RE-Aligning Care Act

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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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 CHIP; support state experimentation. Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the CHIP 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; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which contained a temporary extension of current SGR payments to physicians; H.R. 3962, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which sets 2.2% as the update to the single conversion factor in the formula for determining physician payment rates for June 1, 2010, through November 30, 2010; Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011. Medical 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 and FY2011 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. Appropriations FY2011: Advocated for strong investment in Titles VII and VIII programs in FY 2011 Labor, Health & Human Services & Educations appropriations bills; these programs provide direct financial support for health care workforce development and education. Advanced Care Planning: The Personalize Your Care Act of 2010; provides coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans. It would also provide states and communities with grants to create or expand programs that assist with advanced care planning. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act.

Client expense: $240,589 · 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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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 CHIP; support state experimentation. Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the CHIP 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 Medicare's reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which contained a temporary extension of current SGR payments to physicians; H.R. 3962, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which sets 2.2% as the update to the single conversion factor in the formula for determining physician payment rates for June 1, 2010, through November 30, 2010; Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011. Medical 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 and FY2011 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. Appropriations FY2011: Advocated for strong investment in Titles VII and VIII programs in FY 2011 Labor, Health & Human Services & Educations appropriations bills; these programs provide direct financial support for health care workforce development and education. Advanced Care Planning: The Personalize Your Care Act of 2010; provides coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans. It would also provide states and communities with grants to create or expand programs that assist with advanced care planning. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act.

Client expense: $135,939 · 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 Access to Community Health Centers Act (H.R.1643/S.648); Childrens Health Insurance Program Reauthorization Act of 2009 (H.R.2/S.275); Medicaid Prescription Drug Rebate Equalization Act of 2009(S.547/H.R.904); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transitional Care Act (S.1295); AIDS/HIV/STI Screening Act (no bill#); Kids First (no bill#); Reaching Elders with Assessment and Chronic Care Management and Coordination Act (S.1004); EHR for Health Centers Clarification (H.R.6348); Medicare/Medicaid inclusion of onsite translation, social worker, and non-medically needed transport (no bill#); Coordinated Care Networks (H.R.3043, H.R.1614); Medicare ER Diversion Program (no bill#); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Helping Fill the Medicine Rx Gap Act (H.R.2777); Tax Extenders (H.R.4213); Medicare Payment Change House and Senate; FMAP extension.

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

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

H.R.3590 Patient Protection and Affordable Care Act - All Sections related to care coordination, transitional care, long term care services and supports access to affordable insurance, provisions related to individuals with Alzheimer's disease and caregivers and provisions related to research including the Cures Acceleration Network. S.3674/H.R. 5926 Health Outcomes, Planning and Education for Alzheimer's Act, All sections. S.1004/H.R. 2307 Reaching Elders with Assessment and Chronic Care Coordination Act. All provisions relating to Medicare Part B Coverage of geriatric assessment and chronic care management services for eligible beneficiaries and process measures and outcomes for Medicare Beneficiaries with multiple chronic illnesses, including dementia. H.R. 4872 Health Care and Education Reconciliation Act of 2010

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

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

H.R. 3200 America's Affordable Health Choices Act S.245/H.R.468 - Retooling for an Aging America, Building the Healthcare workforce. All provisions relating to expanding education and training opportunities in geriatric and long-term care for licensed health professionals, direct care workers, and family caregivers. H.R.3590 Patient Protection and Affordable Care Act - All Sections related to care coordination, transitional care, long term care services and supports access to affordable insurance, provisions related to individuals with Alzheimer's disease and caregivers and provisions related to research including the Cures Acceleration Network. H.R. 4872 Health Care and Education Reconciliation Act of 2010 S.697/H.R.1721, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program S.1004, Realigning Care Act, All Sections S.2809/H.R.4123 Alzheimers Treatment & Caregiver Support Act, All Sections S.3036/H.R.4689 National Alzheimers Project Act, All Sections H.R.908, Missing Alzheimer's Disease Patient Alert Program Reauthorization of 2009

