Mental Illness Chronic Care Improvement Act of 2009

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support implementation of comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

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

Government targets: AMTRAK - Natl Railroad Passenger Corporation, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, Social Security Administration (SSA), Veterans Affairs, Dept of (VA)

H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period 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) S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act H.R. 667, the Heroes at Home Act H.R. 2505, the Reaching Rural Veterans Through Telehealth Act H.R. 5025, HITECH Extension for Behavioral Health Services Act of 2010 S.3709, HITECH Extension for Behavioral Health Services Act of 2010 H.R. 5466, SAMHSA Modernization Act of 2010 H.R. 5636, Community Mental Health and Addiction Safety Net Equity Act of 2010 H.R. 5712, Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 H.R. 5295, Healthcare Truth and Transparency Act of 2010 H.R. 4985, Medicare Decisions Accountability Act of 2010 (repeal IPAB) S. 3425, Embedded Mental Health Providers for Reserves Act of 2010 H.R. 5392, Council on Integration of Health Care Education Act of 2010 H.R. 6147, to treat psychologists as physicians under Medicare H.R.6143, Medicare Mental Health Inpatient Equity Act CMS-1504-P: Medicare Program: Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates (August 3, 2010). Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011; Proposed Rule; CMS-1503-P; 75 Federal Register 40,040 (July 13, 2010).

Client expense: $102,791 · Firm income: Not reported

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 S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act of 2009 H.R. 5025, HITECH Extension for Behavioral Health Services Act of 2010 S.3709, HITECH Extension for Behavioral Health Services Act of 2010 H.R. 5636, Community Mental Health and Addiction Safety Net Equity Act of 2010 H.R. 5712, Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 H.R. 4985, Medicare Decisions Accountability Act of 2010 (repeal IPAB) H.R. 5290, More Doctors, More Choices Act of 2010 H.R. 6147, to treat psychologists as physicians under Medicare H.R.6143, Medicare Mental Health Inpatient Equity Act CMS-1504-P: Medicare Program: Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates (August 3, 2010). Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011; Proposed Rule; CMS-1503-P; 75 Federal Register 40,040 (July 13, 2010).

Client expense: $102,791 · Firm income: Not reported

S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act of 2009 H.R. 5025, HITECH Extension for Behavioral Health Services Act of 2010 H.R. 5466, SAMHSA Modernization Act of 2010 H.R. 5636, Community Mental Health and Addiction Safety Net Equity Act of 2010 H.R. 5690, Meaningful End to Defensive Medicine & Aimless Lawsuits (MedMal) Act of 2010 H.R. 5295, Healthcare Truth and Transparency Act of 2010 H.R. 4985, Medicare Decisions Accountability Act of 2010 S. 3425, Embedded Mental Health Providers for Reserves Act of 2010 S.3709, HITECH Extension for Behavioral Health Services Act of 2010 H.R. 5392, Council on Integration of Health Care Education Act of 2010 H.R. 6147, to treat psychologists as physicians under Medicare H.R.6143, Medicare Mental Health Inpatient Equity Act

Client expense: $102,791 · Firm income: Not reported

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

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. Met with senior HHS officials to talk about implementation of health reform. See also Medicare and Medicaid.

S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act of 2009 H.R. 5025, HITECH Extension for Behavioral Health Services Act of 2010 H.R. 5466, SAMHSA Modernization Act of 2010 H.R. 5636, Community Mental Health and Addiction Safety Net Equity Act of 2010 H.R. 5690, Meaningful End to Defensive Medicine & Aimless Lawsuits (MedMal) Act of 2010 H.R. 5295, Healthcare Truth and Transparency Act of 2010 H.R. 4985, Medicare Decisions Accountability Act of 2010 S. 3425, Embedded Mental Health Providers for Reserves Act of 2010 H.R. 4851, Continuing Extension Act of 2010 H.R. 5392, Council on Integration of Health Care Education Act of 2010 HIPAA Privacy Rule Accounting of Disclosures Under the Health Information Technology for Economic and Clinical Health Act; Request for Information; 75 Federal Register 23214 (May 3, 2010).

