other health issues; H.R. 1424 Paul Wellstone Mental Health and Addiction Equity Act of 2007, Sec. 2, 3, 5 and 6 and all provisions relating to physician-owned hospitals as well as mental health parity; S. 558 Mental Health Parity Act of 2007, all provisions related to mental health parity; H.R. 1666 Health Care Price Transparency Promotion Act of 2007, all provisions to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs; S. 866 Health Promotion First Act, all provisions pertaining to health promotion reearch and dissemination; S. 1893 Children's Health Insurance Program Reauthorization Act of 2007, all provisions related to this bill; H.R. 2851 and S. 400 Michelle's Law, all provisions to amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to ensure that dependent students who take a medically necessary leave of absence do not lose health insurance coverage, and for other purposes; H.R. 5544 Patients and Public Health Partnership Act of 2008, all provisions to amend the Public Health Service Act to authorize a demonstration project for integrated health systems to expand access to primary and preventive care for the medically underserved, and for other purposes; H.R. 2606 340B Program Improvement and Integrity Act of 2007, all provisions to amend section 340B of the Public Health Service Act to revise and expand the drug discount program under that section to improve the provision of discounts on drug purchases for certain safety net providers; S. 1595 Critical Access Hospital Flexibility Act of 2007, all provisions to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program; S. 334 Healthy Americans Act, all provisions to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away; H.R. 5885Health Information Technology Promotion Act of 2008, to promote a better health information system; S. 2853, to amend title XVIII of the Social Security Act to remove the cap on disproportionate share adjustment percentages for certain rural hospitals; H.R. 5739 Physician Availability Act of 2008, to assure that the services of a non-emergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds; H.R. 1174 Healthy Hospitals Act of 2007, to amend title XVIII of the Social Security Act to require public reporting of health care-associated infections data by hospitals and ambulatory surgical centers and to permit the Secretary of Health and Human Services to establish a pilot program to provide incentives to hospitals and ambulatory surgical centers to eliminate the rate of occurrence of such infections; H.R. 5942 National Trauma Center Stabilization Act of 2008, to ensure the continued and future availability of lifesaving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, emergency needs, and information technology; H.R. 6179 Promoting Health Information Technology Act of 2008, to encourage and enhance the adoption of interoperable health information technology to improve health care quality, reduce medical errors, and increase the efficiency of care; H.R. 6357 Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008' or the `PRO(TECH)T Act of 2008, to amend the Public Health Service Act to promote the adoption of health information technology, and for other purposes; H.R. 3014 Health Equity and Accountability Act of 2007, to improve the health of minority individuals, and for other purposes.

Client expense: $4,070,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA)