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

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

H.R. 3590: the Patient Protection and Affordable Care Act H.R. 4872: the Health Care and Education Reconciliation Act of 2010 S. 534: A bill to amend title XVIII of the Social Security Act to reduce cost-sharing under part D of such title for certain non-institutional full-benefit dual eligible individuals. S. 647: A bill to amend titles XVIII and XIX of the Social Security Act to improve the transparency of information on skilled nursing facilities and nursing facilities and to clarify and improve the trageting of the enforcement of requirements with respect to such facilities. S.1110: A bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy. S. 683: A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older American with equal access to community-based attendant services and supports, and for other purposes. S. 46: A bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. S. 750: A bill to amend the Public Health Service Act to attract and retain trained health care professionals and direct care workers dedicated to providing quality care to the growing population of older Americans. H.R. 2006: To amend the Social Security Act to enhance the social security of the Nation by ensuing adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect and exploitation, and for other purposes. H.R. 43: To amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. H.R. 448: Elder Abuse Victims Act of 2009. H.R. 3200: America's Affordable Health Choices Act of 2009. To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 1407: To amend title XVIII of the Social Security Act to reduce cost-sharing under Part D of such title of certain non-instutional full-benefit dual eligible individuals. S. 702: A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under Cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance. H.R. 1255: To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits on behalf of such resident. H.R. 1457: To amend the Public Health Service Act to deem certain geriatric health training to be obligated service for purposes of the National Health Service Corps Loan Repayment Program, and for other purposes. H.R. 3962: To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 4505: A bill that will allow state veterans homes to provide services to non-veteran parents of any child (one or more) who died while serving in the armed forces, has passed in the House and Senate. S. 1679: An original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce. H.R. 2223: To provide for nationwide expansion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers. S. 1131: A bill to amend title XVIII of the Social Security Act to provide certain high cost Medicare beneficiaries suffering from multiple chronic conditions with access to coordinated, primary care medical services in lower cost treatment settings, such as their residences, under a plan of care developed by a team of qualified and experiences health care professionals. S.1004: A bill to amend title XVIII of the Social Security Act to provide Medicare beneficiaries with access to geriatric assessments and chronic care management and coordination services, and for other purposes. H.R. 2: To amend title XXI of the Social Security Act to extend and improve the Children's Health Insurance Program, and for other purposes. S. 795: A bill to amend the Social Security Act to enhance the social security of the Nation by ensuring adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation, and for other purposes. S.631: A bill to provide for nationwide expansion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers. S. 458: A bill to amend the False Claims Act. H.R. 2043: To amend the Public Health Service Act to authorize capitation grants to increase the number of nursing faculty and students, and for other purposes. H.R. 1642: To provide loans and grants for fire sprinkler retrofitting in nursing facilities. H.R. 1494: To ensure that a private for-profit nursing home affected by a major disaster receives the same reimbursement as a public nursing home affected by a major disaster. H.R. 448: To protect seniors in the United States from elder abuse by establishing specialized elder abuse prosecution and research programs and activities to aid victims of elder abuse, to provide training to prosecutors and other law enforcement related to elder abuse prevention and protection, to establish programs that provide for emergency crisis response teams to combat elder abuse, and for other purposes. H.R. 3191: To amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes. S. 386: A bill to improve enforcement of mortgage fraud, securities fraud, financial institutional fraud, and other frauds related to federal assistance and relief programs, for the recovery of funds lost to these frauds, and for other purposes. H.R. 5457: Nursing Home Patient and Medicaid Assistance Act of 2010. H.R. 6130: The Strengthening Medicare Anti-Fraud Measures Act of 2010. H.R. 6261: To amend titles XVIII and XIX of the Social Security Act to improve oversight of nursing facilities under the Medicare and Medicaid programs by ensuring adequate, trained surveyors, and for other purposes. H.R. 5712: Veterans', Seniors', Childrens', Health Tech. Corrections Act of 2010. H.R. 1586: FAA Air Transportation Modernization and Safety Improvement Act-which provides for an extension of additional FMAP support until June 2011. H.R. 6074: Enhancing Quality through Survey System Improvements Act of 2010. H.R. 5950: A bill introduced on June 29th, Rep Joe Courtney (D-CT), introduced the Improving Access to Medicare Coverage Act of 2010, which requires observation stays exceeding 24 hours to be considered as inpatient days for the purpose of meeting the 3-day inpatient hospital requirement for Medicare coverage of SNF stays. H.R. 5850: To solve the staffing issues and backlog in processing HUD 232 loans. H.R. 5950: Improving Access to Medicare Coverage Act of 2010. H.R. 5546: To provide for the establishment of a fraud, waste and abuse detection and mitigation program for the Medicare program under Titles XVIII of the Social Security Act. S. 2781: Rosa's Law. H.R. 5457: Nursing Home Patient and Medicaid Assistance Act of 2010.

Client expense: $500,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), SENATE

S 3543 - Medication Therapy Management Expanded Benefits Act of 2010 HR 3108 - Medication Therapy Management Benefits Act of 2009 Under Line 17: We would like to include the Dept of Health and Human Services' Office of the National Coordinator for Health Information Technology (ONC) HR 5389 - Medicare Clinical Pharmacist Practitioner Services Coverage Act of 2010 HR 2307/S 1004 - Reaching Elders with Assessment and Chronic Care Management and Coordination Act (Public Law 111-148) - Patient Protection and Affordable Care Act [Sections on long-term care pharmacy waste reduction programs, CMS Innovation Center, and pharmacists participation in Accountable Care Organizations (ACOs)] (Docket Number: CMS6010IFC) Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements (Docket Number: CMS-2238-P2) Medicaid Program; Withdrawal of Determination of Average Manufacturer Price, Multiple Source Drug Definition, and Upper Limits for Multiple Source Drugs (Docket Number: CMS-6028-P) Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers (RIN 0991-AB58) Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Final Rule (Docket Number: CMS-0033-F) Medicare and Medicaid Programs; Electronic Health Record Incentive Program (Docket Number: CMS0023IFC) Medicare Program; Identification of Backward Compatible Version of Adopted Standard for EPrescribing and the Medicare Prescription Drug Program (NCPDP SCRIPT 10.6) CMS May 21, 2010 Memorandum to Medicare Part D Sponsors on revised guidance for implementing the Medicare Coverage Gap Discount Program CMS Medicare Part D Coverage Gap Discount Program - Manufacturer Agreements CMS September 10, 2010 Memorandum on Additional Guidance concerning Closing the Coverage Gap in 2011 CMS: Letter on Implementation of Retail Survey Price under the Deficit Reduction Act and the Patient Protection and Affordable Care Act (P.L. 111-148) - August 6, 2010

Client expense: $212,859 · Firm income: Not reported

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

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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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 CHIP; support state experimentation. Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the CHIP 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; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which contained a temporary extension of current SGR payments to physicians; H.R. 3962, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which sets 2.2% as the update to the single conversion factor in the formula for determining physician payment rates for June 1, 2010, through November 30, 2010; Urged action on legislation to provide stability and predictability for Medicare physician payments at least through 2011. Medical 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 and FY2011 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. Appropriations FY2011: Advocated for strong investment in Titles VII and VIII programs in FY 2011 Labor, Health & Human Services & Educations appropriations bills; these programs provide direct financial support for health care workforce development and education. Advanced Care Planning: The Personalize Your Care Act of 2010; provides coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans. It would also provide states and communities with grants to create or expand programs that assist with advanced care planning. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act.

Client expense: $277,506 · 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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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 CHIP; support state experimentation. Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the CHIP 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; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which contained a temporary extension of current SGR payments to physicians; H.R. 3962, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which sets 2.2% as the update to the single conversion factor in the formula for determining physician payment rates for June 1, 2010, through November 30, 2010; Urged action on legislation to provide stability and predictability for Medicare physician payments at least through 2011. Medical 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 and FY2011 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. Appropriations FY2011: Advocated for strong investment in Titles VII and VIII programs in FY 2011 Labor, Health & Human Services & Educations appropriations bills; these programs provide direct financial support for health care workforce development and education. Advanced Care Planning: The Personalize Your Care Act of 2010; provides coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans. It would also provide states and communities with grants to create or expand programs that assist with advanced care planning. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act.

