Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions in the Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Care Act (H.R.3590, P.L. 111-148)); and Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872), P.L. 111-152); Medicare Commission legislation (S.1110, S. 1380, H.R.2718), provisions that would empower a Commission to implement Medicare policy changes; geographic variation legislation (H.R. 2844, H.R. 2919, H.R. 2921, H.R. 2201, S.Amdt. 887) affecting hospitals and/or physician payment policy; value-based purchasing legislation (H.R. 1776); other workforce legislation (H.R. 1946, S.1569)); Puerto Rico Medicare Parity (H.R. 2680, H.R. 1501, H.R.1502); Medicare physician payment adjustment (HR. 3961, S.1776, H.R.3326, H.R. 3590, H.R. 4851, S. 3153, H.R. 4213); Section 508 wage index extension and gainsharing extension (H.R. 4213); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); Medicare 72-hour payment window limitation (H.R.4213); HIT incentive payments and meaningful use requirements in final rule CMS-0033-F (H.R. 6072, S. 3708); the "coding offset" in the proposed and final Medicare inpatient prospective payment system rule for 2011 (CMS-1498); the Medicare and Medicaid Extenders Act (H.R. 4994, later P.L. 111-309); and cancer hospital Medicare payment issues. Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) and ARRA FMAP Extension (H.R. 4263, H.R. 2847, H.R.4213) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679), Affordable Healthcare for America Act (H.R. 3962), Patient Protection and Affordable Care Act (H.R. 3590, P.L. 111-148), and the Health and Education Affordability Reconciliation Act of 2010 (H.R. 4872, P.L. 111-152)), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); HIT incentive payments and meaningful use requirements in final rule CMS-0033-F (H.R. 6072, S.3708); and the Medicare and Medicaid Extenders Act (H.R. 4994, later P.L. 111-309).

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

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

American Health Security Act (H.R. 1200); Access for All America Act (H.R. 1296/S.486); Primary Care Volunteer Incentive Act (H.R. 1185); Health Access and Health Professions Supply Act (S.790); Title VII Reauthorization (S.1720); Conrad State 30 Improvement Act (S.628); Recognizing the value of community health centers (HCon.Res.144/S.Con.Res.25). Tri-Caucus Health Equity and Accountant Act; Health Information Technology Public Utility Act of 2009 (S.890); Womens Medical House Demonstration Act (S.1303); Family Healthcare Accessibility Act (H.R.1745); Community Coalitions for Access and Quality Improvement Act (H.R.1614/S.652); Health Access and Health Professions Supply Act (S.790); GAO Study request on VA/CHCs Act (no bill#); Affordable Health Choices Act (H.R.3200); Resident Physician Shortage Act (S.973/H.R.2251); Seniors Mental Health Access Improvement Act (H.R.1693/S.671); Public Health Workforce Development Act (H.R.2620/S.1143); Helping Fill the Medicine Rx Gap Act (H.R.2777/S.1201); Primary Care Training Enhancement Act (H.R.2930); Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act (S.1404); Community & Rural Medical Residency Preservation Act (S.1300) Americas Healthy Future Act of 2009, Chairmans Mark Senate Finance Committee; MedPAC Reform Act of 2009 (S.1110); Consumers Health Care Act of 2009 (S.1278); Preserving Patient Access to Primary Care Act of 2009 (H.R.2350); Senate HELP Affordable Health Choices Act (S.1679); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transition Care Act of 2009 (S.1295); School Based Health Clinic Establishment Act of 2009 (H.R.3003); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Affordable Health Care for America Act (H.R.3962); The Patient Protection and Affordable Care Act (H.R.3590); Community-Based Residency Training Act (H.R.4409); Reconciliation Act of 2010 (H.R.4872); EHR Clarification for health centers (H.R.6348); Senate EHR/HIT Clarification; Vision Preservation Act (draft).

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

Medicare Issues S. 1239 340 B Program Improvement and Integrity Act of 2009 H.R. 444 340 B Program Improvement and Integrity Act of 2009 S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 444/S 1239: 340B PROGRAM IMPROVEMENT AND INTEGRITY ACT; ALL PROVISIONS OF THE BILL MEDICARE ISSUES; BILL NUMBER NOT YET ASSIGNED; S 1110: MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC) REFORM ACT OF 2009; ALL PROVISIONS OF THE BILL

Client expense: $610,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, 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 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, 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 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines, as currently interpreted guidelines would require accreditation of each hospital as a standalone entity and require them to each have a separate governing body, medical staff, etc. in order to be accredited by the joint commission; Crowley- Sessions Letter to CMS urging reevaluation of the IPPS regulation that would apply a 2.9 percent cut to hospital payments in FY 2011; Letter to CMS re development of the Self-referral disclosure protocol that is authorized by the PPACA; HR 5712 Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program; HR 6005 Ensuring Equality for Early EHR Adoption Act of 2010, to amend titles XVIII and XIX of the Social Security Act to provide for the temporary treatment of certain electronic health records as certified EHR technology for purposes of health information technology payment incentives under the Medicare and Medicaid Programs. Sen. Stabenow and Sen. Murkoswki, Rep. Crowley and Rep. Sessions letter to CMS asking to reevaluate the proposed IPPS regulations that will hit hospital payments in FY 2011; Pomeroy, Moran letter to CMS, regarding concersn of the proposed Medicare OPPS regulation for FY 2011 does not show continued access to full range of outpatient therapeutic services for small, rural & CAH hospitals.