Legislation regarding Medicare and Medicaid Reimbursement issues which include provisions to expand access, improve services, stabilize payments to hospitals and other providers under Medicaid, Medicare, and/or SCHIP by addressing reimbursement, parity, quality, self-referral, workforce, payment issues, rehabilitation hospitals, long term care hospitals, rural hospitals and various regulations. HR 2055 Improving Children's Access to Health Care Act, to improve children's access to health care coverage under the Medicaid Program and the State Children's Health Insurance Program (SCHIP). HR 2606, 340B Drug Expansion Act of 2007, to revise and expand the drug discount program under that section to improve the provision of discounts on drug purchases for certain safety net providers. S 355, Social Security and Medicare Solvency Commission Act, to create a permanent, 15-member commission to make recommendations on how best to save the entitlement programs HR 4105; the Medicare Recovery Audit Contractor Program Moratorium Act of 2007 that would enact a one-year, nationwide moratorium on the Recovery Audit Contract (RAC) program. H Con Res 312/S Con Res 70, fiscal year (FY)2009 budget resolutions, Medicare and Medicaid reductions HR 5480/S 2662, Medicare Funding Warning Response Act, various provisions S 2785, Save Medicare Act physician payment, exceptions process for therapy caps, direct billing by independent labs for pathology services, cost-based payment for rural lab services, and provisions allowing certain hospitals to be eligible for wage index reclassification. S. 3101; Medicare Improvements for Patients and Providers physician payment, exceptions process for therapy caps, direct billing by independent labs for pathology services, cost-based payment for rural lab services, and provisions allowing certain hospitals to be eligible for wage index HR 6331, Medicare Improvements for Patients and Providers Act physician payment, exceptions process for therapy caps, direct billing by independent labs for pathology services, cost-based payment for rural lab services, and provisions allowing certain hospitals to be eligible for wage index HR 6252/S3144, would delay for 18 months the Medicare competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies. self-referral HR 1424; Paul Wellstone Mental Health and Addiction Equity Act provision banning the growth of physician-owned specialty hospitals workforce, HR3043/S1710; Labor, HHS Appropriations bill; nursing education, national health service corp, rural health programs, childrens hospitals GME, S 543/HR 1459, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007"; to extend the 60 percent compliance threshold used to determine whether a hospital or unit of a hospital is an inpatient rehabilitation facility under the Medicare program. HR 3162, "Children's Health and Medicare Protection Act" payment: HR 2206, U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act supplemental appropriations bill (HR 2206) contained moratorium on medicaid regulations regarding capping payment to public providers and GME HR 1480/1741/S 787, to place a two-year moratorium on the Centers for Medicare & Medicaid Services implementation of medicaid regulations regarding capping payment to public providers and GME funding from Section 1011 of the Medicare Modernization Act of 2003 (MMA), HR 1293, Access to Medicare Imaging Act stop the reduction Medicare reimbursements for some medical imaging services HR 882, Access to Emergency Services Act that would increase by 10 percent Medicare reimbursements to physicians who provide care in emergency departments (EDs) or post-stabilization care related to emergency medical conditions in other areas of hospitals HR 552/S 329, The Pulmonary and Cardiac Rehabilitation Act of 2007 to provide for coverage of items and services under a cardiac rehabilitation program and a pulmonary rehabilitation program. HR 3533/S2460, "Public & Teaching Hospital Preservation Act" to extend a moratorium prohibiting CMS from implementing the Medicaid proposed rule that would limit Medicaid payments to public hospitals and narrow the definition of government provider and eliminate Medicaid GME HR 3668, TMA, Abstinence Education, and QI Programs Extension Act includes provision which would mitigate the impact of the behavioral offset in the FY08 Inpatient Prospective Payment System (IPPS) final rule S 2499; Medicare, Medicaid, and SCHIP Extension Act Permanently freezes the inpatient rehabilitation services compliance threshold at 60 percent, Extends for six months the work geographic index floor, for six months the provision that allows independent laboratories to continue to bill Medicare directly for the technical component of certain physician pathology services, Provides reasonable cost reimbursement for clinical lab tests performed by certain small rural hospitals, Section 508 hospitals quality S 1226, Children's Health Care Quality Act would allow the Centers for Medicare & Medicaid Services to fund evidence-based demonstrations to improve hospital care for children. HR 1666, Health Care Price Transparency Promotion Act which would build on existing state efforts to report hospital pricing data and require insurers to disclose estimated out-of-pocket costs to consumers S 465; Advance Directives Improvement and Education Act of 2007" to improve access to information about healthcare options and legal rights for care near the end of