Client expense: $110,890 · Firm income: Not reported

H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 H.R. 1468, Medical Justice Act of 2009 S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act H.R. 3962, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 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. 5025, HITECH Extension for Behavioral Health Services Act of 2010 H.R. 5466, SAMHSA Modernization Act of 2010 H.R. 5636, Community Mental Health and Addiction Safety Net Equity Act of 2010 H.R. 5712, Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 H.R. 5295, Healthcare Truth and Transparency Act of 2010 H.R. 4985, Medicare Decisions Accountability Act of 2010 S. 3425, Embedded Mental Health Providers for Reserves Act of 2010 H.R. 5392, Council on Integration of Health Care Education Act of 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) HIPAA Privacy Rule Accounting of Disclosures Under the Health Information Technology for Economic and Clinical Health Act; Request for Information; 75 Federal Register 23214 (May 3, 2010)

Client expense: $110,890 · Firm income: Not reported

H.R. 1693/S. 671, Seniors Mental Health Access Improvement Act of 2009 H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act of 2009 H.R. 3962, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 S. 1776, Medicare Physician Fairness Act of 2009 H.R. 5025, HITECH Extension for Behavioral Health Services Act of 2010 H.R. 5636, Community Mental Health and Addiction Safety Net Equity Act of 2010 H.R. 5712, Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 H.R. 4985, Medicare Decisions Accountability Act of 2010 H.R. 5290, More Doctors, More Choices Act of 2010 H.R. 4851, Continuing Extension Act of 2010

Client expense: $110,890 · Firm income: Not reported

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

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. Support comprehensive health care reform legislation (Patient Protection and Affordable Care Act, HR 3590 and Health Care & Education Reconciliation Act of 201, HR 4872) and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits; delaying CMS competitive bidding program; and having DMEPOS included as essential benefits in health insurance coverage. Providing insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the proposed excise tax on medical devices -- that an excise tax on manufacturers would increase their costs which are likely to be passed on to consumers, resulting in increased costs for medical equipment for people with disabilities and chronic conditions who depend on them. Providing for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Providing for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Providing for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 133% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. - Support elimination of Medicare Part D coverage gap (Part D "donut hole") and immediate $250 rebate for beneficiaries who fall into donut hole in 2010. continued next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

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)

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

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

The Mental Illness Chronic Care Improvement Act (HR 3065/S 1136), all provisions of bill which authorizes a Medicaid demonstration program to improve the health outcomes and satisfaction of individuals with chronic mental illness. Medicaid Services Restoration Act of 2009 (S 1217), all provisions related to clarifying the definition and scope of rehabilitation services and targeted case management. Jobs for Main Street Act (HR 2847), all provisions related to extending the increase in the federal medical assistance percentage to June 30, 2011.

Client expense: $28,293 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. HR 3200 in House, Americas Healthy Future Act (Senate Finance Committee) and Affordable Health Choices Act (Senate HELP Committee) - no Senate bill numbers yet. Support health care reform legislation and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). Issues with asterisks indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: oRequiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. oProhibiting annual and lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation oRequiring health insurance to cover rehabilitation and habilitative services and durable medical equipment, prosthetics and orthodics. oStop or limit copays for preventive care. Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in ways that respects that what works for many people will not work for all; Provide for prevention and wellness including oDeveloping standards for accessible medical equipment; oAuthorizing funds to establish a Prevention and Public Health Investment Fund; oProviding for community Transformation Grants that include focus on the needs of people with disabilities; oIncluding disability status within data collection on health disparities; oProviding training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including oCovering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living, remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670) make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708 -- end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * regarding immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Urged legislation to clarify that state Medicaid plans must ensure the provision of mandated care and Services to needy individuals not simply reimburse them, if they manage to obtain such services. (HR 3200 s. 1781(e) (page 826)) Without such a clarifying provision, current trends in the courts could significantly contract the availability of health services to underserved individuals and groups. First month purchase option Maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use so people with long term need will get the wheelchair that they need. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported language in HR 3200 and Senate Finance health bill that would exempt Class III and higher power wheel chairs from the rental period. Community First Choice Option in Americas Healthy Future Act -- allow states to create Medicaid plans that would reverse the institutional bias in Medicaid and provided 6% increase in FMAP matching funds to states. H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. In the House, HR 3962 (Affordable Care for America Act) and in the Senate HR 3590 (Patient Protection and Affordable Care Act) and Americas Healthy Future Act (Senate Finance Committee) and Affordable Health Choices Act (Senate HELP Committee). Support health care reform legislation and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and chronic conditions and all Americans (including those who lack health insurance). Issues with asterisks * indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in House and/or Senate bills, that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting annual and lifetime caps on coverage. People with serious injuries or conditions often quickly exceed these caps due to lengthy hospital stays and/or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. -- Providing for a temporary high risk pool through which people with disabilities and other pre-existing conditions may obtain health insurance pending full implementation of health insurance market reforms. Concerns about the medical device excise tax that is proposed in both the House and Senate bills. The excise tax on manufacturers would increase their costs and could potentially increase costs for medical equipment for people with disabilities and chronic conditions who depend on them. Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry professionals on how to treat individuals with disabilities; Concerns about well-intended wellness provisions that reward people for meeting health standards set by employers and insurance companies with potentially serious unintended onsequences that people with disabilities or other chronic conditions will be unable to meet the health or participation standards because of a limitation, and consequently they would have to pay more for their health coverage, including but not limited to higher deductibles, than people without disabilities or chronic conditions. Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) provisions* and the Community First ChoiceOption in health care reform. Support increasing Medicaid elibility to a nationwide standard for those whose incomes are up to 150% of the Federal Poverty Level. Since many people with disabilities have low incomes, this would extend Medicaid coverage to many people with disabilities, including childless adults. continued on next page Note -- Asterisk * indicates issue pursued both independently and as part of health care reform. CLASS Act* -- S. 697/H.R. 1721 included in HR 3590 (Senate health care reform bill) and HR 3962 (House health care reform bill) . Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS provisions will save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. Became Community First Choice Option in health care reform bills. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. First month purchase option* Advocated to maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported inclusion in HR 3590 and HR 3962 of provisions to exempt Class III and higher power wheel chairs from the rental period and to retain the first-month purchase option under existing law. Community First Choice Option* would allow states to create Medicaid plans that would reverse the institutional bias in Medicaid. The option would provide a 6% increase in FMAP matching funds to states. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services. See also Medicare and Medicaid.