Client expense: $136,378 · 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

H.R. 3200 America's Affordable Health Choices Act S.245/H.R.468 - Retooling for an Aging America, Building the Healthcare workforce. All provisions relating to expanding education and training opportunities in geriatric and long-term care for licensed health professionals, direct care workers, and family caregivers. H.R.3590 Patient Protection and Affordable Care Act S.697/H.R.1721, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program S.1004, Realigning Care Act, All Sections S.2809/H.R.4123 Alzheimers Treatment & Caregiver Support Act, All Sections S.3036/H.R.4689 National Alzheimers Project Act, All Sections H.R.908, Missing Alzheimer's Disease Patient Alert Program Reauthorization of 2009

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

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

H.R.3590 Patient Protection and Affordable Act - All Sections related to care coordination, transitional care, long term care services and supports access to affordable insurance and provisions related to individuals with Alzheimer's disease and caregivers. H.R.3962 Affordable Healthcare for America Act -All Sections related to care coordination, transitional care, long-term care services and supports access to affordable insurance and provisions related to individuals with Alzheimer's disease and caregivers. S.1004/H.R. 2307 Reaching Elders with Assessment and Chronic Care Coordination Act. All provisions relating to Medicare Part B Coverage of geriatric assessment and chronic care management services for eligible beneficiaries and process measures and outcomes for Medicare Beneficiaries with multiple chronic illnesses, including dementia. H.R.3590 Patient Protection and Affordable Care Act

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

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

Medicare Access to Community Health Centers Act (H.R.1643/S.648); Childrens Health Insurance Program Reauthorization Act of 2009 (H.R.2/S.275); Medicaid Prescription Drug Rebate Equalization Act of 2009(S.547/H.R.904); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transitional Care Act(S.1295); AIDS/HIV/STI Screening Act (no bill#); Kids First (no bill#); Reaching Elders with Assessment and Chronic Care Management and Coordination Act (S.1004); Medicare/Medicaid inclusion of onsite translation, social worker, and non-medically needed transport (no bill#); Coordinated Care Networks (H.R.3043, H.R.1614); Medicare ER Diversion Program (no bill#); DSH Collaborative Care Network Pilot Program Act of 2009(H.R.3430); Helping Fill the Medicine Rx Gap Act (H.R.2777); Tax Extenders (H.R.4213)

Client expense: $180,000 · Firm income: Not reported

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

HR 3108 - Medication Therapy Management Benefits Act of 2009 S 3543 - Medication Therapy Management Expanded Benefits Act of 2010 Under Line 17: We would like to include the Dept of Health and Human Services' Office of the National Coordinator for Health Information Technology (ONC) HR 2307/S 1004 - Reaching Elders with Assessment and Chronic Care Management and Coordination Act (Public Law 111-148) - Patient Protection and Affordable Care Act (Sections on long-term care pharmacy waste reduction programs and pharmacists participation in Accountable Care Organizations (ACOs) (Docket Number: CMS-4085-F) Medicare Program; Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs (Docket Number: CMS6010IFC] Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements (Docket Number: CMS-0033-P) Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule (Docket Number: RIN 0991-AB58) Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology (Docket Number: RIN 0991AB59) Proposed Establishment of Certification Programs for Health Information Technology (74 FR 28937) ONC Draft Recommendations for the Term "Meaningful Use" of Electronic Health Records (CAG-00420N) CMS Proposed Decision Memo for Counseling to Prevent Tobacco Use 2011 Preliminary Advanced Notice with Final Call Letter to Medicare Plans CMS April 30, 2010 Memorandum to Medicare Part D Sponsors on Draft guidance for implementing the Medicare Coverage Gap Discount Program CMS May 21, 2010 Memorandum to Medicare Part D Sponsors on revised guidance for implementing the Medicare Coverage Gap Discount Program

Client expense: $151,510 · Firm income: Not reported

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

H.R. 3590: the Patient Protection and Affordable Care Act H.R. 4872: the Health Care and Education Reconciliation Act of 2010 S. 534: A bill to amend title XVIII of the Social Security Act to reduce cost-sharing under part D of such title for certain non-institutional full-benefit dual eligible individuals. S. 647: A bill to amend titles XVIII and XIX of the Social Security Act to improve the transparency of information on skilled nursing facilities and nursing facilities and to clarify and improve the trageting of the enforcement of requirements with respect to such facilities. S.1110: A bill to amend title XVIII of the Social Security Act to create a sensible infrastructure ofr delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy. S. 683: A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older American with equal access to community-based attendant services and supports, and for other purposes. S. 46: A bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. S. 750: A bill to amend the Public Health Service Act to attract and retain trained health care professionals and direct care workers dedicated to providing quality care to the growing population of older Americans. H.R. 2006: To amend the Social Security Act to enhance the social security of the Nation by ensuing adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute edler abuse, neglect and exploitation, and for other purposes. H.R. 43: To amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. H.R. 448: Elder Abuse Victims Act of 2009. H.R. 3200: America's Affordable Health Choices Act of 2009. To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 1407: To amend title XVIII of the Social Security Act to reduce cost-sharing under Part D of such title of certain non-instutional full-benefit dual eligible individuals. S. 702: A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under Cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance. H.R. 1255: To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits on behalf of such resident. H.R. 1457: To amend the Public Health Service Act to deem certain geriatric health training to be obligated service for purposes of the National Health Service Corps Loan Repayment Program, and for other purposes. H.R. 3962: To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. S. 1679: An original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce. H.R. 2223: To provide for nationwide expansion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers. S. 1131: A bill to amend title XVIII of the Social Security Act to provide certain high cost Medicare beneficiaries suffering from multiple chronic conditions with access to coordinated, primary care medical services in lower cost treatment settings, such as their residences, under a plan of care developed by a team of qualified and experiences health care professionals. S.1004: A bill to amend title XVIII of the Social Security Act to provide Medicare beneficiaries with access to geriatric assessments and chronic care management and coordination services, and for other purposes. H.R. 2: To amend title XXI of the Social Security Act to extend and improve the Children's Health Insurance Program, and for other purposes. S. 795: A bill to amend the Social Security Act to enhance the social security of the Nation by ensuring adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation, and for other purposes. S.631: A bill to provide for nationwide expansion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers. S. 458: A bill to amend the False Claims Act. H.R. 2043: To amend the Public Health Service Act to authorize capitation grants to increase the number of nursing faculty and students, and for other purposes. H.R. 1642: To provide loans and grants for fire sprinkler retrofitting in nursing facilities. H.R. 1494: To ensure that a private for-profit nursing home affected by a major disaster receives the same rreimbursement as a public nursing home affected by a major disaster. H.R. 448: To protect seniors in the United States from elder abuse by establishing specialized elder abuse prosecution and research programs and activities to aid victims of elder abuse, to provide training to prosecutors and other law enforcement related to elder abuse prevention and protection, to establish programs that provide for emergency crisis response teams to combat elder abuse, and for other purposes. H.R. 3191: To amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes. S. 386: A bill to improve enforcement of mortgage fraud, securities fraud, financial institutional fraud, and other frauds related to federal assistance and relief programs, for the recovery of funds lost to these frauds, and for other purposes. H.R. 5457: Nursing Home Patient and Medicaid Assistance Act of 2010.