life rehabilitation hospitals, S543/HR 1459, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007"; to extend the 60 percent compliance threshold used to determine whether a hospital or unit of a hospital is an inpatient rehabilitation facility under the Medicare program S 2499; Medicare, Medicaid, and SCHIP Extension Act Permanently freezes the inpatient rehabilitation services compliance threshold at 60 percent, rural hospitals, S 1605/HR 2860, Health Care Access and Rural Equity Act (H-CARE) S 1595, Critical Access Hospital Flexibility Act CAHs would gain flexibility to respond to daily and seasonal fluctuations in patient load S 2499;; Medicare, Medicaid, and SCHIP Extension Act Extends for six months the work geographic index floor, for six months the provision that allows independent laboratories to continue to bill Medicare directly for the technical component of certain physician pathology services, Provides reasonable cost reimbursement for clinical lab tests performed by certain small rural hospitals long term care hospitals: HR 562/S338, Medicare Long-Term Care Hospital Improvement establishing facility and patient criteria for long-term care hospitals and related improvements under the Medicare Program. S 2499; Medicare, Medicaid, and SCHIP Extension Act Provides regulatory relief for three years to ensure continued access to current long-term care hospital services, while also imposing a limited moratorium on the development of new, long-term care facilities. Medicaid, HR 2512, Reducing Coverage Gaps for Kids Act To amend titles XIX and XXI of the Social Security Act to prohibit States from requiring eligibility determinations for children for benefits under the Medicaid Program and the State Children's Health Insurance Program (SCHIP) more frequently than once every year. HR 2147, Healthy Kids Act to amend titles XXI and XIX of the Social Security Act to extend the State Children's Health Insurance Program (SCHIP) and streamline enrollment under SCHIP and Medicaid and to amend the Internal Revenue Code of 1986 to provide for a healthy savings tax credit for purchase of children's health coverage. HR1111, Kids Come First Act to ensure that every uninsured child in America has health insurance coverage, HR 1878, To amend title XIX of the Social Security Act to permit States, at their option, to require certain individuals to present satisfactory documentary evidence of proof of citizenship or nationality for purposes of eligibility for Medicaid HR 3533/S2460 "Public & Teaching Hospital Preservation Act" to extend a moratorium prohibiting CMS from implementing the Medicaid proposed rule that would limit Medicaid payments to public hospitals and narrow the definition of government provider and eliminate Medicaid GME HR 5613, Protecting the Medicaid Safety Net Act, temporary, one-year moratorium on seven Medicaid regulations S 2819, Economic Recovery in Health Care Act to implement a one-year moratorium on proposed regulatory changes to Medicaid and the State Childrens Health Insurance Program (SCHIP), and to provide states in need with federal relief HR 2462, the supplemental funding bill for Iraq and Afghanistan provision to place a temporary, one-year moratorium on seven Medicaid regulations, including the rules to limit Medicaid payments to public hospitals and to eliminate Government Medical Education (GME). SCHIP: S 1224, that would reauthorize the State Childrens Health Insurance Program and expand it to allow additional coverage to six million children within 10 years S 895/HR 1535, HR 3162, "Children's Health and Medicare Protection Act" HR 976 in the Senate, Children's Health Insurance Program Reauthorization Act S. 1893, the Children's Health Insurance Program Reauthorization Act of 2007 S 2049, The Better Health for America's Children Act," to block a new policy to limit states' ability to enroll children in the State Children's Health Insurance Program S 2152, Kids First Actalternative SCHIP bill that would restrict coverage to individuals younger than age 19 in low-income families HR 3963; Children's Health Insurance Program Reauthorization Act revised bill to extend and expand the State Childrens Health Insurance Program (SCHIP) S 2499 the bill extends SCHIP through March 31, 2009, and provides adequate funding to states to maintain their current enrollment through that date. HR 3533, "Public & Teaching Hospital Preservation Act" to extend a moratorium prohibiting CMS from implementing the Medicaid proposed rule that would limit Medicaid payments to public hospitals and narrow the definition of government provider and eliminate Medicaid GME regulations including, but not limited to, provisions of PL 106-554, Consolidated Appropriations Act, provisions related to critical access hospitals, inpatient hospital services Direct Graduate Medical Education, Hospital Outpatient Services, Skilled Nursing Facilities, State Children's Health Insurance Program PL 108-173, Medicare Prescription Drug, Improvement, and Modernization Act, provisions related to rural hospitals, inpatient hospital services, skilled nursing facilities, hospice care, hospital outpatient departments, health care quality PL 109-171; Deficit Reduction Act, provisions related to rehabilitation hospitals, medicaid DSH payment, medicare-dependent hospitals, gainsharing, Medicaid, SHCHIP the FY08 IPPS proposed rule, proposed Medicaid rule (CMS 2258-P), the Recovery Audit Contract (RAC) demonstration.