Client expense: $4,270,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), 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 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

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions in the Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Care Act (H.R.3590, P.L. 111-148)); and Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872), P.L. 111-152); Medicare Commission legislation (S.1110, S. 1380, H.R.2718), provisions that would empower a Commission to implement Medicare policy changes; geographic variation legislation (H.R. 2844, H.R. 2919, H.R. 2921, H.R. 2201, S.Amdt. 887) affecting hospitals and/or physician payment policy; value-based purchasing legislation (H.R. 1776); other workforce legislation (H.R. 1946, S.1569)); Puerto Rico Medicare Parity (H.R. 2680, H.R. 1501, H.R.1502); Medicare physician payment adjustment (HR. 3961, S.1776, H.R.3326, H.R. 3590, H.R. 4851, S. 3153, H.R. 4213); Section 508 wage index extension and gainsharing extension (H.R. 4213); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); Medicare 72-hour payment window limitation (H.R.4213); HIT incentive payments and meaningful use requirements in final rule CMS-0033-F (H.R. 6072, S. 3708); and the "coding offset" in the proposed and final Medicare inpatient prospective payment system rule for 2011 (CMS-1498). Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) and ARRA FMAP Extension (H.R. 4263, H.R. 2847, H.R.4213) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679), Affordable Healthcare for America Act (H.R. 3962), Patient Protection and Affordable Care Act (H.R. 3590, P.L. 111-148), and the Health and Education Affordability Reconciliation Act of 2010 (H.R. 4872, P.L. 111-152)), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); and HIT incentive payments and meaningful use requirements in final rule CMS-0033-F (H.R. 6072, S.3708).

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

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

Medicare Issues S. 301 Physician Payments Sunshine Act of 2009 S. 1679 Affordable Health Choices Act H.R. 3200 American Affordable Health Choices Act of 2009 Tri Caucus Healthcare Reform Bill S. 1796 Americas Healthy Future Act of 2009 S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 2502 Comparative Effectiveness Research Act of 2009 S. 1213 Patient-Centered Outcomes Research Act of 2009 H.R. 444 340 B Program Improvement and Integrity Act of 2009 S. 1239 340 B Program Improvement and Integrity Act of 2009 H.R. 3962 Affordable Health Care for America Act H.R. 3590 Patient Protection and Affordable Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, Patent & Trademark Office (PTO), SENATE

S. 1679 Affordable Health Choices Act H.R. 3200 American Affordable Health Choices Act of 2009 Tri Caucus Healthcare Reform Bill S. 1796 Americas Healthy Future Act of 2009 S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 2502 Comparative Effectiveness Research Act of 2009 S. 1213 Patient-Centered Outcomes Research Act of 2009 S. 301 Physician Payments Sunshine Act of 2009 H.R. 3962 Affordable Health Care for America Act H.R. 3590 Patient Protection and Affordable Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, Patent & Trademark Office (PTO), SENATE

American Health Security Act (H.R. 1200); Access for All America Act (H.R. 1296/S.486); Primary Care Volunteer Incentive Act (H.R. 1185); Health Access and Health Professions Supply Act (S.790); Title VII Reauthorization (S.1720); Conrad State 30 Improvement Act (S.628); Recognizing the value of community health centers (HCon.Res.144/S.Con.Res.25). Tri-Caucus Health Equity and Accountant Act; Health Information Technology Public Utility Act of 2009 (S.890); Womens Medical House Demonstration Act (S.1303); Family Healthcare Accessibility Act (H.R.1745); Community Coalitions for Access and Quality Improvement Act (H.R.1614/S.652); Health Access and Health Professions Supply Act (S.790); GAO Study request on VA/CHCs Act (no bill#); Affordable Health Choices Act (H.R.3200); Resident Physician Shortage Act (S.973/H.R.2251); Seniors Mental Health Access Improvement Act (H.R.1693/S.671); Public Health Workforce Development Act (H.R.2620/S.1143); Helping Fill the Medicine Rx Gap Act (H.R.2777/S.1201); Primary Care Training Enhancement Act (H.R.2930); Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act (S.1404); Community & Rural Medical Residency Preservation Act (S.1300) Americas Healthy Future Act of 2009, Chairmans Mark Senate Finance Committee; MedPAC Reform Act of 2009 (S.1110); Consumers Health Care Act of 2009 (S.1278); Preserving Patient Access to Primary Care Act of 2009 (H.R.2350); Senate HELP Affordable Health Choices Act (S.1679); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transition Care Act of 2009 (S.1295); School Based Health Clinic Establishment Act of 2009 (H.R.3003); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Affordable Health Care for America Act (H.R.3962); The Patient Protection and Affordable Care Act (H.R.3590); Community-Based Residency Training Act (H.R.4409); Reconciliation Act of 2010 (H.R.4872).