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. 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 H.R. 3200, Americas Affordable Health Choices 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 S. 1857, H.R. 4204, Enhanced Act of 2009 S. 1776, Medicare Physician Fairness Act of 2009 Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010; Final Rule; 74 Federal Register 617380 (November 25, 2009). Proposed Rule; Medicare Program; Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs Docket No. CMS-4085-P] 74 Federal Register 54633 (October 22, 2009)

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

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. 15, National Health Insurance Act 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. 3200, Americas Affordable Health Choices Act of 2009 H.R. 3014 Small Business Health Information Technology Financing 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, 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. 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. 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 S. 1857, H.R. 4204, 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. 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 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. 3200, Americas Affordable Health Choices 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. 3590, Patient Protection and Affordable Care Act Comments on ONC Consumer Preferences Draft Requirements Document

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

The Mental Illness Chronic Care Improvement Act (HR 3065/S 1136), all provisions of bill which authorizes a Medicaid demonstration program to improve the health outcomes and satisfaction of individuals with chronic mental illness. Medicaid Services Restoration Act of 2009 (S 1217), all provisions related to clarifying the definition and scope of rehabilitation services and targeted case management. Jobs for Main Street Act (HR 2847), all provisions related to extending the increase in the federal medical assistance percentage to June 30, 2011.

Client expense: $28,293 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1 "American Recovery and Reinvestment Act of 2009," provisions relating to funding for community mental health centers. Issues relating to funding increases for the Substance Abuse and Mental Health Services Administration (SAMHSA) to be included in the FY10 Labor/HHS appropriations bills. Issues relating to health care reform, specifically provisions relating to the assurance of sufficient mental health benefits. S 1136 "Mental Illness Chronic Care Improvement Act of 2009," all provisions. HR 3200 "America's Affordable Health Choices Act of 2009," all provisions pertaining to the adequacy of mental health services for low income persons. S 1679 "Affordable Health Choices Act," all provisions pertaining to the adequacy of mental health services for low income persons.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care reform and issues in both health care reform and independent legislation. See following page. See also Medicare and Medicaid. HR 3200 in House, Americas Healthy Future Act (Senate Finance Committee) and Affordable Health Choices Act (Senate HELP Committee) - no Senate bill numbers yet. Support health care reform legislation and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). Issues with asterisks indicate legislation pursued both as part of health care reform and independently. Issues include: Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: oRequiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. oProhibiting annual and lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation oRequiring health insurance to cover rehabilitation and habilitative services and durable medical equipment, prosthetics and orthodics. oStop or limit copays for preventive care. Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in ways that respects that what works for many people will not work for all; Provide for prevention and wellness including oDeveloping standards for accessible medical equipment; oAuthorizing funds to establish a Prevention and Public Health Investment Fund; oProviding for community Transformation Grants that include focus on the needs of people with disabilities; oIncluding disability status within data collection on health disparities; oProviding training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including oCovering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living, remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670) make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708 -- end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * regarding immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Urged legislation to clarify that state Medicaid plans must ensure the provision of mandated care and Services to needy individuals not simply reimburse them, if they manage to obtain such services. (HR 3200 s. 1781(e) (page 826)) Without such a clarifying provision, current trends in the courts could significantly contract the availability of health services to underserved individuals and groups. First month purchase option Maintain the current ability for Medicare beneficiaries to purchase their power wheelchair in the first month of use so people with long term need will get the wheelchair that they need. Both the House and Senate included language in health reform that would require a beneficiary to rent a power wheelchair for 13 months before purchase. Supported language in HR 3200 and Senate Finance health bill that would exempt Class III and higher power wheel chairs from the rental period. Community First Choice Option in Americas Healthy Future Act -- allow states to create Medicaid plans that would reverse the institutional bias in Medicaid and provided 6% increase in FMAP matching funds to states. H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