Legislation regarding Medicare and Medicaid Reimbursement issues which include provisions to expand access, improve services, stabilize payments to hospitals and other providers under Medicaid, Medicare, and/or SCHIP by addressing reimbursement, parity, quality, self-referral, workforce, payment issues, rehabilitation hospitals, long term care hospitals, rural hospitals and various regulations. HR 2055 Improving Children's Access to Health Care Act, to improve children's access to health care coverage under the Medicaid Program and the State Children's Health Insurance Program (SCHIP). HR 2606, 340B Drug Expansion Act of 2007, to revise and expand the drug discount program under that section to improve the provision of discounts on drug purchases for certain safety net providers. S 355, Social Security and Medicare Solvency Commission Act, to create a permanent, 15-member commission to make recommendations on how best to save the entitlement programs HR 4105; the Medicare Recovery Audit Contractor Program Moratorium Act of 2007 that would enact a one-year, nationwide moratorium on the Recovery Audit Contract (RAC) program. H Con Res 312/S Con Res 70, fiscal year (FY)2009 budget resolutions, Medicare and Medicaid reductions HR 5480/S 2662, Medicare Funding Warning Response Act, various provisions self-referral HR 1424; Paul Wellstone Mental Health and Addiction Equity Act provision banning the growth of physician-owned specialty hospitals workforce, HR3043/S1710; Labor, HHS Appropriations bill; nursing education, national health service corp, rural health programs, childrens hospitals GME, S 543/HR 1459, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007"; to extend the 60 percent compliance threshold used to determine whether a hospital or unit of a hospital is an inpatient rehabilitation facility under the Medicare program. HR 3162, "Children's Health and Medicare Protection Act" payment: HR 2206, U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act supplemental appropriations bill (HR 2206) contained moratorium on medicaid regulations regarding capping payment to public providers and GME HR 1480/1741/S 787, to place a two-year moratorium on the Centers for Medicare & Medicaid Services implementation of medicaid regulations regarding capping payment to public providers and GME funding from Section 1011 of the Medicare Modernization Act of 2003 (MMA), HR 1293, Access to Medicare Imaging Act stop the reduction Medicare reimbursements for some medical imaging services HR 882, Access to Emergency Services Act that would increase by 10 percent Medicare reimbursements to physicians who provide care in emergency departments (EDs) or post-stabilization care related to emergency medical conditions in other areas of hospitals HR 552/S 329, The Pulmonary and Cardiac Rehabilitation Act of 2007 to provide for coverage of items and services under a cardiac rehabilitation program and a pulmonary rehabilitation program. HR 3533/S2460, "Public & Teaching Hospital Preservation Act" to extend a moratorium prohibiting CMS from implementing the Medicaid proposed rule that would limit Medicaid payments to public hospitals and narrow the definition of government provider and eliminate Medicaid GME HR 3668, TMA, Abstinence Education, and QI Programs Extension Act includes provision which would mitigate the impact of the behavioral offset in the FY08 Inpatient Prospective Payment System (IPPS) final rule S 2499; Medicare, Medicaid, and SCHIP Extension Act Permanently freezes the inpatient rehabilitation services compliance threshold at 60 percent, Extends for six months the work geographic index floor, for six months the provision that allows independent laboratories to continue to bill Medicare directly for the technical component of certain physician pathology services, Provides reasonable cost reimbursement for clinical lab tests performed by certain small rural hospitals, Section 508 hospitals quality S 1226, Children's Health Care Quality Act would allow the Centers for Medicare & Medicaid Services to fund evidence-based demonstrations to improve hospital care for children. HR 1666, Health Care Price Transparency Promotion Act which would build on existing state efforts to report hospital pricing data and require insurers to disclose estimated out-of-pocket costs to consumers S 465; Advance Directives Improvement and Education Act of 2007" to improve access to information about healthcare options and legal rights for care near the end of life rehabilitation hospitals, S543/HR 1459, Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007"; to extend the 60 percent compliance threshold used to determine whether a hospital or unit of a hospital is an inpatient rehabilitation facility under the Medicare program S 2499; Medicare, Medicaid, and SCHIP Extension Act Permanently freezes the inpatient rehabilitation services compliance threshold at 60 percent, rural hospitals, S 1605/HR 2860, Health Care Access and Rural Equity Act (H-CARE) S 1595, Critical Access Hospital Flexibility Act CAHs would gain flexibility to respond to daily and seasonal fluctuations in patient load S 2499;; Medicare, Medicaid, and SCHIP Extension Act Extends for six months the work geographic index floor, for six months the provision that allows independent laboratories to continue to bill Medicare directly for the technical component of certain physician pathology services, Provides reasonable cost reimbursement for clinical lab tests performed by certain small rural hospitals long term care hospitals: HR 562/S338 Medicare Long-Term Care Hospital Improvement establishing facility and patient criteria for long-term care hospitals and related improvements under the Medicare Program. S 2499; Medicare, Medicaid, and SCHIP Extension Act Provides regulatory relief for three years to ensure continued access to current long-term care hospital services, while also imposing a limited moratorium on the development of new, long-term care facilities. Medicaid, HR 2512, Reducing Coverage Gaps for Kids Act To amend titles XIX and XXI of the Social Security Act to prohibit States from requiring eligibility determinations for children for benefits under the Medicaid Program and the State Children's Health Insurance Program (SCHIP) more frequently than once every year. HR 2147, Healthy Kids Act to amend titles XXI and XIX of the Social Security Act to extend the State Children's Health Insurance Program (SCHIP) and streamline enrollment under SCHIP and Medicaid and to amend the Internal Revenue Code of 1986 to provide for a healthy savings tax credit for purchase of children's health coverage. HR1111, Kids Come First Act to ensure that every uninsured child in America has health insurance coverage, HR 1878, To amend title XIX of the Social Security Act to permit States, at their option, to require certain individuals to present satisfactory documentary evidence of proof of citizenship or nationality for purposes of eligibility for Medicaid HR 3533/S2460 "Public & Teaching Hospital Preservation Act" to extend a moratorium prohibiting CMS from implementing the Medicaid proposed rule that would limit Medicaid payments to public hospitals and narrow the definition of government provider and eliminate Medicaid GME HR 5613, Protecting the Medicaid Safety Net Act, temporary, one-year moratorium on seven Medicaid regulations SCHIP: S 1224, that would reauthorize the State Childrens Health Insurance Program and expand it to allow additional coverage to six million children within 10 years S 895/HR 1535, HR 3162, "Children's Health and Medicare Protection Act" HR 976 in the Senate, Children's Health Insurance Program Reauthorization Act S. 1893, the Children's Health Insurance Program Reauthorization Act of 2007 S 2049, The Better Health for America's Children Act," to block a new policy to limit states' ability to enroll children in the State Children's Health Insurance Program S 2152, Kids First Actalternative SCHIP bill that would restrict coverage to individuals younger than age 19 in low-income families HR 3963; Children's Health Insurance Program Reauthorization Act revised bill to extend and expand the State Childrens Health Insurance Program (SCHIP) S 2499 the bill extends SCHIP through March 31, 2009, and provides adequate funding to states to maintain their current enrollment through that date. HR 3533, "Public & Teaching Hospital Preservation Act" to extend a moratorium prohibiting CMS from implementing the Medicaid proposed rule that would limit Medicaid payments to public hospitals and narrow the definition of government provider and eliminate Medicaid GME regulations including, but not limited to, provisions of PL 106-554, Consolidated Appropriations Act, provisions related to critical access hospitals, inpatient hospital services Direct Graduate Medical Education, Hospital Outpatient Services, Skilled Nursing Facilities, State Children's Health Insurance Program PL 108-173, Medicare Prescription Drug, Improvement, and Modernization Act, provisions related to rural hospitals, inpatient hospital services, skilled nursing facilities, hospice care, hospital outpatient departments, health care quality PL 109-171; Deficit Reduction Act, provisions related to rehabilitation hospitals, medicaid DSH payment, medicare-dependent hospitals, gainsharing, Medicaid, SHCHIP the FY08 IPPS proposed rule, proposed Medicaid rule (CMS 2258-P), the Recovery Audit Contract (RAC) demonstration.