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 3200: AMERICA'S AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL TRI CAUCUS HEALTHCARE REFORM BILL; BILL NOT YET INTRODUCED; ALL PROVISIONS OF THE BILL S 1796: AMERICA'S HEALTHY FUTURE ACT OF 2009; ALL PROVISIONS OF THE BILL S.301: PHYSICIAN PAYMENTS SUNSHINE ACT OF 2009; ALL PROVISIONS OF THE BILL S 1110: MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC) REFORM ACT OF 2009; ALL PROVISIONS OF THE BILL HR 2502: COMPARATIVE EFFECTIVENESS RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL S 1213: PATIENT CENTERED OUTCOMES RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL HR 3962: AFFORDABLE HEALTH CARE FOR AMERICA ACT OF 2009; ALL PROVISIONS OF THE BILL HR 3590: PATIENT PROTECTION & AFFORDABLE CARE ACT OF 2009; ALL PROVISIONS OF THE BILL S 1679: AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL HR 1362/S 1273: NATIONAL MS AND PARKINSON'S DISEASE REGISTRIES ACT; ALL PROVISIONS OF THE BILL DEPARTMENT OF DEFENSE APPROPRIATIONS: BILL NOT YET INTRODUCED; MS RESEARCH FUNDING NATIONAL ACTION PLAN FOR INFERTILITY

Client expense: $780,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Patent & Trademark Office (PTO), SENATE

S 301: PHYSICIAN PAYMENTS SUNSHINE ACT OF 2009; ALL PROVISIONS OF THE BILL MEDICARE ISSUES; BILL NUMBER NOT YET ASSIGNED; HR 3200: AMERICA'S AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL TRI CAUCUS HEALTHCARE REFORM BILL; BILL NUMBER NOT YET ASSIGNED; ALL PROVISIONS OF THE BILL S 1796: AMERICA'S HEALTHY FUTURE ACT OF 2009; ALL PROVISIONS OF THE BILL S 1110: MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC) REFORM ACT OF 2009; ALL PROVISIONS OF THE BILL HR 2502: COMPARATIVE EFFECTIVENESS RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL S 1213: PATIENT-CENTERED OUTCOMES RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL HR 444/S 1239: 340B PROGRAM IMPROVEMENT AND INTEGRITY ACT; ALL PROVISIONS OF THE BILL HR 3962: AFFORDABLE HEALTH CARE FOR AMERICA ACT OF 2009; ALL PROVISIONS OF THE BILL HR 3590: PATIENT PROTECTION & AFFORDABLE CARE ACT OF 2009; ALL PROVISIONS OF THE BILL S 1679: AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL

Client expense: $780,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Patent & Trademark Office (PTO), SENATE

HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, 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 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, 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 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines, as currently interpreted guidelines would require accreditation of each hospital as a standalone entity and require them to each have a separate governing body, medical staff, etc. in order to be accredited by the joint commission; Crowley- Sessions Letter to CMS urging reevaluation of the IPPS regulation that would apply a 2.9 percent cut to hospital payments in FY 2011.

Client expense: $4,230,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), 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. 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

S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 3590 Patient Protection and Affordable Care Act H.R. 4872 Health Care and Education Reconciliation Act of 2010

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

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

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions in the Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Care Act (H.R.3590, P.L. 111-148)); and Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872), P.L. 111-152); Medicare Commission legislation (S.1110, S. 1380, H.R.2718), provisions that would empower a Commission to implement Medicare policy changes; geographic variation legislation (H.R. 2844, H.R. 2919, H.R. 2921, H.R. 2201, S.Amdt. 887) affecting hospitals and/or physician payment policy; value-based purchasing legislation (H.R. 1776); other workforce legislation (H.R. 1946, S.1569)); Puerto Rico Medicare Parity (H.R. 2680, H.R. 1501, H.R.1502); Medicare physician payment adjustment (HR. 3961, S.1776, H.R.3326, H.R. 3590, H.R. 4851, S. 3153, H.R. 4213); Section 508 wage index extension and gainsharing extension (H.R. 4213); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); Medicare 72-hour payment window limitation (H.R.4213); and HIT incentive payments and meaningful use requirements in proposed rule CMS-0033-P. Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) and ARRA FMAP Extension (H.R. 4263, H.R. 2847, H.R.4213) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679), Affordable Helahtcare for America Act (H.R. 3962), Patient Protection and Affordable Care Act (H.R. 3590, P.L. 111-148), and the Health and Education Affordability Reconciliation Act of 2010 (H.R. 4872, P.L. 111-152)), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); and HIT incentive payments and meaningful use requirements in proposed rule CMS-0033-P.