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

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), 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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which contained a temporary extension of current SGR payments to physicians; H.R. 3962, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which sets 2.2% as the update to the single conversion factor in the formula for determining physician payment rates for June 1, 2010, through November 30, 2010. Medical 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 and FY2011 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. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act.

Client expense: $427,338 · 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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which contained a temporary extension of current SGR payments to physicians; H.R. 3962, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which sets 2.2% as the update to the single conversion factor in the formula for determining physician payment rates for June 1, 2010, through November 30, 2010. Medical 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 and FY2011 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. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage: Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act.

Client expense: $169,266 · 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

H.R. 3200 America's Affordable Health Choices Act S.1004/H.R. 2307 Reaching Elders with Assessment and Chronic Care Coordination Act. 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. H.R.3590 Patient Protection and Affordable Care Act S.697/H.R.1721, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program. S.245/H.R.468 - 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. S.1004, Realigning Care Act, All Sections S.2809/H.R.4123 Alzheimer's Treatment & Caregiver Support Act, All Sections S.3036/H.R.4689 National Alzheimers Project Act, All Sections

Client expense: $140,000 · Firm income: Not reported

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

HR 2718/S 1110 - MedPAC Reform Act of 2009 HR 2307/S 1004 - Reaching Elders with Assessment and Chronic Care Management and Coordination Act Under Line 17: We would like to include the Dept of Health and Human Services' Office of the National Coordinator for Health Information Technology (ONC) and the Office of Inspector General (OIG) S 1634 - The Medicare Prescription Drug Improvement Act of 2009 S 266 - Medicare Prescription Drug Gap Reduction Act of 2009 HR 203 - Medicare Fraud Prevention Act of 2009 HR 27 - Medicare Fraud Prevention and Enforcement Act of 2009 HR 616/S 511 - Access to Durable Medical Equipment Act HR 574/S 254 - Medicare Home Infusion Therapy Coverage Act of 2009 HR 2560/S 1131 - Independence At Home Act HR 1970/S 956 - Preserve Patient Access to the Reputable DMEPOS Providers Act of 2009 HR 3700/S 1951 - Fair Medicaid Drug Payment Act (From 110th Congress)/Concept to Include Medicaid Average Manufacturers Price Reimbursement Formula in Health Care Reform HR 3108 - Medication Therapy Management Benefits Act of 2009/Concept to Include Medication Therapy Management Provisions in Health Care Reform S 683 - Community Choice Act of 2009 HR 1392/S 1221 - Amends the Social Security Act to ensure more appropriate payment amounts for drugs and biologicals under Part B of the Medicare Program by excluding customary prompt pay discounts extended to wholesalers from the manufacturer's average sales price S AMDT 3320 to the Commerce, Justice, Science, and Related Agencies Appropriations Act, 2010 (H.R.2847) [Section on the treatment of pharmacies under durable medical equipment accreditation requirements] (Public Law 110-275) Medicare Improvements for Patients and Providers Act of 2008 sections on Medicare DMEPOS (Docket Number CMS-4085-P) Medicare Program; Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs (Docket Number: CMS1561IFC) Medicare Program; Changes to the Competitive Acquisition of Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) by Certain Provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Docket Number: CMS-1540-F) Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2007; Certain Provisions Concerning Competitive Acquisition for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); Accreditation of DMEPOS Suppliers (Docket Number: CMS-6006-F) Medicare Program: Surety Bond Requirement for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (Docket Number: CMS-0033-P) Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule (Docket Number: RIN 0991-AB58) Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology (Docket Number: RIN 0991AB59) Proposed Establishment of Certification Programs for Health Information Technology (74 FR 28937) ONC Draft Recommendations for the Term "Meaningful Use" of Electronic Health Records CMS August 2009 Memo: Fraud, Waste and Abuse (FWA) Training Clarification (regarding changes to 42 C.F.R. 422.503(b)(4)(vi) and 42 C.F.R. 423.504 (b)(4)(vi)) Final 2010 Medicare Part D Call Letter on NDC Non-Matched List 2011 Preliminary Advanced Notice with Draft Call Letter to Medicare Plans 2011 Preliminary Advanced Notice with Final Call Letter to Medicare Plans Draft Medicare Part D Model Notices for Beneficiaries: Mail-Order and Excluded Provider GAO Report on Medicaid Outpatient Prescription Drugs: Second Quarter 2008 Federal Upper Limits for Reimbursement Compared with Average Retail Pharmacy Acquisition Costs OIG Report on A Comparison of Medicaid Federal Upper Limit Amounts to Acquisition Costs, Medicare Payment Amounts, and Retail Prices

Client expense: $149,615 · Firm income: Not reported

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

Medicare Access to Community Health Centers Act (H.R.1643/S.648); Childrens Health Insurance Program Reauthorization Act of 2009 (H.R.2/S.275); Medicaid Prescription Drug Rebate Equalization Act of 2009(S.547/H.R.904); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transitional Care Act(S.1295); AIDS/HIV/STI Screening Act (no bill#); Kids First (no bill#); Reaching Elders with Assessment and Chronic Care Management and Coordination Act (S.1004); Medicare/Medicaid inclusion of onsite translation, social worker, and non-medically needed transport (no bill#); Coordinated Care Networks (H.R.3043, H.R.1614); Medicare ER Diversion Program (no bill#); DSH Collaborative Care Network Pilot Program Act of 2009(H.R.3430); Helping Fill the Medicine Rx Gap Act (H.R.2777).