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. 15, National Health Insurance Act 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 S. 264, E-Centives Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 H.R. 3014 Small Business Health Information Technology Financing 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, Mental Illness Chronic Care Improvement Act S. 1099, Independent Health Record Trust 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. 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. 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. 264, E-Centives Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 S. 1099, Independent Health Record Trust 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 Medicare Program: Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2010 Payment Rates; Proposed Changes to the Ambulatory Surgical Center Payment System and CY 2010 Payment Rates; Proposed Rule (Vol. 74, No. 137), July 20, 2009 Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010; Proposed Rule; 74 Federal Register 33,520 (July 13, 2009)

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

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. 264, E-Centives Act of 2009 H.R. 1011, Community Mental Health Services Improvement Act of 2009 S. 1099, Independent Health Record Trust 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. 3200, Americas Affordable Health Choices Act of 2009

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

The Mental Illness Chronic Care Improvement Act (HR 3065/S 1136), all provisions of bill which authorizes a Medicaid demonstration program to improve the health outcomes and satisfaction of individuals with chronic mental illness. Medicaid Services Restoration Act of 2009 (S 1217), all provisions related to clarifying the definition and scope of rehabilitation services and targeted case management.

Client expense: $39,707 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1 "American Recovery and Reinvestment Act of 2009," provisions relating to funding for community mental health centers. Issues relating to funding increases for the Substance Abuse and Mental Health Services Administration (SAMHSA) to be included in the FY10 Labor/HHS appropriations bills. Issues relating to health care reform, specifically provisions relating to the assurance of sufficient mental health benefits. S 1136 "Mental Illness Chronic Care Improvement Act of 2009," all provisions. HR 3200 "America's Affordable Health Choices Act of 2009," all provisions pertaining to the adequacy of mental health services for low income persons. S 1679 "Affordable Health Choices Act," all provisions pertaining to the adequacy of mental health services for low income persons.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See next page Support comprehensive health care reform and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). We hope that comprehensive health care reform will: Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. *Pursued both independently and as part of health care reform: CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * Support legislation to prohibit immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

See next page Support comprehensive health care reform and the related goals of reducing costs, improving quality and expanding health care coverage for Americans with disabilities and all Americans (including those who lack health insurance). We hope that comprehensive health care reform will: Provide for home and community-based services and supports for people with disabilities and chronic conditions such as Community Living Assistance and Supports (CLASS) Act* and the Community Choice Act.* Provide for comparative effectiveness research and using the resulting information in a way that respects that what works for many people will not work for all; Provide for prevention and wellness including --Developing standards for accessible medical equipment; --Authorizing funds to establish a Prevention and Public Health Investment Fund; --Providing for community Transformation Grants that include focus on the needs of people with disabilities; -- Including disability status within data collection on health disparities; -- Proving training programs for primary care providers and dentistry on how to treat individuals with disabilities; Provide for health coverage that adequately meets the needs of people with disabilities and chronic conditions including -- Covering durable medical equipment, prosthetics and orthotics (DMEPOS) including but not limited to power wheelchairs -- that meet the individual needs of people with disabilities and chronic conditions, enable them to be as independent as possible, to live in their homes and participate in their communities, and enable them to be employed without fear of losing health care/services and supports they need. This includes retaining the first month purchase option for people who have permanent or long-term need for power wheelchairs and including DMEPOS as covered in essential health insurance benefits. Provide for insurance market reforms, such as those included in the Senates Affordable Health Choices Act and the Houses Americas Affordable Health Choices Act that could greatly improve the lives of people with disabilities and chronic conditions by allowing increased access to health care, such as: --Requiring health insurers to provide the same coverage, charge the same premiums and renew policies to people no matter what their disability or other pre-existing or newly acquired conditions. Currently, unless they have employer-sponsored plans, people with disabilities are often denied coverage altogether, the policies exclude needed services or the premiums are way too costly. --Prohibiting lifetime caps on coverage. Currently many insurance companies have a lifetime benefit of $1 million. People with serious injuries or conditions often quickly exceed this cap due to lengthy hospital stays or extensive rehabilitation -- Requiring health insurance to cover rehabilitation and habilitative services. *Pursued both independently and as part of health care reform: CLASS Act* -- S. 697/H.R. 1721 included in the Senates Affordable Health Choices Act. Support legislation to establish a voluntary payroll deduction insurance plan so that people with disabilities will be able to pay for assistance with activities of daily living. This would enable them to remain in their homes and off of the Medicaid program. CBO estimates that the CLASS Act will bring billions into the federal treasury and save Medicaid $2.5 billion in the first 10 years alone. Community Choice Act* (S. 683/H.R. 1670). Support legislation to make services in the home and community the norm under Medicaid - enabling people to stay in their homes and remain part of their communities rather than having to go into nursing homes or other institutions to receive needed services. End Medicares 24-month waiting period* - S 700/HR 1708. Support legislation to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. Comparative Effectiveness Research HR 2502/S 1213* Support legislation to create non-government independent entities to study the comparative effectiveness of treatments in health care. HR 1346/S 540 * Support legislation to prohibit immunity from state laws for companies that have products that are approved medical devices but that cause harm. Mental Illness Chronic Care Improvement (MICCI) Act, S 1136* Support legislation to facilitate access to needed medical services. Amend the Medicare Savings Programs and the Low Income Subsidy* to align, simplify and increase income eligibility, eliminate or substantially increase asset limits, stabilize the programs and make administrative simplifications. Supported H.R.2575 to provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and orthotics devices, components and benefits for other medical and surgical services.

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. 15, National Health Insurance Act 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 S. 264, E-Centives Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 H.R. 3014 Small Business Health Information Technology Financing 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, Mental Illness Chronic Care Improvement Act S. 1099, Independent Health Record Trust 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. ___, Affordable Health Choices Act H.R. 3191, Positive Aging Act of 2009 Guidance Specifying the Technologies and Methodologies That Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals for Purposes of the Breach Notification Requirements Under Section 13402 of Title XIII (Health Information Technology for Economic and Clinical Health Act) of the American Recovery and Reinvestment Act of 2009; Request for Information

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. 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. 264, E-Centives Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 S. 1099, Independent Health Record Trust 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. ___, Affordable Health Choices Act H.R. 3191, Positive Aging Act of 2009 Notice and Request for Comments: Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System Payment Update for Rate Year Beginning July 1, 2009 (RY 2010)

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

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. 264, E-Centives Act of 2009 H.R. 1011, Community Mental Health Services Improvement Act of 2009 S. 1099, Independent Health Record Trust 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. ___, Affordable Health Choices Act H.R. 3200, Americas Affordable Health Choices Act of 2009 Request for Information: Guidance Specifying the Technologies and Methodologies That Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals for Purposes of the Breach Notification Requirements Under Section 13402 of Title XIII (Health Information Technology for Economic and Clinical Health Act) of the American Recovery and Reinvestment Act of 2009

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

HR 1 "American Recovery and Reinvestment Act of 2009," provisions relating to funding for community mental health centers. Issues relating to funding increases for the Substance Abuse and Mental Health Services Administration (SAMHSA) to be included in the FY10 Labor/HHS appropriations bills. Issues relating to health care reform, specifically provisions relating to the assurance of sufficient mental health benefits. S 1136 "Mental Illness Chronic Care Improvement Act of 2009," all provisions. HR 3200 "America's Affordable Health Choices Act of 2009," all provisions pertaining to the adequacy of mental health services for low income persons. Issues pertaining to the adequacy of mental health services for low income persons in future Senate legislation.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Mental Illness Chronic Care Improvement Act (HR 3065/S. 1136), all provisions of bill which authorizes a Medicaid demonstration program to improve the health outcomes and satisfaction of individuals with chronic mental illness. Medicaid Services Restoration Act of 2009 (S 1217), all provisions related to clarifying the definition and scope of rehabilitation services and targeted case management. Ending the Medicare Disability Waiting Period Act of 2009 (HR 1708/ S 700), all provisions relating to ending the two year waiting period for individuals on disability insurance to receive Medicare coverage for their health care needs. The Guidance, Understanding, and Information for Dual Eligibles (GUIDE) Act (HR2390), all provisions relating to the creation of a three year demonstration program that would give financial assistance to community provider organizations to aid clients with a mental disability to access medication and navigate the complex Medicare enrollment process. The Seniors Mental Health Access Improvement Act (H.R. 1693), all provisions related to allowing licensed Marriage and Family Therapists and Professional Counselors to seek reimbursement through Medicare.

Client expense: $65,698 · Firm income: Not reported