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, White House Office

H.R. 444, 340B Program Improvement and Integrity Act of 2009, 340B drug price expansion H.R. 1832, Medicare Prescription Drug Affordability Act of 2009 S. 266, Medicare Prescription Drug Gap Reduction Act of 2009 S. 301, Physician Payments Sunshine Act of 2009 ESRD "bundling issues" and ESRD drug reimbursement issues HCPCS coding decisions Reimbursement for Part B drugs administered in hospital out patient departments, dialysis centers and physician offices Physician fee schedule payment rates for lab tests Medicaid rebates Implementation of MIPPA H.R. 1699, Patient Access to Critical Lab Test H.R. 1452, Medicare Clinical Diagnostic Laboratory Fee Schedule Modernization Act of 2009 Reimbursement /Payment laboratory tests H.R. 676, US National Health Care Act or the Expanded and Improved Medicare for All Act S. 1110, Medicare Payment Advisory Commission Reform Act of 2009 H.R. 2502, Comparative Effectiveness Research Act of 2009 S. 1213, Patient Centered Outcomes Research Act of 2009 H.R. 3200, America's Affordable Health Choices Act of 2009 Reimbursement for Clinical Lab Tests Reimbursement for Medicare Part D Drugs S. 1679, America's Affordable Health Choices Act of 2009 H.R. 3962, Affordable Health Care for Americans Act H.R. 3590, Patient Protection & Affordable Health Care Act H.R. 4872, Health Care and Education Reconciliation Act of 2010 H.R. 4851, Continuing Extension Act of 2010 H.R. 4213, Workers, State, and Business Relief Act of 2010 H.R. 2847, Hiring Incentives to Restore Employment Act Extension of the TC Grandfather Clause

Client expense: $712,000 · Firm income: Not reported

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

HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, 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 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, 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 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines, as currently interpreted guidelines would require accreditation of each hospital as a standalone entity and require them to each have a separate governing body, medical staff, etc. in order to be accredited by the joint commission.

Client expense: $3,730,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

HR 3200: AMERICA'S AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL TRI CAUCUS HEALTHCARE REFORM BILL; BILL NOT YET INTRODUCED; ALL PROVISIONS OF THE BILL S 1796: AMERICA'S HEALTHY FUTURE ACT OF 2009; ALL PROVISIONS OF THE BILL S.301: PHYSICIAN PAYMENTS SUNSHINE ACT OF 2009; ALL PROVISIONS OF THE BILL S 1110: MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC) REFORM ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 2502: COMPARATIVE EFFECTIVENESS RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL; S 1213: PATIENT CENTERED OUTCOMES RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 3962: AFFORDABLE HEALTH CARE FOR AMERICA ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 3590: PATIENT PROTECTION & AFFORDABLE CARE ACT OF 2009; ALL PROVISIONS OF THE BILL; S 1679: AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 4489: TO AMEND CHAPTER 89 OF TITLE 5, UNITED STATES CODE, TO ENSURE PROGRAM INTEGRITY, TRANSPARENCY, AND COST SAVINGS IN THE PRICING AND CONTRACTING OF PRESCRIPTION DRUG BENEFITS UNDER THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM; ALL PROVISIONS OF THE BILL

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

Government targets: HOUSE OF REPRESENTATIVES, Patent & Trademark Office (PTO), SENATE

S 301: PHYSICIAN PAYMENTS SUNSHINE ACT OF 2009; ALL PROVISIONS OF THE BILL MEDICARE ISSUES; BILL NUMBER NOT YET ASSIGNED; ALL PROVISIONS OF THE BILL HR 3200: AMERICA'S AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL TRI CAUCUS HEALTHCARE REFORM BILL; BILL NUMBER NOT YET ASSIGNED; ALL PROVISIONS OF THE BILL; S 1796: AMERICA'S HEALTHY FUTURE ACT OF 2009; ALL PROVISIONS OF THE BILL; S 1110: MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC) REFORM ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 2502: COMPARATIVE EFFECTIVENESS RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL; S 1213: PATIENT-CENTERED OUTCOMES RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 444/S 1239: 340B PROGRAM IMPROVEMENT AND INTEGRITY ACT; ALL PROVISIONS OF THE BILL; HR 3962: AFFORDABLE HEALTH CARE FOR AMERICA ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 3590: PATIENT PROTECTION & AFFORDABLE CARE ACT OF 2009; ALL PROVISIONS OF THE BILL; S 1679: AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL

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

Government targets: HOUSE OF REPRESENTATIVES, Patent & Trademark Office (PTO), SENATE

H.R.1011, Community Mental Health Services Improvement Act H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 S. 391, Healthy Americans Act S. 1110/H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1679, Affordable Health Choices Act H.R. 4204/S. 1857, Establishing a Network of Health-Advancing National Centers of Excellence for Depression (ENHANCED) Act of 2009 H.R. 667, the Heroes at Home Act H.R. 2505, the Reaching Rural Veterans Through Telehealth Act H.R. 3590, Patient Protection and Affordable Care Act Medical Devices: Neurological Devices; Electroconvulsive Therapy Device; Establishing a Public Docket; Docket No. FDA2009N0392; 74 Federal Register 46607 (September 10, 2009)

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 20/S. 324, Melanie Blocker Stokes Mom's Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act H.R. 193, AmeriCare Health Care Act of 2009 H.R. 468/S. 245, Retooling the Health Care Workforce for an Aging America Act of 2009 H.R. 619, to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases H.R. 676, United States National Health Care Act or the Expanded and Improved Medicare for All Act H.R.1011, Community Mental Health Services Improvement Act H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 H.R. 194, MediKids Health Insurance Act of 2009 H.R. 211/S. 211, Calling for 2-1-1 Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 (medical malpractice reform) H.R. 1468, Medical Justice Act of 2009 (medical malpractice reform) S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act (medical malpractice reform) H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 H.R. 914, Physician Workforce Enhancement Act of 2009 H.R. 1457, Geriatrics Loan Forgiveness Act of 2009 H.R. 1932/S. 999 Child Health Care Crisis Relief Act of 2009 H.R. 2537, Mental Health in Schools Act of 2009 H.R. 3090, Health Equality and Accountability Act of 2009 S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act S. 391, Healthy Americans Act S. 1110/H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1679, Affordable Health Choices Act H.R. 3191, Positive Aging Act of 2009 H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 3961, Physician Payment Reform Act of 2009 H.R. 1721/S. 697, Community Living Assistance Services and Supports (CLASS) Act H.R. 4204/S. 1857, Establishing a Network of Health-Advancing National Centers of Excellence for Depression (ENHANCED) Act of 2009 H.R. 667, the Heroes at Home Act H.R. 2505, the Reaching Rural Veterans Through Telehealth Act S. 1776, Medicare Physician Fairness Act of 2009 H.R. 4872, Health Care and Education Reconciliation Act of 2010 Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule; 75 Federal Register 1844 (January 13, 2010) Interim Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Docket No. CMS-2009-0040-0048; 75 Federal Register 5410 (February 2, 2010)

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 20/S. 324, Melanie Blocker Stokes Mom's Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act H.R. 468/S. 245, Retooling the Health Care Workforce for an Aging America Act of 2009 H.R. 1350, Post-Abortion Depression Research and Care Act of 2009 H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 H.R. 914, Physician Workforce Enhancement Act of 2009 H.R. 1932, S. 999 Child Health Care Crisis Relief Act S. 391, Healthy Americans Act S. 1110, H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 4204/S. 1857, Establishing a Network of Health-Advancing National Centers of Excellence for Depression (ENHANCED) Act of 2009 H.R. 4872, Health Care and Education Reconciliation Act of 2010

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

S. 1110/H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 4872, Health Care and Education Reconciliation Act of 2010 H.R. 3590, Patient Protection and Affordable Care Act

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 211/S. 211, Calling for 2-1-1 Act of 2009 H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 S. 1180/H.R. 1011, Community Mental Health Services Improvement Act of 2009 S. 391, Healthy Americans Act S. 1110, H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1136, Mental Illness Chronic Care Improvement Act of 2009 S. 1679, Affordable Health Choices Act H.R. 1721/S. 697, Community Living Assistance Services and Supports (CLASS) Act H.R. 4204/S. 1857, Establishing a Network of Health-Advancing National Centers of Excellence for Depression (ENHANCED) Act of 2009 H.R. 3590, Patient Protection and Affordable Care Act H.R. 4872, Health Care and Education Reconciliation Act of 2010 Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule; 75 Federal Register 1844 (January 13, 2010)

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 1011, Community Mental Health Services Improvement Act of 2009 S. 391, Healthy Americans Act S. 1110, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1679, Affordable Health Choices Act H.R. 667, the Heroes at Home Act H.R. 2505, the Reaching Rural Veterans Through Telehealth Act H.R. 3590, Patient Protection and Affordable Care Act Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule; 75 Federal Register 1844 (January 13, 2010)

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 1011, Community Mental Health Services Improvement Act of 2009 H.R. 1457, Geriatrics Loan Forgiveness Act of 2009 H.R. 1932/S. 999 Child Health Care Crisis Relief Act of 2009 S. 391, Healthy Americans Act S. 1110/H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act S. 1776, Medicare Physician Fairness Act of 2009 H.R. 3961, Medicare Physician Payment Reform Act of 2009 H.R. 4872, Health Care and Education Reconciliation Act of 2010

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 193, AmeriCare Health Care Act of 2009 H.R. 468/S. 245, Retooling the Health Care Workforce for an Aging America Act of 2009 H.R. 619, to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases H.R. 676, Expanded and Improved Medicare for All Act H.R. 1693/S. 671, Seniors Mental Health Access Improvement Act of 2009 (MFTs and MHCs under Medicare) H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 H.R. 194, MediKids Health Insurance Act of 2009 S. 391, Healthy Americans Act S. 1110, H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1136, Mental Illness Chronic Care Improvement Act of 2009 S. 1679, Affordable Health Choices Act H.R. 3191, Positive Aging Act of 2009 H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 3961, Physician Payment Reform Act of 2009 H.R. 4204/S. 1857, Establishing a Network of Health-Advancing National Centers of Excellence for Depression (ENHANCED) Act of 2009 S. 1776, Medicare Physician Fairness Act of 2009 H.R. 4872, Health Care and Education Reconciliation Act of 2010

Client expense: $190,000 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

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

American Health Security Act (H.R. 1200); Access for All America Act (H.R. 1296/S.486); Primary Care Volunteer Incentive Act (H.R. 1185); Health Access and Health Professions Supply Act (S.790); Title VII Reauthorization (S.1720); Conrad State 30 Improvement Act (S.628); Recognizing the value of community health centers (HCon.Res.144/S.Con.Res.25). Tri-Caucus Health Equity and Accountant Act; Health Information Technology Public Utility Act of 2009 (S.890); Womens Medical House Demonstration Act (S.1303); Family Healthcare Accessibility Act (H.R.1745); Community Coalitions for Access and Quality Improvement Act (H.R.1614/S.652); Health Access and Health Professions Supply Act (S.790); GAO Study request on VA/CHCs Act (no bill#); Affordable Health Choices Act (H.R.3200); Resident Physician Shortage Act (S.973/H.R.2251); Seniors Mental Health Access Improvement Act (H.R.1693/S.671); Public Health Workforce Development Act (H.R.2620/S.1143); Helping Fill the Medicine Rx Gap Act (H.R.2777/S.1201); Primary Care Training Enhancement Act (H.R.2930); Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act (S.1404); Community & Rural Medical Residency Preservation Act (S.1300) Americas Healthy Future Act of 2009, Chairmans Mark Senate Finance Committee; MedPAC Reform Act of 2009 (S.1110); Consumers Health Care Act of 2009 (S.1278); Preserving Patient Access to Primary Care Act of 2009 (H.R.2350); Senate HELP Affordable Health Choices Act (S.1679); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transition Care Act of 2009 (S.1295); School Based Health Clinic Establishment Act of 2009 (H.R.3003); DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430); Affordable Health Care for America Act (H.R.3962); The Patient Protection and Affordable Care Act (H.R.3590); Community-Based Residency Training Act (H.R.4409); Reconciliation Act of 2010 (H.R.4872).

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

Medicare Issues S. 301 Physician Payments Sunshine Act of 2009 S. 1679 Affordable Health Choices Act H.R. 3200 American Affordable Health Choices Act of 2009 Tri Caucus Healthcare Reform Bill S. 1796 Americas Healthy Future Act of 2009 S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 2502 Comparative Effectiveness Research Act of 2009 S. 1213 Patient-Centered Outcomes Research Act of 2009 H.R. 444 340 B Program Improvement and Integrity Act of 2009 S. 1239 340 B Program Improvement and Integrity Act of 2009 H.R. 3962 Affordable Health Care for America Act H.R. 3590 Patient Protection and Affordable Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, Patent & Trademark Office (PTO), SENATE

S. 1679 Affordable Health Choices Act H.R. 3200 American Affordable Health Choices Act of 2009 Tri Caucus Healthcare Reform Bill S. 1796 Americas Healthy Future Act of 2009 S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 2502 Comparative Effectiveness Research Act of 2009 S. 1213 Patient-Centered Outcomes Research Act of 2009 S. 301 Physician Payments Sunshine Act of 2009 H.R. 3962 Affordable Health Care for America Act H.R. 3590 Patient Protection and Affordable Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, Patent & Trademark Office (PTO), SENATE

HR 3200 America's Affordable Health Choices Act of 2009 S 1796, America's Healthy Future Act of 2009, provisions relating to the chairman's mark S 1679 The Affordable Health Choices Act HR 1253 Health Insurance Restrictions and Limitations Clarification Act of 2009 HR 3590 Patient Protection and Affordable Care Act HR 4872 Health Care and Education Reconciliation Act of 2010 HR 2560 Independence at Home Act of 2009 S 1131 Independence at Home Act of 2009 HR 3688 To encourage programs of health promotion or disease prevention HR 3472 To provide for health insurance coverage premium discounts for healthy behavior and improvements toward behavior HR 1548 Pathway for Biosimilars Act S 1110 Medicare Payment Advisory Commission (MedPac) Reform Act of 2009 HR 2718 Medicare Payment Advisory Commission (MedPac) Reform Act of 2009 S 1156 Safe Routes to School Program Reauthorization Act HR 1585 FIT Kids Act S 634 FIT Kids Act HR 1342 The Child Nutrition Promotion and School Lunch Protection Act S 934 The Child Nutrition Promotion and School Lunch Protection Act HR 2105 The Personal Health Investment Today Act HR 2276 The Improved Nutrition and Physical Activity Act S 1060 Obesity Prevention, Treatment, and Research Act S 803 Healthy Workforce Act of 2009 HR 1897 Healthy Workforce Act of 2009