Client expense: $210,000 · Firm income: Not reported

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

H.R. 3590: the Patient Protection and Affordable Care Act H.R. 4872: the Health Care and Education Reconciliation Act of 2010 S. 534: A bill to amend title XVIII of the Social Security Act to reduce cost-sharing under part D of such title for certain non-institutional full-benefit dual eligible individuals. S. 647: A bill to amend titles XVIII and XIX of the Social Security Act to improve the transparency of information on skilled nursing facilities and nursing facilities and to clarify and improve the trageting of the enforcement of requirements with respect to such facilities. S.1110: A bill to amend title XVIII of the Social Security Act to create a sensible infrastructure ofr delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy. S. 683: A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older American with equal access to community-based attendant services and supports, and for other purposes. S. 46: A bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. S. 750: A bill to amend the Public Health Service Act to attract and retain trained health care professionals and direct care workers dedicated to providing quality care to the growing population of older Americans. H.R. 2006: To amend the Social Security Act to enhance the social security of the Nation by ensuing adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute edler abuse, neglect and exploitation, and for other purposes. H.R. 43: To amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. H.R. 448: Elder Abuse Victims Act of 2009. H.R. 3200: America's Affordable Health Choices Act of 2009. To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 1407: To amend title XVIII of the Social Security Act to reduce cost-sharing under Part D of such title of certain non-instutional full-benefit dual eligible individuals. S. 702: A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under Cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance. H.R. 1255: To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits on behalf of such resident. H.R. 1457: To amend the Public Health Service Act to deem certain geriatric health training to be obligated service for purposes of the National Health Service Corps Loan Repayment Program, and for other purposes. H.R. 3962: To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. S. 1679: An original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce. H.R. 2223: To provide for nationwide expansion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers. S. 1131: A bill to amend title XVIII of the Social Security Act to provide certain high cost Medicare beneficiaries suffering from multiple chronic conditions with access to coordinated, primary care medical services in lower cost treatment settings, such as their residences, under a plan of care developed by a team of qualified and experiences health care professionals. S.1004: A bill to amend title XVIII of the Social Security Act to provide Medicare beneficiaries with access to geriatric assessments and chronic care management and coordination services, and for other purposes. H.R. 2: To amend title XXI of the Social Security Act to extend and improve the Children's Health Insurance Program, and for other purposes. S. 795: A bill to amend the Social Security Act to enhance the social security of the Nation by ensuring adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation, and for other purposes. S.631: A bill to provide for nationwide expansion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers. S. 458: A bill to amend the False Claims Act. H.R. 2043: To amend the Public Health Service Act to authorize capitation grants to increase the number of nursing faculty and students, and for other purposes. H.R. 1642: To provide loans and grants for fire sprinkler retrofitting in nursing facilities. H.R. 1494: To ensure that a private for-profit nursing home affected by a major disaster receives the same rreimbursement as a public nursing home affected by a major disaster. H.R. 448: To protect seniors in the United States from elder abuse by establishing specialized elder abuse prosecution and research programs and activities to aid victims of elder abuse, to provide training to prosecutors and other law enforcement related to elder abuse prevention and protection, to establish programs that provide for emergency crisis response teams to combat elder abuse, and for other purposes. H.R. 3191: To amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes. S. 386: A bill to improve enforcement of mortgage fraud, securities fraud, financial institutional fraud, and other frauds related to federal assistance and relief programs, for the recovery of funds lost to these frauds, and for other purposes.

Client expense: $460,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), 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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Medical 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. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification.

Client expense: $292,628 · 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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Medical 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. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification.

Client expense: $152,236 · 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

H.R. 3200 America's Affordable Health Choices Act S.1004/H.R. 2307 Reaching Elders with Assessment and Chronic Care Coordination Act. 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. S697/HR1721, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program. S750, Caring for An Aging America Act, all provisions relating to training of health care professionals and direct care workers S245/HR468 - 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: $90,000 · Firm income: Not reported

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

Medicare Access to Community Health Centers Act (H.R.1643/S.648); Childrens Health Insurance Program Reauthorization Act of 2009 (H.R.2/S.275); Medicaid Prescription Drug Rebate Equalization Act of 2009(S.547/H.R.904); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transitional Care Act (S.1295); AIDS/HIV/STI Screening Act (no bill#); Kids First (no bill#); Reaching Elders with Assessment and Chronic Care Management and Coordination Act (S.1004); Medicare/Medicaid inclusion of onsite translation, social worker, and non-medically needed transport (no bill#); Coordinated Care Networks (H.R.3043, H.R.1614); Medicare ER Diversion Program (no bill#); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Helping Fill the Medicine Rx Gap Act (H.R.2777).