H.R.1459 and S.543, "To improve Medicare beneficiary to inpatient rehabilitation facilities," specifically to establish the criteria in HCFA Ruling 85-2, of July 31, 1985 (50 Fed. Reg. 31040), as the sole standard for determining the medical necessity of services for inpatient rehabilitation. H.R.4105, "To impose a moratorium on the use of recovery audit contractors under the Medicare Integrity Program," while supporting initiatives to ensure accountability in the Medicare program, the processes used by CMS and its contractors need to be reviewed to be sure that those processes are accurately identifying inappropriate claims No bill number at this time, support legislation that would enhance the Ethics in Patient Referrals Act of 1989 (the "Stark" law) to include physician ownership in a "whole" hospital S.458 and H.R. 1105, "physician pathology services under the Medicare program," specifically to extend the authority, currently expiring on June 30, 2008, to make direct payments to independent labs for the technical component of pathology services. H.R. 1177, "to extend and improve protections for sole community hospitals under the Medicare Program," specifically to extend the outpatient prospective payment system hold harmless provision and to permit the use of a more current cost reporting year to allow redetermination of hospital target amounts. S.630 and H.R. 2159, "to provide for a minimum payment rate by Medicare Advantage organizations for services furnished by a critical access hospital and a rural health clinic under the Medicare program," specifically to allow critical access hospitals to receive at least 101 percent of their costs for inpatient, swing-bed and outpatient hospital services S.2786, "Medicare Rural Health Access Improvement," specifically to extend th 5 percent bonus payment to physicians practicing in provider scarcity areas (critical access, sole community provider, and Medicare dependent or low-volume areas). H.R. 1845 and S.1428, "to assure access to durable medical equipment under the Medicare Program," specifically to adopt language that would allow hospital owned durable medical equipment companies that are willing to accept the competitive bid rate to provide durable medical equipment to patients upon discharge. S.1595, "flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program" specifically in favor of such increased flexibility.