Client expense: $248,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, 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

S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 3590 Patient Protection and Affordable Care Act H.R. 4872 Health Care and Education Reconciliation Act of 2010

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

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

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions in the Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Care Act (H.R.3590)); and Health Care and Education Reconciliation Act of 2010 (H.R. 4872)); Medicare Commission legislation (S.1110, S. 1380, H.R.2718), provisions that would empower a Commission to implement Medicare policy changes; geographic variation legislation (H.R. 2844, H.R. 2919, H.R. 2921, H.R. 2201, S.Amdt. 887) affecting hospitals and/or physician payment policy; value-based purchasing legislation (H.R. 1776); other workforce legislation (H.R. 1946, S.1569)); Puerto Rico Medicare Parity (H.R. 2680, H.R. 1501, H.R.1502); Medicare physician payment adjustment (HR. 3961, S.1776, H.R.3326, H.R. 3590, H.R. 4851, S. 3153, H.R. 4213); Section 508 wage index extension and gainsharing extension (H.R. 4213); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213). Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) and ARRA FMAP Extension (H.R. 4263, H.R. 2847) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679), Affordable Helahtcare for America Act (H.R. 3962), Patient Protection and Affordable Care Act (H.R. 3590), and the Health and Education Reconciliation Act of 2010 (H.R. 4872)), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213).

Client expense: $310,000 · Firm income: Not reported

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

S. 1679 Affordable Health Choice Act H.R. 3200 American Affordable Health Choices Act of 2009 Tri Caucus Healthcare Reform Bill S. 1796 America's Healthy Future Act of 2009 S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 2502 Comparative Effectiveness Research Act of 2009 S. 1213 Patient-Centered Outcomes Research Act of 2009 S. 301 Physician Payments Sunshine Act of 2009 H.R. 3962 Affordable Health Care for America Act H.R. 3590 Patient Protection and Affordable Care Act

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

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

Medicare Issues S. 301 Physician Payments Sunshine Act of 2009 S. 1679 Affordable Health Choices Act H.R. 3200 America's Affordable Health Choices Act of 2009 Tri Caucus Healthcare Reform Bill S. 1796 America's Healthy Future Act of 2009 S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 2502 Comparative Effectiveness Research Act of 2009 S. 1213 Patient-Centered Outcomes Research Act of 2009 H.R. 3962 Affordable Health Care for America Act H.R. 3590 Patient Protection and Affordable Care Act

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

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

Medicare issues S. 301 Physician Payments Sunshine Act of 2009 S. 717 21st Century Cancer ALERT (Access to Life Saving Early detection, Research and Treatment) Act Kennedy Healthcare Reform Bill House Tri Committee Healthcare Reform Bill Tri Caucus Healthcare Reform Bill Senate Finance Healthcare Reform Bill S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 2502 Comparative Effectiveness Research Act of 2009 S. 1213 Patient-Centered Outcomes Research Act of 2009

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

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

Kennedy Healthcare Reform Bill House Tri Committee Healthcare Reform Bill Tri Caucus Healthcare Reform Bill Senate Finance Healthcare Reform Bill S. 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H.R. 2502 Comparative Effectiveness Research Act of 2009 S. 1213 Patient-Centered Outcomes Research Act of 2009

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

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

American Health Security Act (H.R. 1200); Access for All America Act (H.R. 1296/S.486); Primary Care Volunteer Incentive Act (H.R. 1185); Edward M. Kennedy Serve America Act (H.R. 1388/S.277); Health Access and Health Professions Supply Act (S.790); Title VII Reauthorization (S.1720); Health Care Reform; Conrad State 30 Improvement Act (S.628); Recognizing the value of community health centers (HCR 144/SCR25). Tri-Caucus Health Equity and Accountant Act; Health Information Technology Public Utility Act of 2009 (S.890); Womens Medical House Demonstration Act (S.1303); Family Healthcare Accessibility Act (H.R.1745); Community Coalitions for Access and Quality Improvement Act (H.R.1614/S.652); Health Access and Health Professions Supply Act (S.790); GAO Study request on VA/CHCs Act (no bill#); Affordable Health Choices Act (H.R.3200); Resident Physician Shortage Act (S.973/H.R.2251); Seniors Mental Health Access Improvement Act (H.R.1693/S.671); Public Health Workforce Development Act (H.R.2620/S.1143); Helping Fill the Medicine Rx Gap Act (H.R.2777/S.1201); Primary Care Training Enhancement Act (H.R.2930); Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act (S.1404); Community & Rural Medical Residency Preservation Act (S.1300) Americas Healthy Future Act of 2009, Chairmans Mark Senate Finance Committee; MedPAC Reform Act of 2009 (S.1110); Consumers Health Care Act of 2009 (S.1278); Preserving Patient Access to Primary Care Act of 2009 (H.R.2350); Senate HELP - Affordable Health Choices Act (S.1679); Ryan White Reauthorization House and Senate; Health Equity and Accountability Act of 2009 (H.R.3090); Medicare Telehealth Enhancement Act of 2009 (H.R.2068); Medicare Transition Care Act of 2009 (S.1295); School Based Health Clinic Establishment Act of 2009 (H.R.3003);DSH Collaborative Care Network Pilot Program Act of 2009 (H.R.3430).