Client expense: $200,000 · Firm income: Not reported

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

Senate Finance Committee Draft Policy Options (Baucus/Grassley) - expanded care coordination services in Medicaid, promotion of prevention and wellness in Medicare and Medicaid, health disparaties, quality improvements, health information technology House Tri-Committee Discussion Draft for Health Reform (Waxman, Rangel, Miller) - sections 1176-1179 Medicare Advantage special needs plans, section 1301 Medicare Accountable Care Organization Pilot Program, section 1302 Medicare Medical Home pilot program Medicare Transitional Care Act of 2009 - HR 2773 (Blumenauer)/S 1295 (Bennet) - entire bill RE-Aligning Care Act - HR 2307 (Green)/S 1004 (Lincoln) - entire bill Independence At Home Act of 2009 - HR 2560 (Markey)/S 1131 (Wyden) - entire bill

Client expense: $173,000 · Firm income: Not reported

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

Senate Finance Committee Draft Policy Options (Baucus/Grassley) - expanded care coordination services in Medicaid, promotion of prevention and wellness in Medicare and Medicaid, health disparaties, quality improvements, health information technology House Tri-Committee Discussion Draft for Health Reform (Waxman, Rangel, Miller) - sections 1176-1179 Medicare Advantage special needs plans, section 1301 Medicare Accountable Care Organization Pilot Program, section 1302 Medicare Medical Home pilot program Medicare Transitional Care Act of 2009 - HR 2773 (Blumenauer)/S 1295 (Bennet) - entire bill RE-Aligning Care Act - HR 2307 (Green)/S 1004 (Lincoln) - entire bill Independence At Home Act of 2009 - HR 2560 (Markey)/S 1131 (Wyden) - entire bill

Client expense: $173,000 · Firm income: Not reported

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

Aging, health and Medicare, including S. 1004 and H.R. 2307. Funding for Title VII health professions programs.

Client expense: Not reported · Firm income: Not reported

H.R. 3200 America's Affordable Health Choices Act S.1004/H.R. 2307 Reaching Elders with Assessment and Chronic Care Coordination Act. 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. HR3590 Patient Protection and Affordable Care Act S697/HR1721, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program. S750, Caring for An Aging America Act, all provisions relating to training of health care professionals and direct care workers S245/HR468 - 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. S1004, Realigning Care Act, All Sections HR632/S557 National Silver Alert Act HR4123/S2809 Alzheimer's Treatment & Caregiver Support Act

Client expense: $140,000 · Firm income: Not reported

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

HR 2718/S 1110 - MedPAC Reform Act of 2009 HR 2307/S 1004 - Reaching Elders with Assessment and Chronic Care Management and Coordination Act S 1634 - The Medicare Prescription Drug Improvement Act of 2009 Under Line 17: We would like to include the Office of the National Coordinator for Health Information Technology S 266 - Medicare Prescription Drug Gap Reduction Act of 2009 HR 203 - Medicare Fraud Prevention Act of 2009 HR 27 - Medicare Fraud Prevention and Enforcement Act of 2009 HR 616/S 511 - Access to Durable Medical Equipment Act HR 574/S 254 - Medicare Home Infusion Therapy Coverage Act of 2009 HR 2560/S 1131 - Independence At Home Act HR 1970/S 956 - Preserve Patient Access to the Reputable DMEPOS Providers Act of 2009 HR 3700/S 1951 - Fair Medicaid Drug Payment Act (From 110th Congress)/Concept to Include Medicaid Average Manufacturers Price Reimbursement Formula in Health Care Reform HR 3108 - Medication Therapy Managament Benefits Act of 2009/Concept to Include Medication Therapy Management Provisions in Health Care Reform HR 3663 - Amends the Social Security Act to delay the October 1, 2009 deadline on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies. (Public Law 111-72) S 683 - Community Choice Act of 2009 HR 1392/S 1221 - Amends the Social Security Act to ensure more appropriate payment amounts for drugs and biologicals under Part B of the Medicare Program by excluding customary prompt pay discounts extended to wholesalers from the manufacturer's average sales price (Public Law 110-275) Medicare Improvements for Patients and Providers Act of 2008 sections on Medicare DMEPOS (Docket Number CMS-4085-P) Medicare Program; Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs (Docket Number: CMS1561IFC) Medicare Program; Changes to the Competitive Acquisition of Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) by Certain Provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Docket Number: CMS-1540-F) Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2007; Certain Provisions Concerning Competitive Acquisition for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); Accreditation of DMEPOS Suppliers (Docket Number: CMS-6006-F) Medicare Program: Surety Bond Requirement for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (Docket No. CMS-4085-P) Medicare Program; Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs Docket Number: CMS-10260 (OMB#: 0938-1051) Collection Activities; Medicare Advantage and Prescription Drug Program: Final Marketing Provisions (74 FR 28937) ONC Draft Recommendations for the Term "Meaningful Use" of Electronic Health Records CMS August 2009 Memo: Fraud, Waste and Abuse (FWA) Training Clarification (regarding changes to 42 C.F.R. 422.503(b)(4)(vi) and 42 C.F.R. 423.504 (b)(4)(vi)) Final 2010 Medicare Part D Call Letter Draft Part D Model Notices for Beneficiaries: Mail-Order and Excluded Provider

Client expense: $117,517 · Firm income: Not reported

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

Medicare Access to Community Health Centers Act (H.R.1643/S.648); Children's Health Insurance Program Reauthorization Act of 2009 (H.R.2/S.275); Medicaid Prescription Drug Rebate Equalization Act of 2009(S.547/H.R.904); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transitional Care Act(S.1295); AIDS/HIV/STI Screening Act (no bill#); Kids First (no bill#); Reaching Elders with Assessment and Chronic Care Management and Coordination Act (S.1004) Medicare/Medicaid inclusion of onsite translation, social worker, and non-medically needed transport (no bill#); Coordinated Care Networks (H.R.3043, H.R.1614); Medicare ER Division Program (no bill#); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Helping Fill the Medicine Rx Gap Act (H.R. 2777).

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

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

Aging, Health Care Workforce and Medicare, including H.R. 3590, H.R. 3962, S. 750, S. 245, S. 1004, H.R. 468, H.R. 2307, H.R. 3200 and health care reform bills. Appropriations funding for Title VII geriatrics health professions programs.

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

Government targets: 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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Medical 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. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962 and H.R. 3590): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification.

Client expense: $289,221 · 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

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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). Medical 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. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962 and H.R. 3590): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification.