Issues pertaining to coverage and other health issues; H.R. 1424 Paul Wellstone Mental Health and Addiction Equity Act of 2007, Sec. 2, 3, 5 and 6 and all provisions relating to physician-owned hospitals as well as mental health parity; S. 558 Mental Health Parity Act of 2007, all provisions related to mental health parity; H.R. 1666 Health Care Price Transparency Promotion Act of 2007, all provisions to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs; S. 866 Health Promotion First Act, all provisions pertaining to health promotion reearch and dissemination; S. 1893 Children's Health Insurance Program Reauthorization Act of 2007, all provisions related to this bill; H.R. 2851 and S. 400 Michelle's Law, all provisions to amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to ensure that dependent students who take a medically necessary leave of absence do not lose health insurance coverage, and for other purposes; H.R. 5544 Patients and Public Health Partnership Act of 2008, all provisions to amend the Public Health Service Act to authorize a demonstration project for integrated health systems to expand access to primary and preventive care for the medically underserved, and for other purposes; H.R. 2606 340B Program Improvement and Integrity Act of 2007, all provisions to amend section 340B of the Public Health Service Act to revise and expand the drug discount program under that section to improve the provision of discounts on drug purchases for certain safety net providers; S. 1595 Critical Access Hospital Flexibility Act of 2007, all provisions to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program; S. 334 Healthy Americans Act, all provisions to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away.

H.R. 5613: Medicaid Safety Net Act of 2008 S. 2819: Economic Recovery in Health Care Act S. 2786: Medicare Rural Health Access Improvement Act H.R. 4105: Moratorium on the Recovery Audit Contractor (RAC) program H.R. 5721: Strengthening the Safety Net Act of 2008 H.R. 3066: To permit pass-through payment for reasonable costs of CRNA services in Critical Access Hospitals S. 1277: Critical Access to Clinical Lab Services Act S. 1595: Critical Access Hospital Flexibility Act

Client expense: Not reported · Firm income: Not reported

FFY 2008 Administration Budget Proposal and Its Effect on Hospitals S. 1595 - Critical Access Hospital Flexibility Act of 2007 S. 1277 - Critical Access to Clinical Lab Services Act of 2007 S. 630 / H.R. 1563 / H.R. 2159 - Rural Health Services Preservation Act of 2007 S. 458 / H.R. 1105 - Physician Pathology Services Continuity Act of 2007 H.R. 1899 - Enhanced Options for Rural Health Care Act of 2007 S. 629 - Loans and Grants for Construction and Rehabilitation of CAHs S. 1605 - Craig Thomas Rural Hospital Provider Equity Act of 2007 S. 1376 / H.R. 2606 - 340B Program Improvement and Integrity Act of 2007 H.R. 1177 - Sole Community Hospital Preservation Act of 2007 H.R. 1730 - MedPAC Rural Representation Act S. 1604 - Nursing Education and Quality of Health Care Act of 2007 H.R. 1866 - Medicare Access to Rural Anestheisiology Act of 2007 S. 543 / H.R. 1459 - Preserving Patient Access to Inpatient Rehabilitation Hospitals Act Reauthorization and Funding of State Children's Health Insurance Program Medicare and Medicaid Spending Reductions for Hospitals Medicaid State Plan Amendments and Waivers Renewal of the Missouri Medicaid Partnership Agreement with CMS

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

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

FFY 2008 Administration Budget Proposal and Its Effect on Hospitals S. 1595 - Critical Access Hospital Flexibility Act of 2007 S. 1277 - Critical Access to Clinical Lab Services Act of 2007 S. 630/H.R. 1563/H.R. 2159 - Rural Health Services Preservation Act of 2007 S. 458/H.R. 1105 Physician Pathology Services Continuity Act of 2007 H.R. 1899 Enhanced Options for Rural Health Care Act of 2007 S. 629 Loans and Grants for Construction and Rehabilitation of CAHs S. 1605 Craig Thomas Rural Hospital and Provider Equity Act of 2007 S. 1376/H.R. 2606 340B Program Improvement and Integrity Act of 2007 H.R. 1177 Sole Community Hospital Preservation Act of 2007 H.R. 1730 MedPAC Rural Representation Act S. 1604 Nursing Education and Quality of Health Care Act of 2007 H.R. 1866 Medicare Access to Rural Anesthesiology Act of 2007 S. 543/H.R. 1459 Preserving Patient Access to Inpatient Rehabilitation Hospitals Act Reauthorization and Funding of the State Childrens Health Insurance Program Medicare and Medicaid Spending Reductions for Hospitals Medicaid State Plan Amendments and Waivers Renewal of the Missouri Medicaid Partnership Agreement with CMS

Client expense: $228,009 · Firm income: Not reported

S. 1595 - Critical Access Hospital Flexibility Act of 2007 S. 1277 - Critical Access to Clinical Lab Services Act of 2007 S. 543/H.R. 1459 - Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007 S. 630/H.R. 1563/H.R. 2159 - Rural Health Services Preservation Act of 2007 S. 458/H.R. 1105 Physician Pathology Services Continuity Act of 2007 H.R. 1899 Enhanced Options for Rural Health Care Act of 2007 S. 629 Loans and Grants for Construction and Rehabilitation of CAHs S. 1605 The Craig Thomas Rural Hospital and Provider Equity Act of 2007 (R-HoPE) S. 1376/H.R. 2606 340B Program Improvement and Integrity Act of 2007 H.R. 1177 Sole Community Hospital Preservation Act of 2007 H.R. 1730 MedPAC Rural Representation Act S. 1604 Nursing Education and Quality of Health Care Act of 2007 H.R. 1866 Medicare Access to Rural Anesthesiology Act of 2007 H.R. 3162/H.R. 976 State Childrens Health Insurance Program S. 1958/H.R. 3057 Medicare Long-Term Care Hospital Patient Safety and Improvement Act of 2007 H.R. 3043 2008 Appropriations for U.S. Departments of Labor, Health & Human Services and Education (Health Spending Bill) H.R. 3997 Renewal of Federal Mental Health Parity Law S. 558 Mental Health Parity Act of 2007 H.R. 2699 Medical Student Loan Repayment S. 1947/H.R. 1046 Medicare Quality Improvement Organization (QIO) System Medicaid Prescription Drug 340B Program Expansion Proposed Medicaid Regulations to Limit the Use of Local and State Funds Proposed Medicaid Regulations to Eliminate Federal Funding of Medical Graduate Medical Education Behavioral Offset Cuts Under Medicare Inpatient Prospective Payment System Medicare, Medicaid and SCHIP Extension Act of 2007 Repeal of the Whole Hospital Exception Under the Stark Anti-Fraud Law Renewal of the Missouri Medicaid Partnership Agreement Between the State of Missouri and CMS Medicare Inpatient PPS Behavioral Offset

S. 1595 - Critical Access Hospital Flexibility Act of 2007 S. 1277 - Critical Access to Clinical Lab Services Act of 2007 S. 543/H.R. 1459 - Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007 S. 630/H.R. 1563/H.R. 2159 - Rural Health Services Preservation Act of 2007

Client expense: $370,323 · Firm income: Not reported

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

workforce, HR3043/S1710, S 543/HR 1459; payment: HR 2206, HR 1480/1741/S 787, Section 1011 of the Medicare Modernization Act of 2003 (MMA), HR 1293, HR 882, HR 552/S 329 ; self referral ; quality S 1226, HR 1666, S 465; rehabilitation hospitals, S543/HR 1459; rural hospitals, HR 2860, S 1605, S 1595; long term care hospitals: HR 562/S338 ; Medicaid reform, HR 2512, HR 2147, HR1111, HR 1878; SCHIP: S 1224, S 895/HR 1535; Labor HR 2122, S 1639, HR800/S1041, HR 2123, HR 378, HR 1644, HR1111, HR 2147; regulations including, but not limited to, provisions of PL 106-554, PL 108-173, PL 109-171; the FY08 IPPS proposed rule, proposed Medicaid rule (CMS 2258-P); Medicare and Medicaid Reimbursement issues including HR 2055, HR 2606, S Con Res 21/H Con Res 99, HJ Res. 20, S 355;

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

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

S. 458/H.R. 1105 — Physician Pathology Services Continuity Act of 2007 H.R. 1899 — Enhanced Options for Rural Health Care Act of 2007 S. 629 — Loans and Grants for Construction and Rehabilitation of CAHs S. 1605 — Craig Thomas Rural Hospital and Provider Equity Act of 2007 S. 1376/H.R. 2606 — 340B Program Improvement and Integrity Act of 2007 H.R. 1177 — Sole Community Hospital Preservation Act of 2007 H.R. 1730 — MedPAC Rural Representation Act S. 1604 — Nursing Education and Quality of Health Care Act of 2007 H.R. 1866 — Medicare Access to Rural Anesthesiology Act of 2007 S. 543/H.R. 1459 — Preserving Patient Access to Inpatient Rehabilitation Hospitals Act Reauthorization and Funding of the State Children’s Health Insurance Program Medicare and Medicaid Spending Reductions for Hospitals Medicaid State Plan Amendments and Waivers Renewal of the Missouri Medicaid Partnership Agreement with CMS FFY 2008 Administration Budget Proposal and Its Effect on Hospitals S. 1595 - Critical Access Hospital Flexibility Act of 2007 S. 1277 - Critical Access to Clinical Lab Services Act of 2007 S. 630/H.R. 1563/H.R. 2159 — Rural Health Services Preservation Act of 2007

Client expense: $228,009 · Firm income: Not reported