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

H.R. 444, 340B Program Improvement and Integrity Act of 2009, 340B drug price expansion H.R. 1832, Medicare Prescription Drug Affordability Act of 2009 S. 266, Medicare Prescription Drug Gap Reduction Act of 2009 S. 301, Physician Payments Sunshine Act of 2009 ESRD "bundling issues" and ESRD drug reimbursement issues HCPCS coding decisions Reimbursement for Part B Drugs administered in hospital out patient departments, dialysis centers and physician officers Physicians fee schedule payment rates for lab tests Medicaid rebates Implementation of MIPPA H.R. 1699 Patient Access to Critical Lab Test H.R. 1452 Medicare Clinical Diagnostic Laboratory Fee Schedule Modernization Act of 2009 Reimbursement /Payment laboratory tests H.R. 676 - US National Health Care Act or the Expanded and Improved Medicare for All Act House Tri-Committee Health Reform Bill Senate Finance Health Reform Bill S. 1110, Medicare Payment Advisory Commission Reform Act of 2009 H.R. 2502, Comparative Effectiveness Research Act of 2009 S. 1213, Patient Centered Outcomes Research Act of 2009 H.R. 3200, America's Affordable Health Choices Act of 2009 Reimbursement for Clinical Lab Tests Reimbursement for Medicare Part D Drugs S. 1679, America's Affordable Health Choices Act of 2009 H.R. 3962, Affordable Health Care for Americans Act H.R. 3590, Patient Protection & Affordable Health Care Act

Client expense: $750,000 · Firm income: Not reported

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

HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Senator Schumer and Senator Roberts Letter eliminating IME Cuts CMS to withdraw the Capital IME cut that was included in last years Medicare IPPS rule; Letter to President Obama from Neal/ Tiberi on Capital IME Protect America's teaching hospitals asking him to withdraw a provision in the FY 2010 IPPS rule that would cut reimbursements to teaching hospitals. Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, 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 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, 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 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961Medicare Physician Payment Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development.

Client expense: $5,400,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

S 301: PHYSICIAN PAYMENTS SUNSHINE ACT OF 2009; ALL PROVISIONS OF THE BILL MEDICARE ISSUES; BILL NUMBER NOT YET ASSIGNED; ALL PROVISIONS OF THE BILL HR 3200: AMERICAN AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL TRI CAUCUS HEALTHCARE REFORM BILL; BILL NUMBER NOT YET ASSIGNED; ALL PROVISIONS OF THE BILL; S 1796: AMERICA'S HEALTHY FUTURE ACT OF 2009; ALL PROVISIONS OF THE BILL; S 1110: MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC) REFORM ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 2502: COMPARATIVE EFFECTIVENESS RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL; S 1213: PATIENT-CENTERED OUTCOMES RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 444/S 1239: 340B PROGRAM IMPROVEMENT AND INTEGRITY ACT; ALL PROVISIONS OF THE BILL; HR 3962: AFFORDABLE HEALTH CARE FOR AMERICA ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 3590: PATIENT PROTECTION & AFFORDABLE CARE ACT OF 2009; ALL PROVISIONS OF THE BILL; S 1679: AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL

Client expense: $680,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Patent & Trademark Office (PTO), SENATE

HR 3200: AMERICA'S AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL TRI CAUCUS HEALTHCARE REFORM BILL; BILL NOT YET INTRODUCED; ALL PROVISIONS OF THE BILL S 1796: AMERICA'S HEALTHY FUTURE ACT OF 2009; ALL PROVISIONS OF THE BILL S.301: PHYSICIAN PAYMENTS SUNSHINE ACT OF 2009; ALL PROVISIONS OF THE BILL HR 697/S 1258: FAMILY BUILDING ACT OF 2009; ALL PROVISIONS OF THE BILL; S 1110: MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC) REFORM ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 2502: COMPARATIVE EFFECTIVENESS RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL; S 1213: PATIENT CENTERED OUTCOMES RESEARCH ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 3962: AFFORDABLE HEALTH CARE FOR AMERICA ACT OF 2009; ALL PROVISIONS OF THE BILL; HR 3590: PATIENT PROTECTION & AFFORDABLE CARE ACT OF 2009; ALL PROVISIONS OF THE BILL S 1679: AFFORDABLE HEALTH CHOICES ACT OF 2009; ALL PROVISIONS OF THE BILL

Client expense: $680,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Patent & Trademark Office (PTO), SENATE