Client expense: $147,925 · 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

H.R. 1407: To amend title XVIII of the Social Security Act to reduce cost-sharing under Part D of such title for certain non-institutional full-benefit dual eligible individuals. S. 534: A bill to amend title XVIII of the Social Security Act to reduce cost-sharing under part D of such title for certain non-institutional full-benefit dual eligible individuals. S. 647: A bill to amend titles XVIII and XIX of the Social Security Act to improve the transparency of information on skilled nursing facilities and nursing facilities and to clarify and improve the targeting of the enforcement of requirements with respect to such facilities. S. 1110: A bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy. S. 683: A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. S. 46: A bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. S. 750: A bill to amend the Public Health Service Act to attract and retain trained health care professionals and direct care workers dedicated to providing quality care to the growing population of older Americans. H.R. 1: Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for fiscal year ending September 30, 2009, and for other purposes. H.R. 2: The Children's Health Insurance Program Reauthorization Act of 2009, establishing a Medicaid and CHIP Payment and Access Commission (MACPAC). This new Commission will provide Congress with a new, credible forum to discuss specific ways to strengthen the nation's Medicaid payment system, and ensure the growing needs of America's most vulnerable, frail, elderly and the disabled beneficiaries are met and in the years ahead. H.R. 2006: To amend the Social Security Act to enhance the social security of the Nation by ensuring adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect and exploitation, and for other purposes. H.R. 43: To amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. H.R. 1255: A bill which protects the interests of each resident of intermediate care facilities for the mentally retarded or developmentally disabled (ICFs/MRDD) in related class action lawsuits. H.R. 448: Elder Abuse Victims Act of 2009. H.R. 3200: America's Affordable Health Choices Act of 2009. To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. S. 1796: America's Healthy Future Act of 2009. To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 632: To encourage, enhance, and integrate Silver Alert plans throughout the United States, to authorize grants for the assistance of organizations to find missing adults, and for other purpose. S. 1131: A bill to amend title XVIII of the Social Security Act to provide certain high cost Medicare beneficiaries suffering from multiple chronic conditions with access to coordinated, primary care medical services in lower cost treatment settings, such as their residences, under a plan of care developed by a team of qualified and experienced health care professionals. S. 1004: A bill to amend title XVIII of the Social Security Act to provide Medicare beneficiaries with access to geriatric assessments and chronic care management and coordination services, and for other purposes. S. 702: A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under Cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance. H.R. 1255: To protect the interests of each resident of intermediate care facilities for the mentally retarded in class action lawsuits on behalf of such resident. H.R. 632: To encourage, enhance, and integrate Silver Alert plans throughout the United States, to authorize grants for the assistance of organizations to find missing adults, and for other purposes. H.R. 1457: To amend the Public Health Service Act to deem certain geriatric health training to be obligated service for purposes of the National Health Service Corps Loan Repayment Program, and for other purposes. H.R. 3191: To amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes. H.R. 3962: To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 3590: The Patient Protection and Affordable Care Act. S. 1679 An original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce. H.R. 2223: To provide for nationwide expansion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers.

Client expense: $440,000 · Firm income: Not reported

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

H.R. 3200 America's Affordable Health Choices Act S.1004/H.R. 2307 Reaching Elders with Assessment and Chronic Care Coordination Act. 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. S697/HR1721, The Community Living Assistance Services and Supports Act, all provisions relating to establishing a national, voluntary disability insurance program. S750, Caring for An Aging America Act, all provisions relating to training of health care professionals and direct care workers S245/HR468 - 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: $90,000 · Firm income: Not reported

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

Medicare Access to Community Health Centers Act (H.R.1643/S.648); Childrens Health Insurance Program Reauthorization Act of 2009 (H.R.2/S.275); Medicaid Prescription Drug Rebate Equalization Act of 2009(S.547/H.R.904); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transitional Care Act (S.1295); AIDS/HIV/STI Screening Act (no bill#); Kids First (no bill#); Reaching Elders with Assessment and Chronic Care Management and Coordination Act (S.1004); Medicare/Medicaid inclusion of onsite translation, social worker, and non-medically needed transport (no bill#); Coordinated Care Networks (H.R.3043, H.R.1614); Medicare ER Division Program (no bill#); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Helping Fill the Medicine Rx Gap Act (H.R.2777).

Client expense: $200,000 · Firm income: Not reported

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

House Tri-Committee "America's Affordable Health Choices Act of 2009" (Waxman, Rangel and Miller - HR 3200) - Medicare Advantage reforms (subtitle D), accountable care organization pilot program (sec. 1301), medical home pilot program (sec. 1302), coverage and waiver of cost-sharing for preventive services (sec. 1305), required coverage of preventive services (Title VII, subtitle B, sec. 1711), Medicaid medical home pilot program (Title VII, subtitle C, sec. 1722). Senate Finance Chairman's Mark "America's Healthy Future Act of 2009" (no bill number) - promoting prevention and wellness in Medicare and Medicaid (Title II, subtitles A and B), improving quality and efficiency (Title III, subtitle A), encouraging development of new patient care models - accountable care organizations & CMS Innovation Center (Title III, part III), Medicare Advantage reform (Title III, subtitle C), patient-centered outcomes research (Title III, subtitle F). Medicare Transitional Care Act of 2009 - HR 2773 (Blumenauer)/S. 1295 Bennet) - entire bill RE-Aligning Care Act - HR 2307 (Green)/S 1004 (Lincoln) - entire bill Independence At Home Act of 2009 - HR 2560 (Markey)/S 1131 (Wyden) - entire bill

Client expense: $150,183 · Firm income: Not reported

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

Lobbied for a Senate sponsor for the Alzheimer's Treatment and Caregiver Support Act and for co-sponsors for H.R. 3043, the Medicare Adult Day Care Services Act of 2009." Urged cosponsorship and inclusion in Senate HELP, Senate Finance, and the House Tri-Committee health reform bills for the following proposals: S. 647 (and not yet introduced House version) of the "Nursing Home Transparancy and Improvement Act of 2009;" S. 245 and H.R. 468, "Retooling the Health Care Workforce;" S. 697 and H.R. 1721, Community Living Assistance Services and Supports (CLASS) Act;" S. 1004 and H.R. 2307, The RE-Aligning Care Act, and S. 1131 and H.R. 2560, The Independence at Home Act; H.R. 3191, "The Positive Aging Act;" and S. 1263, the Senior Navigation and Planning Act of 2009.

Client expense: $22,500 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1407: To amend title XVIII of the Social Security Act to reduce cost-sharing under Part D of such title for certain non-institutional full-benefit dual eligible individuals. S. 534: A bill to amend title XVIII of the Social Security Act to reduce cost-sharing under part D of such title for certain non-institutional full-benefit dual eligible individuals. S. 647: A bill to amend titles XVIII and XIX of the Social Security Act to improve the transparency of information on skilled nursing facilities and nursing facilities and to clarify and improve the targeting of the enforcement of requirements with respect to such facilities. S. 1110: A bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy. S. 683: A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. S. 46: A bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. S. 750: A bill to amend the Public Health Service Act to attract and retain trained health care professionals and direct care workers dedicated to providing quality care to the growing population of older Americans. H.R. 1: Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for fiscal year ending September 30, 2009, and for other purposes. H.R. 2: The Children's Health Insurance Program Reauthorization Act of 2009, establishing a Medicaid and CHIP Payment and Access Commission (MACPAC). This new Commission will provide Congress with a new, credible forum to discuss specific ways to strengthen the nation's Medicaid payment system, and ensure the growing needs of America's most vulnerable, frail, elderly and the disabled beneficiaries are met and in the years ahead. H.R. 2006: To amend the Social Security Act to enhance the social security of the Nation by ensuring adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect and exploitation, and for other purposes. H.R. 43: To amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. H.R. 1255: A bill which protects the interests of each resident of intermediate care facilities for the mentally retarded or developmentally disabled (ICFs/MRDD) in related class action lawsuits. H.R. 448: Elder Abuse Victims Act of 2009. H.R. 3200: America's Affordable Health Choices Act of 2009. To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. S. 1796: America's Healthy Future Act of 2009. To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 632: To encourage, enhance, and integrate Silver Alert plans throughout the United States, to authorize grants for the assistance of organizations to find missing adults, and for other purpose. S. 1131: A bill to amend title XVIII of the Social Security Act to provide certain high cost Medicare beneficiaries suffering from multiple chronic conditions with access to coordinated, primary care medical services in lower cost treatment settings, such as their residences, under a plan fo care developed by a team of qualified and experienced health care professionals. S. 1004: A bill to amend title XVIII of the Social Security Act to provide Medicare beneficiaries with access to geriatric assessments and chronic care management and coordination services, and for other purposes. S. 702: A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under Cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance.

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

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

HR 1670/S 638, Community Choice Act, providing for Medicaid coverage of community-based attendant services for nursing-home-eligible elders and people with disabilities - support and advocate for inclusion in health care reform. S 434, Emplowered at Home Act, to enable more elders and people with disabilities to qualify for Medicaid coverage of adult day services and home- and community-based services - support HR 3200, America's Affordable Health Choices Act - advocating against Medicare reimbursement freeze for nursing homes, home health care providers, and hospice. In favor of research and evaluation before bundling of post-acute care is implemented. S 1257/HR 2852, Project 2020-to establish single entry points into the LTSS system and enhance nursing home diversion programs - support HR 3043, Medicare Adult Day Services Act-provides for Medicare coverage of subsitute adult day services - support S 1004/HR 2307, RE-Aligning Care Act, to link eligible seniors suffering from chronic illnesses with a qualified health professional to coordinate their care - for S1131/HR2560, Independence at Home Act, authorizing voluntary chronic care coordination pilot programs for high-cost Medicare beneficiaries with multiple chronic conditions - support and favor inclusion in health care reform. HR 2773/S 1295, Medicare Transitional Care Act, providing Medicare coverage of transitional services upon discharge from a hospital - support

Client expense: $116,068 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Senate Finance Chairman's Mark - America's Healthy Future Act (Baucus): role of public programs (Title I, Subtitle G), promoting disease prevention and wellness (Title II), linking payment to quality in Medicare (Title III, Subtitle A, Part I), development of new patient care models (Title III, Subtitle A, Part III), Medicare Advantange (Title III, Subtitle C) HR 3200 America's Affordable Health Choices Act (Waxman, Rangel, Miller)- accountable care organizations (Division B, Title III, Sec. 1301), medical homes (Division B, Title III, Section 1302), Medicare Advantage (Division B, Title I, Subtitle D), Special needs plans (Division B, Title I, Subtitle D, Sec. 1176 & 1177) S 1249 (Klobuchar) Medicare Payment Improvement Act of 2009 (entire bill) HR 2844 (Kind) Medicare Payment Improvement Act of 2009 (entire bill) S 1262 (Cantwell) Medical Efficiency and Delivery Improvement of Care Act of 2009 (Title III, Sec 3003) S 1133 (Wyden) Empowering Medicare Patient Choices Act (entire bill) HR 2580 (Blumenauer) Empowering Medicare Patient Choices Act (entire bill) S 1004 (Lincoln) RE-Aligning Care Act (entire bill) HR 2307 (Green) RE-Aligning Care Act (entire bill) S 1131 (Wyden) Independence at Home Act of 2009 (entire bill) HR 2560 (Markey) Independence at Home Act of 2009 (entire bill) S 1009 (Bennet) Medicare Care Transitions Program Act of 2009 (entire bill)

Client expense: $93,696 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Medicare Payment Advisory Commission (MedPAC), SENATE

Aging, Health Care Workforce and Medicare, including S. 750, S. 245, S. 1004, H.R. 468, H.R. 2307, H.R. 3200 and health care reform bills. Appropriations funding for Title VII geriatrics health professions programs.

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

Government targets: 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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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. Medical 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. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation: Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury.

Client expense: $300,237 · 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/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. 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. Medical 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. 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. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation: Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury.

Client expense: $147,842 · 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

HR 2307/S. 1004, Realigning Care Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE