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); 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

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

S.660, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies H.R. 756, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies S.1380, Medicare Payment Advisory Commission (MedPAC) Reform Act, a bill to make the commission an executive branch agency, and provide the Commission new resources and authority to implement Medicare payment policy S.301, Physician Payments Sunshine Act, a bill that would require disclosure of the relationships between physicians and the manufacturers of drugs and devices H.R. 3138, Physician Payments Sunshine Act, a bill that would require disclosure of the relationships between physicians and the manufacturers of drugs and devices H.R. 2502, Comparative Effectiveness Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and create a Comparative Effectiveness Research Trust Fund S.1213, Patient-Centered Outcomes Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and to establish a Patient-Centered Outcomes Research Trust Fund H.R. 2824, Doctor-Patient Relationship and Research Protection Act, a bill to support federally funded comparative effectiveness research for drugs, devices, and other therapies S.1142, Informed Health Care Decision Making Act, a bill with respect to the inclusion of effectiveness information in drug and device labeling and advertising H.R. 4700, the Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing H.R. 2249, the Health Care Price Transparency Promotion Act of 2009, to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs. H.R. 4803, the Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information

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

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

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. 684, Medicare Prescription Drug Savings and Choice Act (Berry) Part D reforms; H.R. 904, Medicaid Prescription Drug Rebate Equalization Act (Stupak) Medicaid drug costs; H.R. 1407, Medicare Part D Home and Community Services Copayment Equity Act (Doggett) Part D cost sharing; H.R. 1670, Community Choice Act (Davis) Medicaid coverage; H.R. 1832, Medicare Prescription Drug Affordability Act (Wexler) Part D reforms; (cont.) MMM (Legislative) H.R. 2501, Medicare Cost Contract Extension and Refinement Act (Pomeroy) Medicare cost plans; H.R. 2686, Medicare Advantage Payments (Israel) Medicare Advantage benchmark adjustments; H.R. 2688, Empowered at Home Act (Pallone) home and community-based services under Medicaid; H.R. 2700, Prescription Coverage Now Act (Doggett) low-income assistance under Medicare Part D; H.R. 2718, MedPAC Reform Act (Cooper) implementation of Medicare payment policies; H.R. 2758, Medicare Specialty Care Improvement and Protection Act (Kind) Medicare Advantage special needs plans; H.R. 2847, Jobs for Main Street Act (Mollohan) Medicaid FMAP; H.R. 2860, Medicare Drug Savings Through Choice Act (Murphy) Part D reforms; H.R. 3152, Helping Seniors Choose their Medicare Drug Plan Act (Holt) Part D enrollment; H.R. 3200, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; H.R. 3418, Medicare Prescription Drug Cost Equalization Act (Ellsworth) Part D exceptions process; H.R. 3590, Patient Protection and Affordable Care Act (Reid) Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; H.R. 3631, Medicare Premium Fairness Act (Titus) Part B premiums; H.R. 3961, Medicare Physician Payment Reform Act (Dingell) Medicare physician payment; H.R. 3962, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; H.R. 4213, Tax Extenders Act (Rangel) MA Special Needs Plans, Cost Plans, Medicare physician payment, Medicaid FMAP; H.R. 4263 (Baldwin) Medicaid FMAP extension; H.R. 4691, Temporary Extension Act (Rangel) Medicare physician payment; H.R. 4752, Medicare Prescription Drug Price Negotiation Act (Welch) HHS Secretarys role in negotiating Part D drug prices; H.R. 4851, Continuing Extension Act (Levin) Medicare physician payment; H.R. 4872, Health Care and Education Reconciliation Act (Spratt) changes to Medicare Advantage funding, Medicare Part D coverage gap, Medicaid funding; H.R. 4917 (Schauer) Medicare Part D formulary changes; H.J.Res. 45 Medicare physician payment, pay-as-you-go budget rules; S. 75, Generics First Act (Kohl) Part D reforms; S. 266, Medicare Prescription Drug Gap Reduction Act (Nelson) Part D reforms; S. 330, Medicare Prescription Drug Savings and Choice Act (Durbin) Part D reforms; S. 534, Home and Community Services Copayment Equity Act (Nelson) Part D reforms; S. 547, Drug Rebate Equalization Act (Bingaman) Medicaid drug costs; S. 677, REPAIR Act (Ensign) means-testing Part D premiums; S. 683, Community Choice Act (Harkin) Medicaid coverage; S. 960, Medicare Early Access Act (Rockefeller) Medicare buy-in option; S. 1079, Medicare Cost Contract Extension and Refinement Act (Klobuchar) Medicare cost plans; S. 1307, Medicare Specialty Care Improvement and Protection Act (Feingold) Medicare Advantage special needs plans; S. 1380, MedPAC Reform Act (Rockefeller) implementation of Medicare payment policies; S. 1634, Medicare Prescription Drug Coverage Improvement Act (Rockefeller) government operated Part D plan, dual eligibles; S. 1669, Equal Access to Medicare Options Act (Kerry) guaranteed issue Medigap, Medicare Advantage enrollment; S. 1776, Medicare Physician Fairness Act (Stabenow) Medicare physician payment; S. 1796, Americas Healthy Future Act (Baucus) Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform; S. 2949, (Baucus) Medicaid QI Program funding; S. 3000 (Rockefeller) Medicaid FMAP extension; S. 3153, Continuing Extension Act (Grassley) Medicare physician payment MMM (Regulatory Issues) Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, data, and audit issues, bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits), application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff, measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, compliance/fraud and abuse training, and Medicare/Medicaid integration and contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education program; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues, MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost/rebate issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including documentation of citizenship requirements, state benefit flexibility options, and Medicaid managed care organization provider tax issues; standards for electronic prescribing; and health information technology standards and policies.

Client expense: $2,700,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

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 - Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; HR 3590, Patient Protection and Affordable Care Act - Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; HR 3961, Medicare Physician Payment Reform Act - Medicare physician payment; HR 3962, Affordable Health Care for America Act - Medicare Advantage, Part D, special needs plans , Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; HR 4213, Tax Extenders Act - Medicare Advantage, special needs plans, cost plans, Medicare physician payment, Medicaid FMAP; HR 4691, Temporary Extension Act - Medicare physician payment; HR 4851, Continuing Extension Act - Medicare physician payment; HR 4872, Health Care and Education Reconciliation Act - changes to Medicare Advantage funding, Medicare Part D coverage gap, Medicaid funding; HR Res 45 - Medicare physician payment, pay-as-you-go rules; S 960, Medicare Early Access Act - Medicare buy-in option; S 1307, Medicare Specialty Care Improvement and Protection Act - Medicare Advantage special needs plans; S 1380, MedPAC Reform Act - implementation of Medicare payment policies; S 1796, America's Healthy Future Act - Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform;

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

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

HR 3200, America's Affordable Health Choices Act - Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; HR 3590, Patient Protection and Affordable Care Act - Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; HR 3961, Medicare Physician Payment Reform Act - Medicare physician payment; HR 3962, Affordable Health Care for America Act - Medicare Advantage, Part D, special needs plans , Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; HR 4213, Tax Extenders Act - Medicare Advantage, special needs plans, cost plans, Medicare physician payment, Medicaid FMAP; HR 4691, Temporary Extension Act - Medicare physician payment; HR 4851, Continuing Extension Act - Medicare physician payment; HR 4872, Health Care and Education Reconciliation Act - changes to Medicare Advantage funding, Medicare Part D coverage gap, Medicaid funding; HR Res 45 - Medicare physician payment, pay-as-you-go rules; S 960, Medicare Early Access Act - Medicare buy-in option; S 1307, Medicare Specialty Care Improvement and Protection Act - Medicare Advantage special needs plans; S 1380, MedPAC Reform Act - implementation of Medicare payment policies; S 1796, America's Healthy Future Act - Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform;

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

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

HR 3200, America's Affordable Health Choices Act - Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; HR 3590, Patient Protection and Affordable Care Act - Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; HR 3961, Medicare Physician Payment Reform Act - Medicare physician payment; HR 3962, Affordable Health Care for America Act - Medicare Advantage, Part D, speical needs plans , Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; HR 4213, Tax Extenders Act - Medicare Advantage, special needs plans, cost plans, Medicare physician payment, Medicaid FMAP; HR 4691, Temporary Extension Act - Medicare physician payment; HR 4851, Continuing Extension Act - Medicare physician payment; HR 4872, Health Care and Education Reconciliation Act - changes to Medicare Advantage funding, Medicare Part D coverage gap, Medicaid funding; HR Res 45 - Medicare physician payment, pay-as-you-go rules; S 960, Medicare Early Access Act - Medicare buy-in option; S 1307, Medicare Specialty Care Improvement and Protection Act - Medicare Advantage special needs plans; S 1380, MedPAC Reform Act - implementation of Medicare payment policies; S 1796, America's Healthy Future Act - Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform;

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

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

HR 3200, America's Affordable Health Choices Act - Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; HR 2758, Medicare Specialty Care Improvement and Protection Act - Medicare Advantage, special needs plans; HR 3590, Patient Protection and Affordable Care Act - Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; HR 3961, Medicare Physician Payment Reform Act - Medicare physician payment; HR 3962, Affordable Health Care for America Act - Medicare Advantage, Part D, special needs plans , Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; HR 4213, Tax Extenders Act - Medicare Advantage, special needs plans, cost plans, Medicare physician payment, Medicaid FMAP; HR 4691, Temporary Extension Act - Medicare physician payment; HR 4851, Continuing Extension Act - Medicare physician payment; HR 4872, Health Care and Education Reconciliation Act - changes to Medicare Advantage funding, Medicare Part D coverage gap, Medicaid funding; HR Res 45 - Medicare physician payment, pay-as-you-go rules; S 960, Medicare Early Access Act - Medicare buy-in option; S 1307, Medicare Specialty Care Improvement and Protection Act - Medicare Advantage special needs plans; S 1380, MedPAC Reform Act - implementation of Medicare payment policies; S 1796, America's Healthy Future Act - Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform;

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

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

Medicare Advantage, Part D, special needs plans, medicare cost plans, medicaid issues including MCO provider taxes, eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform - HR 3962, America's Affordable Health Choices Act. Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform - HR 3590, An act entitled The Patient Protection and Affordable Care Act. Changes to Medicare Advantage funding, Medicare Part D coverage gap, Medicaid funding - HR 4872, Health Care and Education Reconciliation Act of 2010. *Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion, Medigap open enrollment, Medicare FFS payment reform - HR 3200, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; proposed legislation re this issue; HR 3590, An act entitled The Patient Protection and Affordable Care Act. *Part D reforms - HR 684, To amend title XVIII of the Social Security Act to deliver a meaningful benefit and lower prescription drug prices under the Medicare Program; HR 1832, To amend part D of title XVIII of the Social Security Act to limit the increase in premium costs for beneficiaries under the Medicare prescription drug program to no more than the Social Security cost-of-living adjustment, and to direct the Secretary of Health and Human Services to negotiate lower prescription drug prices on behalf of Medicare beneficiaries; S 75, A bill to amend title XVIII of the Social Security Act to require the use of generic drugs under the Medicare part D prescription drug program when available unless the brand name drug is determined to be medically necessary; S 266, A bill to amend title XVIII of the Social Security Act to reduce the coverage gap in prescription drug coverage under part D of such title based on savings to the Medicare program resulting from the negotiation of prescription drug prices; S 330, A bill to amend title XVIII of the Social Security Act to deliver a meaningful benefit and lower prescription drug prices under the Medicare program; 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-institutionalized full-benefit dual eligible individuals; HR 2860, To amend title XVIII of the Social Security Act to provide for a Medicare operated prescription drug plan option to deliver a meaningful drug benefit and lower prescription drug prices under the Medicare Program. *Medicaid drug costs - HR 904, To amend title XIX of the Social Security Act to reduce the costs of prescription drugs for enrollees of Medicaid managed care organizations by extending the discounts offered under fee-for-service Medicaid to such organizations; S 547, A bill to amend title XIX of the Social Security Act to reduce the costs of prescription drugs for enrollees of Medicaid managed care organizations by extending the discounts offered under fee-for-service Medicaid to such organizations. *Part D cost sharing - HR 1407, To amend title XVIII of the Social Security Act to reduce cost-sharing under part D of such title for certain non-institutionalized full-benefit dual eligible individuals. *Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform - HR 3200, America's Affordable Health Choices Act. *Medicare physician payments - HR 3961, Medicare Physician Payment Reform Act of 2009; HR 4691, Temporary Extension Act of 2010; HR 4851, Continuing Extension Act of 2010; S 3153, Continuing Extension Act of 2010. *MA special needs plans, cost plans, Medicare physician payments, Medicaid FMAP - HR 4213, American Workers, State, and Business Relief Act of 2010. *Medicaid FMAP extension - HR 4263, State Medicaid Assistance Extension Act of 2009; 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. *Medicaid coverage - HR 1670, To amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes; S 683, A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. *Means-testing Part D premiums - S 677, A bill to amend title XVIII of the Social Security Act to require wealthy beneficiaries to pay a greater share of their premiums under the Medicare prescription drug program. *Medicare cost plans - HR 2501, To amend title XVIII of the Social Security Act to extend reasonable cost contracts under Medicare; S 1079, A bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program. *Medicare Advantage benchmark adjustments - HR 2686, To amend title XVIII of the Social Security Act to provide for a Medicare Advantage benchmark adjustment for certain local areas with VA medical centers and for certain contiguous areas. *Low-income assistance under Medicare Part D - HR 2700, To amend part D of title XVIII of the Social Security Act to assist low-income individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. *Implementation of Medicare payment policies - HR 2718, 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 1380, 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. *Medicare Advantage special needs plans - HR 2758, 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, and for other purposes; S 1307, 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, and for other purposes. *Home and community-based services under Medicaid - HR 2688, 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. *Part D enrollment - HR 3152, 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. *Part D exceptions process, HR 3418, To amend part D of title XVIII of the Social Security Act to apply the exceptions process for tiered formulary drugs to specialty tier drugs. *Part B premiums - HR 3631, 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. *Government-operated Part D plan, dual eligibles - S 1634, A bill to amend titles XVIII and XIX of the Social Security Act to protect and improve the benefits provided to dual eligible individuals under the Medicare and Medicaid programs. *Guaranteed-issue MediGap, Medicare Advantage enrollment - S 1669, A bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy. *Medicaid FMAP - HR 2847, Making appropriations for the Departments of Commerce and Justice, and Science, and Related Agencies for the fiscal year ending September 30, 2010, and for other purposes. *Medicare physician payments - S 1776, 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. *Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform - S 1796, An original bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. *HHS Secretary's role in negotiating Part D drug prices - HR 4752, Medicare Prescription Drug Price Negotiation Act of 2010. *Medicare Part D formulary changes - HR 4917, To amend part D of title XVIII of the Social Security Act to prohibit mid-year changes in the formularies of Medicare Part D plans. *Medicare physician payment, pay-as-you-go budget rules - HJRes 45, Increasing the statutory limit on the public debt. *Medicaid QI Program funding - S 2949, Emergency Aid to American Survivors of the Haiti Earthquake Act.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

S.660, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies H.R. 756, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies S.1380, Medicare Payment Advisory Commission (MedPAC) Reform Act, a bill to make the commission an executive branch agency, and provide the Commission new resources and authority to implement Medicare payment policy S.301, Physician Payments Sunshine Act, a bill that would require disclosure of the relationships between physicians and the manufacturers of drugs and devices H.R. 3138, Physician Payments Sunshine Act, a bill that would require disclosure of the relationships between physicians and the manufacturers of drugs and devices H.R. 2502, Comparative Effectiveness Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and create a Comparative Effectiveness Research Trust Fund S.1213, Patient-Centered Outcomes Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and to establish a Patient-Centered Outcomes Research Trust Fund H.R. 2824, Doctor-Patient Relationship and Research Protection Act, a bill to support federally funded comparative effectiveness research for drugs, devices, and other therapies S.1142, Informed Health Care Decision Making Act, a bill with respect to the inclusion of effectiveness information in drug and device labeling and advertising

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Transportation, Dept of (DOT)

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

Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform - HR 3962, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion, Medigap open enrollment, Medicare FFS payment reform - HR 3200, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; proposed legislation re this issue; HR 3590, An act entitled The Patient Protection and Affordable Care Act. Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform - HR 3590, An act entitled The Patient Protection and Affordable Care Act. Part D reforms - HR 684, To amend title XVIII of the Social Security Act to deliver a meaningful benefit and lower prescription drug prices under the Medicare Program; HR 1832, To amend part D of title XVIII of the Social Security Act to limit the increase in premium costs for beneficiaries under the Medicare prescription drug program to no more than the Social Security cost-of-living adjustment, and to direct the Secretary of Health and Human Services to negotiate lower prescription drug prices on behalf of Medicare beneficiaries; S 75, A bill to amend title XVIII of the Social Security Act to require the use of generic drugs under the Medicare part D prescription drug program when available unless the brand name drug is determined to be medically necessary; S 266, A bill to amend title XVIII of the Social Security Act to reduce the coverage gap in prescription drug coverage under part D of such title based on savings to the Medicare program resulting from the negotiation of prescription drug prices; S 330, A bill to amend title XVIII of the Social Security Act to deliver a meaningful benefit and lower prescription drug prices under the Medicare program; 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-institutionalized full-benefit dual eligible individuals; HR 2860, To amend title XVIII of the Social Security Act to provide for a Medicare operated prescription drug plan option to deliver a meaningful drug benefit and lower prescription drug prices under the Medicare Program. Medicaid drug costs - HR 904, To amend title XIX of the Social Security Act to reduce the costs of prescription drugs for enrollees of Medicaid managed care organizations by extending the discounts offered under fee-for-service Medicaid to such organizations; S 547, A bill to amend title XIX of the Social Security Act to reduce the costs of prescription drugs for enrollees of Medicaid managed care organizations by extending the discounts offered under fee-for-service Medicaid to such organizations. Part D cost sharing - HR 1407, To amend title XVIII of the Social Security Act to reduce cost-sharing under part D of such title for certain non-institutionalized full-benefit dual eligible individuals. Medicaid coverage - HR 1670, To amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes; S 683, A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. Means-testing Part D premiums - S 677, A bill to amend title XVIII of the Social Security Act to require wealthy beneficiaries to pay a greater share of their premiums under the Medicare prescription drug program. Medicare cost plans - HR 2501, To amend title XVIII of the Social Security Act to extend reasonable cost contracts under Medicare; S 1079, A bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program. Medicare Advantage benchmark adjustments - HR 2686, To amend title XVIII of the Social Security Act to provide for a Medicare Advantage benchmark adjustment for certain local areas with VA medical centers and for certain contiguous areas. Low-income assistance under Medicare Part D - HR 2700, To amend part D of title XVIII of the Social Security Act to assist low-income individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. Implementation of Medicare payment policies - HR 2718, 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 1380, 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. Medicare Advantage special needs plans - HR 2758, 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, and for other purposes; S 1307, 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, and for other purposes. Home and community-based services under Medicaid - HR 2688, 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. Part D enrollment - HR 3152, 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. Part D exceptions process, HR 3418, To amend part D of title XVIII of the Social Security Act to apply the exceptions process for tiered formulary drugs to specialty tier drugs. Part B premiums - HR 3631, 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. Government-operated Part D plan, dual eligibles - S 1634, A bill to amend titles XVIII and XIX of the Social Security Act to protect and improve the benefits provided to dual eligible individuals under the Medicare and Medicaid programs. Guaranteed-isse MediGap, Medicare Advantage enrollment - S 1669, A bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy. Medicaid FMAP - HR 2847, Making appropriations for the Departments of Commerce and Justice, and Science, and Related Agencies for the fiscal year ending September 30, 2010, and for other purposes. Medicare physician payments - HR 3326, Making appropriations for the Department of Defense for the fiscal year ending September 30, 2010, and for other purposes; S 1776, 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. Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform - S 1796, An original bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, White House Office

S. 1796 Americas Healthy Future Act (Baucus) Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform; H.R. 3962, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform. S. 1380, MedPAC Reform Act (Rockefeller) implementation of Medicare payment policies; H.R. 3590 The Patient Protection and Affordable Care Act (Reid managers amendment).

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

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

S. 1796 Americas Healthy Future Act (Baucus) Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform; H.R. 3590 The Patient Protection and Affordable Care Act (Reid managers amendment). H.R. 3962, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; S. 1380, MedPAC Reform Act (Rockefeller) implementation of Medicare payment policies.

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

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

S. 1796 Americas Healthy Future Act (Baucus) Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform; H.R. 3962, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform. S. 1380, MedPAC Reform Act (Rockefeller) implementation of Medicare payment policies; H.R. 3590 The Patient Protection and Affordable Care Act (Reid managers amendment).

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

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

S. 1796Americas Healthy Future Act (Baucus) Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform; H.R. 3962, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; S. 1380, MedPAC Reform Act (Rockefeller) implementation of Medicare payment policies; H.R. 3590 The Patient Protection and Affordable Care Act (Reid managers amendment); H.R. 3590 The Patient Protection and Affordable Care Act (Reid managers amendment).

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

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

S. 1796 Americas Healthy Future Act (Baucus) Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform; H.R. 3590 The Patient Protection and Affordable Care Act (Reid managers amendment). H.R. 3962, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; S. 1380, MedPAC Reform Act (Rockefeller) implementation of Medicare payment policies.

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

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

H.R. 684, Medicare Prescription Drug Savings and Choice Act (Berry) Part D reforms; H.R. 904, Medicaid Prescription Drug Rebate Equalization Act (Stupak) Medicaid drug costs; H.R. 1407, Medicare Part D Home and Community Services Copayment Equity Act (Doggett) Part D cost sharing; H.R. 1670, Community Choice Act (Davis) Medicaid coverage; H.R. 1832, Medicare Prescription Drug Affordability Act (Wexler) Part D reforms; H.R. 2501, Medicare Cost Contract Extension and Refinement Act (Pomeroy) Medicare cost plans; H.R. 2686, Medicare Advantage Payments (Israel) Medicare Advantage benchmark adjustments; H.R. 2688, Empowered at Home Act (Pallone) home and community-based services under Medicaid; H.R. 2700, Prescription Coverage Now Act (Doggett) low-income assistance under Medicare Part D; H.R. 2718, MedPAC Reform Act (Cooper) implementation of Medicare payment policies; H.R. 2758, Medicare Specialty Care Improvement and Protection Act (Kind) Medicare Advantage special needs plans; H.R. 2847, Jobs for Main Street Act (Mollohan) Medicaid FMAP; H.R. 2860, Medicare Drug Savings Through Choice Act (Murphy) Part D reforms; H.R. 3152, Helping Seniors Choose their Medicare Drug Plan Act (Holt) Part D enrollment; H.R. 3200, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; H.R. 3326, Defense Appropriations Act (Murtha) Medicare physician payment; H.R. 3418, Medicare Prescription Drug Cost Equalization Act (Ellsworth) Part D exceptions process; H.R. 3590, Patient Protection and Affordable Care Act (Reid) Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; H.R. 3631, Medicare Premium Fairness Act (Titus) Part B premiums; H.R. 3962, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform; S. 75, Generics First Act (Kohl) Part D reforms; S. 266, Medicare Prescription Drug Gap Reduction Act (Nelson) Part D reforms; S. 330, Medicare Prescription Drug Savings and Choice Act (Durbin) Part D reforms; S. 534, Home and Community Services Copayment Equity Act (Nelson) Part D reforms; S. 547, Drug Rebate Equalization Act (Bingaman) Medicaid drug costs; S. 677, REPAIR Act (Ensign) means-testing Part D premiums; S. 683, Community Choice Act (Harkin) Medicaid coverage; S. 960, Medicare Early Access Act (Rockefeller) Medicare buy-in option; S. 1079, Medicare Cost Contract Extension and Refinement Act (Klobuchar) Medicare cost plans; S. 1307, Medicare Specialty Care Improvement and Protection Act (Feingold) Medicare Advantage special needs plans; S. 1380, MedPAC Reform Act (Rockefeller) implementation of Medicare payment policies; S. 1634, Medicare Prescription Drug Coverage Improvement Act (Rockefeller) government operated Part D plan, dual eligibles; S. 1669, Equal Access to Medicare Options Act (Kerry) guaranteed issue Medigap, Medicare Advantage enrollment; S. 1776, Medicare Physician Fairness Act (Stabenow) Medicare physician payment; S. 1796, Americas Healthy Future Act (Baucus) Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform MMM (Regulatory Issues) Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, data, and audit issues, bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits), application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff, measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, compliance/fraud and abuse training, and Medicare/Medicaid integration and contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education program; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues, MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost/rebate issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including documentation of citizenship requirements, state benefit flexibility options, and Medicaid managed care organization provider tax issues; standards for electronic prescribing; and health information technology standards and policies.

Client expense: $2,540,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

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

See page five for specific Health Care issues. H. R. 3200 - America's Affordable Health Choices Act of 2009 H. R. 2718/S. 1110/S. 1380 - Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H. R. 2251/S. 973 - Resident Physician Shortage Reduction Act of 2009 H. R. 2844/S. 1249/H. R. 3074 - Medicare Payment Improvement Act of 2009 H. R. 3590 - Patient Protection and Affordable Care Act H. R. 3854 - Small Business Financing and Investment Act of 2009 H. R. 3961 - Medicare Physician Payment Reform Act of 2009 H. R. 3962 - Affordable Health Care for America Act H. R. 3326 - Department of Defense Appropriations Act, 2010 H. R. 3693 - Ensuring the Future Physician Workforce Act of 2009 H. R. 4371 - To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. S. 733 - National Trauma Center Stabilization Act of 2009 S. 1679 - Affordable Health Choices Act S. 1796 - America's Healthy Future Act of 2009 S. 1776 - Medicare Physician Fairness Act of 2009

Client expense: $8,403 · Firm income: Not reported

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

See page three for specific Medicare/Medicaid issues. H. R. 3200 - America's Affordable Health Choices Act of 2009 H. R. 2718/S. 1110/S. 1380 - Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H. R. 2251/S. 973 - Resident Physician Shortage Reduction Act of 2009 H. R. 2844/S. 1249/H. R. 3074 - Medicare Payment Improvement Act of 2009 H. R. 3590 - Patient Protection and Affordable Care Act H. R. 3854 - Small Business Financing and Investment Act of 2009 H. R. 3961 - Medicare Physician Payment Reform Act of 2009 H. R. 3962 - Affordable Health Care for America Act H. R. 3326 - Department of Defense Appropriations Act, 2010 H. R. 3693 - Ensuring the Future Physician Workforce Act of 2009 H. R. 4371 - To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. S. 733 - National Trauma Center Stabilization Act of 2009 S. 1679 - Affordable Health Choices Act S. 1796 - America's Healthy Future Act of 2009 S. 1776 - Medicare Physician Fairness Act of 2009

Client expense: $8,403 · Firm income: Not reported

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

See page five for specific Health Care issues. H. R. 3200 - America's Affordable Health Choices Act of 2009 H. R. 2718/S. 1110/S. 1380 - Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H. R. 2251/S. 973 - Resident Physician Shortage Reduction Act of 2009 H. R. 2844/S. 1249/H. R. 3074 - Medicare Payment Improvement Act of 2009 H. R. 3590 - Patient Protection and Affordable Care Act H. R. 3854 - Small Business Financing and Investment Act of 2009 H. R. 3961 - Medicare Physician Payment Reform Act of 2009 H. R. 3962 - Affordable Health Care for America Act H. R. 3326 - Department of Defense Appropriations Act, 2010 H. R. 3693 - Ensuring the Future Physician Workforce Act of 2009 H. R. 4371 - To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. S. 733 - National Trauma Center Stabilization Act of 2009 S. 1679 - Affordable Health Choices Act S. 1796 - America's Healthy Future Act of 2009 S. 1776 - Medicare Physician Fairness Act of 2009

Client expense: $59,732 · Firm income: Not reported

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

See page three for specific Medicare/Medicaid issues. H. R. 3200 - America's Affordable Health Choices Act of 2009 H. R. 2718/S. 1110/S. 1380 - Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 H. R. 2251/S. 973 - Resident Physician Shortage Reduction Act of 2009 H. R. 2844/S. 1249/H. R. 3074 - Medicare Payment Improvement Act of 2009 H. R. 3590 - Patient Protection and Affordable Care Act H. R. 3854 - Small Business Financing and Investment Act of 2009 H. R. 3961 - Medicare Physician Payment Reform Act of 2009 H. R. 3962 - Affordable Health Care for America Act H. R. 3326 - Department of Defense Appropriations Act, 2010 H. R. 3693 - Ensuring the Future Physician Workforce Act of 2009 H. R. 4371 - To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. S. 733 - National Trauma Center Stabilization Act of 2009 S. 1679 - Affordable Health Choices Act S. 1796 - America's Healthy Future Act of 2009 S. 1776 - Medicare Physician Fairness Act of 2009

Client expense: $59,732 · Firm income: Not reported

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

Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform - HR 3962, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including MCO provider taxes, eligibility expansion, Medigap open enrollment, Medicare FFS payment reform - HR 3200, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; proposed legislation re this issue; HR 3590, An act entitled The Patient Protection and Affordable Care Act. Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug pricing, Medigap changes, Medicare FFS payment reform - HR 3590, An act entitled The Patient Protection and Affordable Care Act. Part D reforms - HR 684, To amend title XVIII of the Social Security Act to deliver a meaningful benefit and lower prescription drug prices under the Medicare Program; HR 1832, To amend part D of title XVIII of the Social Security Act to limit the increase in premium costs for beneficiaries under the Medicare prescription drug program to no more than the Social Security cost-of-living adjustment, and to direct the Secretary of Health and Human Services to negotiate lower prescription drug prices on behalf of Medicare beneficiaries; S 75, A bill to amend title XVIII of the Social Security Act to require the use of generic drugs under the Medicare part D prescription drug program when available unless the brand name drug is determined to be medically necessary; S 266, A bill to amend title XVIII of the Social Security Act to reduce the coverage gap in prescription drug coverage under part D of such title based on savings to the Medicare program resulting from the negotiation of prescription drug prices; S 330, A bill to amend title XVIII of the Social Security Act to deliver a meaningful benefit and lower prescription drug prices under the Medicare program; 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-institutionalized full-benefit dual eligible individuals; HR 2860, To amend title XVIII of the Social Security Act to provide for a Medicare operated prescription drug plan option to deliver a meaningful drug benefit and lower prescription drug prices under the Medicare Program. Medicaid drug costs - HR 904, To amend title XIX of the Social Security Act to reduce the costs of prescription drugs for enrollees of Medicaid managed care organizations by extending the discounts offered under fee-for-service Medicaid to such organizations; S 547, A bill to amend title XIX of the Social Security Act to reduce the costs of prescription drugs for enrollees of Medicaid managed care organizations by extending the discounts offered under fee-for-service Medicaid to such organizations. Part D cost sharing - HR 1407, To amend title XVIII of the Social Security Act to reduce cost-sharing under part D of such title for certain non-institutionalized full-benefit dual eligible individuals. Medicaid coverage - HR 1670, To amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes; S 683, A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. Means-testing Part D premiums - S 677, A bill to amend title XVIII of the Social Security Act to require wealthy beneficiaries to pay a greater share of their premiums under the Medicare prescription drug program. Medicare cost plans - HR 2501, To amend title XVIII of the Social Security Act to extend reasonable cost contracts under Medicare; S 1079, A bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program. Medicare Advantage benchmark adjustments - HR 2686, To amend title XVIII of the Social Security Act to provide for a Medicare Advantage benchmark adjustment for certain local areas with VA medical centers and for certain contiguous areas. Low-income assistance under Medicare Part D - HR 2700, To amend part D of title XVIII of the Social Security Act to assist low-income individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. Implementation of Medicare payment policies - HR 2718, 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 1380, 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. Medicare Advantage special needs plans - HR 2758, 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, and for other purposes; S 1307, 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, and for other purposes. Home and community-based services under Medicaid - HR 2688, 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. Part D enrollment - HR 3152, 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. Part D exceptions process, HR 3418, To amend part D of title XVIII of the Social Security Act to apply the exceptions process for tiered formulary drugs to specialty tier drugs. Part B premiums - HR 3631, 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. Government-operated Part D plan, dual eligibles - S 1634, A bill to amend titles XVIII and XIX of the Social Security Act to protect and improve the benefits provided to dual eligible individuals under the Medicare and Medicaid programs. Guaranteed-isse MediGap, Medicare Advantage enrollment - S 1669, A bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy. Medicaid FMAP - HR 2847, Making appropriations for the Departments of Commerce and Justice, and Science, and Related Agencies for the fiscal year ending September 30, 2010, and for other purposes. Medicare physician payments - HR 3326, Making appropriations for the Department of Defense for the fiscal year ending September 30, 2010, and for other purposes; S 1776, 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. Medicare Advantage, Part D, special needs plans, Medicare cost plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform - S 1796, An original bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, White House Office

HR1625/S654 - Amend Title XIX of the SSA; HR2714/S1110/S1380 - Expand powers of MedPAC;HR1776/HR3961/HR3326 - Medicare Physician Fees;

Client expense: $52,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare/Part B Premium Hold Harmless. H.R. 3631: Provisions extending the current "hold harmless" policy to all Medicare enrollees to ensure 2010 Part B monthly premiums remain at the current rate. Comprehensive Health Care Reform. H.R. 3590, H.R. 3962, H.R. 3200, S. 1679: provisions related to reducing Medicare Advantage plan payments, reducing the coverage gap in Part D, requiring wealthier Medicare beneficiaries to pay a greater share of the cost of their premiums under Medicare Parts B and D, permitting the Department of Health and Human Services to negotiate drug prices for the Part D program, simplifying plan benefit designs under Part C, expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS), improving the process for reassigning LIS beneficiaries to new plans, expanding coverage of prevention services establishing a Medicare Commission, providing expanded Medicaid coverage for home and community-based services, expanding Medicaid coverage of attendant and other home services and supports, establishing a new national insurance program for long-term supports and services, authorizing funding to provide language services to limited English proficiency beneficiaries, authorizing the collection of data regarding disparities in the provision of care, providing safeguards and subsidies to assure affordability of health coverage for seniors, preserving state benefit laws and requirements, reducing permitted age rating ratio for insurance premiums, inclusion of patient-centered quality reporting requirements for providers, creating new claims reviews processes and provider certification, requiring reporting by practitioners of gifts received from pharmaceutical and medical device manufacturers. Medicare/Commission. S. 1110 and S. 1380: authorizing an enhanced MedPAC as an executive branch commission with authority to implement Medicare payment and policy designed to reduce Medicare spending growth. Medicare/Prescription Drug Plan. S. 330/H.R. 684: authorizing the establishment of a Medicare-operated prescription drug plan; S. 266: authorizing the Secretary of Health and Human Services to negotiate lower prescription drug prices and to use the savings to reduce the coverage gap. Medicare/Part D Generics. S. 75: requiring the use of generics where available unless the brand name drug is determined to be medically necessary. Medicare/Part D cost-sharing. S. 1630: establishing limits on required beneficiary cost-sharing under Part D drug plans. Medicare/Part D dual eligibles. S. 1634: removing enrollment barriers for low-income beneficiaries and establishing a Medicare-operated prescription drug plan. Medicare/Combating Waste, Fraud, Abuse. H.R. 27: relating to additional provisions to combat waste, fraud, and abuse within Medicare; H.R. 203: increasing civil and criminal penalties for acts involving fraud and abuse and increasing the surety bond amount for suppliers of durable medical equipment. Medicare/Therapy Caps. H.R. 43/S. 46: repealing outpatient rehabilitation therapy caps. Medicare/Private Contracts. H.R. 164: prohibiting denial of Social Security benefits to persons who elect not to participate in Medicare. Medicare/Hearing Coverage. H.R. 504: authorizing coverage of hearing aids and auditory rehabilitation services under Medicare Part B. Medicare/Dental Coverage. H.R. 870: authoring coverage under Part B for medically necessary dental procedures. Medicare/Rural Improvements. H.R. 902/S. 382: provision authorizing improvements to services provided to beneficiaries residing in rural areas. Medicare/Shingles Vaccine. H.R. 1038: extending Part B coverage to the shingles vaccine. Medicare/Home Health. H.R. 1094: authorizing home health care agencies to assign the most appropriate skilled service to make the initial assessment visit under a Medicare home health plan of care for rehabilitation services. Medicare/Health Care Vouchers. H.R. 1118: authorizing Medicare-eligible seniors to elect to receive vouchers for a health savings account, premiums for a high deductible health insurance plan, or both, in lieu of regular Medicare benefits and suspending Medicare late enrollment penalties between ages 65 and 70. Medicare/Skilled Nursing Facilities. H.R. 1125, S. 647: provisions related to requiring the reporting of expenditures for nursing services at skilled nursing facilities and requiring disclosure of corporate ownership. Medicare/Prevention. H.R. 1213: provisions authorizing ultrasound screening for abdominal aortic aneurysms to at-risk Medicare beneficiaries between the ages of 65 and 75 without the requirement of a prior initial preventive physical examination; H.R. 1894/S. 769: expanding access to bone mass measurement benefits under Part B. Medicare/Part B Drug Payments. H.R. 1392: relating to appropriate Part B payment amounts for drugs and biologicals. Medicare/Low Income Prescription Drug Benefits. H.R. 1407/S. 534: authorizing a reduction in cost-sharing under Part D for non-institutionalized, full-benefit dual eligible individuals. Medicare/Disability Benefits. S. 700/H.R. 1708, H.R. 2881: phasing-out the 24-month waiting period for disabled individuals to become eligible for Medicare benefits and eliminating the waiting period for individuals with life-threatening conditions. Medicare/Prescription Drugs for kidney transplants. H.R. 1458/S. 565: provision related to continued coverage for immunosuppressive drugs furnished beneficiaries that have received kidney transplants and whose entitlement to coverage would otherwise expire. Medicare/Intravenous Drugs. H.R. 1765/S.701: relating to the payment for intravenous immune globulin (IVIG) for the treatment of primary immune deficiency diseases in a patient's home and for certain disposable pumps as durable medical equipment in place of non-disposable pumps. Medicare/Home Infusion Therapy. H.R. 574/S.254: extending Medicare coverage to home infusion therapy. Medicare/Physical Therapy Services. H.R. 1829: authorizing physical therapists to evaluate and treat Medicare beneficiaries without physician referral. Medicare/Part D Premiums. H.R. 1832: limiting Part D premium increases to no more than the Social Security cost-of-living adjustment and requiring the Secretary of Health and Human Services to negotiate lower prescription drug prices. Medicare/Cancer Hospice and Palliative Care. H.R. 1844: provisions authorizing coverage of comprehensive cancer care planning, establishing a Medicare hospice care demonstration, and authorizing grant programs for cancer palliative care and symptom management, provider education, and related research. Medicare/Hospice and Advanced Care Planning. S. 1150, H.R. 2911: provisions related to changing hospice payments and providing advance care planning resources. Medicare/Physician-Manufacturer Transparency. S. 301: increasing the transparency of the relationship between physicians and the manufacturers of drugs, devices, biologicals, and medical supplies. Medicare/Care Coordination Services. S. 1131, H.R. 2560: provisions establishing pilot care coordination program.

Client expense: $340,000 · Firm income: Not reported

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

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 the American Health Care Choices Act (Senate HELP Committee bill (S.1679)); Senate Finance Committee delivery system, coverage, and financing options papers and bill (America's Healthy Futures Act of 2009); House tri-committee discussion draft bill and legislation (H.R. 3200), including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions; Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Care Act (H.R.3590)); 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). 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)); Senate Finance Committee delivery system, coverage, and financing options papers and legislation (America's Healthy Futures Act of 2009); House tri-committee discussion draft bill and legislation (H.R. 3200), 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)).

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), Housing & Urban Development, Dept of (HUD), SENATE, White House Office

S.660, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies H.R. 756, National Pain Care Policy Act, a bill to promote greater access to chronic pain therapies S.1380, Medicare Payment Advisory Commission (MedPAC) Reform Act, a bill to make the commission an executive branch agency, and provide the Commission new resources and authority to implement Medicare payment policy S.301, Physician Payments Sunshine Act, a bill that would require disclosure of the relationships between physicians and the manufacturers of drugs and devices H.R. 3138, Physician Payments Sunshine Act, a bill that would require disclosure of the relationships between physicians and the manufacturers of drugs and devices H.R. 2502, Comparative Effectiveness Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and create a Comparative Effectiveness Research Trust Fund S.1213, Patient-Centered Outcomes Research Act of 2009, a bill to provide for the conduct of comparative effectiveness research for drugs, devices, and other therapies and to establish a Patient-Centered Outcomes Research Trust Fund H.R. 2824, Doctor-Patient Relationship and Research Protection Act, a bill to support federally funded comparative effectiveness research for drugs, devices, and other therapies S.1142, Informed Health Care Decision Making Act, a bill with respect to the inclusion of effectiveness information in drug and device labeling and advertising

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

America's Affordable Health Choices Act of 2009 (HR 3200); Affordable Health Choices Act (S. 1679); House and Senate Health Reform Proposals; Employee Free Choice Act of 2009 (H.R. 1409/S.560); Long-Term Care Hospital Bills (H.R. 2124/S. 935; MedPAC Reform Act of 2009 (S. 1110, S.1380); Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2010.

Client expense: Not reported · Firm income: $110,000

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), 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 State Children's Health Insurance Program 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 Centers for Medicare & Medicaid Services 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 AMERICAS 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.

Client expense: $3,830,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), 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

See page three for specific Medicare/Medicaid issues. H. R. 3200 - America's Affordable Health Choices Act of 2009 H. R. 1213 - Screening Abdominal Aortic Aneurysms Very Efficiently Act of 2009 H. R. 2350 - Preserving Patient Access to Primary Care Act of 2009 H. R. 2844/S. 1249/H. R. 3074 - Medicare Payment Improvement Act of 2009 H.R. 2718/S. 1110/S. 1380 - Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 330 - Medicare Prescription Drug Savings and Choice Act of 2009 S. 179 - Health Information Technology Act of 2009 S. 717 - 21st Century Cancer ALERT (Access to Life-Saving Early detection, Research and Treatment) Act S. 1679 - Affordable Health Choices Act

Client expense: $59,412 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

See page five for specific Health Care issues. H. R. 3200 - America's Affordable Health Choices Act of 2009 H. R. 914 - Physician Workforce Enhancement Act of 2009 H. R. 1678 - Mitigating the Impact of Uncompensated Service and Time Act of 2009 H. R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 H. R. 1016 - Veterans Health Care Budget Reform and Transparency Act of 2009 H. R. 84 - Veterans Timely Access to Health Care Act H. R. 1213 - Screening Abdominal Aortic Aneurysms Very Efficiently Act of 2009 H. R. 2891 - Access to Frontline Health Care Act of 2009 H. R. 2350 - Preserving Patient Access to Primary Care Act of 2009 H. R. 2251/S. 973 - Resident Physician Shortage Reduction Act of 2009 H. R. 2844/S. 1249/H. R. 3074 - Medicare Payment Improvement Act of 2009 H. R. 1377 - To amend title 38, United States Code, to expand veteran eligibility for reimbursement by the Secretary of Veterans Affairs for emergency treatment furnished in a non-Department facility, and for other purposes. H.R. 2718/S. 1110/S. 1380 - Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 733- National Trauma Center Stabilization Act of 2009 S. 330 - Medicare Prescription Drug Savings and Choice Act of 2009 S. 179 - Health Information Technology Act of 2009 S. 717 - 21st Century Cancer ALERT (Access to Life-Saving Early detection, Research and Treatment) Act S. 252 - Veterans Health Care Authorization Act of 2009 S. 597 - Women Veterans Health Care Improvement Act of 2009 S. 658 - Rural Veterans Health Care Improvement Act of 2009 S. 734 - Rural Veterans Health Care Access and Quality Act of 2009 S. 1679 - Affordable Health Choices Act

Client expense: $59,412 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

See page five for specific Health Care issues. H. R. 3200 - America's Affordable Health Choices Act of 2009 H. R. 914 - Physician Workforce Enhancement Act of 2009 H. R. 1678 - Mitigating the Impact of Uncompensated Service and Time Act of 2009 H. R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 H. R. 1016 - Veterans Health Care Budget Reform and Transparency Act of 2009 H. R. 84 - Veterans Timely Access to Health Care Act H. R. 1213 - Screening Abdominal Aortic Aneurysms Very Efficiently Act of 2009 H. R. 2891 - Access to Frontline Health Care Act of 2009 H. R. 2350 - Preserving Patient Access to Primary Care Act of 2009 H. R. 2251/S. 973 - Resident Physician Shortage Reduction Act of 2009 H. R. 2844/S. 1249/H. R. 3074 - Medicare Payment Improvement Act of 2009 H. R. 1377 - To amend title 38, United States Code, to expand veteran eligibility for reimbursement by the Secretary of Veterans Affairs for emergency treatment furnished in a non-Department facility, and for other purposes. H.R. 2718/S. 1110/S. 1380 - Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 733- National Trauma Center Stabilization Act of 2009 S. 330 - Medicare Prescription Drug Savings and Choice Act of 2009 S. 179 - Health Information Technology Act of 2009 S. 717 - 21st Century Cancer ALERT (Access to Life-Saving Early detection, Research and Treatment) Act S. 252 - Veterans Health Care Authorization Act of 2009 S. 597 - Women Veterans Health Care Improvement Act of 2009 S. 658 - Rural Veterans Health Care Improvement Act of 2009 S. 734 - Rural Veterans Health Care Access and Quality Act of 2009 S. 1679 - Affordable Health Choices Act

Client expense: $32,952 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

See page three for specific Medicare/Medicaid issues. H. R. 3200 - America's Affordable Health Choices Act of 2009 H. R. 1213 - Screening Abdominal Aortic Aneurysms Very Efficiently Act of 2009 H. R. 2350 - Preserving Patient Access to Primary Care Act of 2009 H. R. 2844/S. 1249/H. R. 3074 - Medicare Payment Improvement Act of 2009 H.R. 2718/S. 1110/S. 1380 - Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 330 - Medicare Prescription Drug Savings and Choice Act of 2009 S. 179 - Health Information Technology Act of 2009 S. 717 - 21st Century Cancer ALERT (Access to Life-Saving Early detection, Research and Treatment) Act S. 1679 - Affordable Health Choices Act

Client expense: $32,952 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

See page three for specific Medicare/Medicaid issues. H. R. 3200 - America's Affordable Health Choices Act of 2009 H. R. 1213 - Screening Abdominal Aortic Aneurysms Very Efficiently Act of 2009 H. R. 2350 - Preserving Patient Access to Primary Care Act of 2009 H. R. 2844/S. 1249/H. R. 3074 - Medicare Payment Improvement Act of 2009 H.R. 2718/S. 1110/S. 1380 - Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 330 - Medicare Prescription Drug Savings and Choice Act of 2009 S. 179 - Health Information Technology Act of 2009 S. 717 - 21st Century Cancer ALERT (Access to Life-Saving Early detection, Research and Treatment) Act S. 1679 - Affordable Health Choices Act

Client expense: $59,412 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

See page five for specific Health Care issues. H. R. 3200 - America's Affordable Health Choices Act of 2009 H. R. 914 - Physician Workforce Enhancement Act of 2009 H. R. 1678 - Mitigating the Impact of Uncompensated Service and Time Act of 2009 H. R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 H. R. 1016 - Veterans Health Care Budget Reform and Transparency Act of 2009 H. R. 84 - Veterans Timely Access to Health Care Act H. R. 1213 - Screening Abdominal Aortic Aneurysms Very Efficiently Act of 2009 H. R. 2891 - Access to Frontline Health Care Act of 2009 H. R. 2350 - Preserving Patient Access to Primary Care Act of 2009 H. R. 2251/S. 973 - Resident Physician Shortage Reduction Act of 2009 H. R. 2844/S. 1249/H. R. 3074 - Medicare Payment Improvement Act of 2009 H. R. 1377 - To amend title 38, United States Code, to expand veteran eligibility for reimbursement by the Secretary of Veterans Affairs for emergency treatment furnished in a non-Department facility, and for other purposes. H.R. 2718/S. 1110/S. 1380 - Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 733- National Trauma Center Stabilization Act of 2009 S. 330 - Medicare Prescription Drug Savings and Choice Act of 2009 S. 179 - Health Information Technology Act of 2009 S. 717 - 21st Century Cancer ALERT (Access to Life-Saving Early detection, Research and Treatment) Act S. 252 - Veterans Health Care Authorization Act of 2009 S. 597 - Women Veterans Health Care Improvement Act of 2009 S. 658 - Rural Veterans Health Care Improvement Act of 2009 S. 734 - Rural Veterans Health Care Access and Quality Act of 2009 S. 1679 - Affordable Health Choices Act

Client expense: $59,412 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

S.295, Medicare Quality and Payment Reform Act of 2009; America's Affordable Health Choices Act of 2009 (H.R. 3200); Affordable Health Choices Act of 2009 (S.1679); General Healthcare Reform Legislation; Employee Free Choice Act of 2009 (H.R. 1409/S.560); Long-Term Care Hospitals Legislation (H.R. 2124/S.935); MedPAC Reform Act of 2009 (S.1110; S.1380); Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Fiscal Year 2010 (CMS-1538-F).

Client expense: $389,500 · Firm income: Not reported

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

Medicare Advantage program - HR 3200, To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; proposed legislation re this issue. Part D reforms - HR 684, To amend title XVIII of the Social Security Act to deliver a meaningful benefit and lower prescription drug prices under the Medicare Program; HR 1832, To amend part D of title XVIII of the Social Security Act to limit the increase in premium costs for beneficiaries under the Medicare prescription drug program to no more than the Social Security cost-of-living adjustment, and to direct the Secretary of Health and Human Services to negotiate lower prescription drug prices on behalf of Medicare beneficiaries; S 75, A bill to amend title XVIII of the Social Security Act to require the use of generic drugs under the Medicare part D prescription drug program when available unless the brand name drug is determined to be medically necessary; S 266, A bill to amend title XVIII of the Social Security Act to reduce the coverage gap in prescription drug coverage under part D of such title based on savings to the Medicare program resulting from the negotiation of prescription drug prices; S 330, A bill to amend title XVIII of the Social Security Act to deliver a meaningful benefit and lower prescription drug prices under the Medicare program; 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-institutionalized full-benefit dual eligible individuals; HR 2860, To amend title XVIII of the Social Security Act to provide for a Medicare operated prescription drug plan option to deliver a meaningful drug benefit and lower prescription drug prices under the Medicare Program. Medicaid drug costs - HR 904, To amend title XIX of the Social Security Act to reduce the costs of prescription drugs for enrollees of Medicaid managed care organizations by extending the discounts offered under fee-for-service Medicaid to such organizations; S 547, A bill to amend title XIX of the Social Security Act to reduce the costs of prescription drugs for enrollees of Medicaid managed care organizations by extending the discounts offered under fee-for-service Medicaid to such organizations. Part D cost sharing - HR 1407, To amend title XVIII of the Social Security Act to reduce cost-sharing under part D of such title for certain non-institutionalized full-benefit dual eligible individuals. Medicaid coverage - HR 1670, To amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes; S 683, A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes. Means-testing Part D premiums - S 677, A bill to amend title XVIII of the Social Security Act to require wealthy beneficiaries to pay a greater share of their premiums under the Medicare prescription drug program. Medicare cost plans - HR 2501, To amend title XVIII of the Social Security Act to extend reasonable cost contracts under Medicare; S 1079, A bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program. Medicare Advantage benchmark adjustments - HR 2686, To amend title XVIII of the Social Security Act to provide for a Medicare Advantage benchmark adjustment for certain local areas with VA medical centers and for certain contiguous areas. Low-income assistance under Medicare Part D - HR 2700, To amend part D of title XVIII of the Social Security Act to assist low-income individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. Implementation of Medicare payment policies - HR 2718, 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 1380, 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. Medicare Advantage special needs plans - HR 2758, 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, and for other purposes; S 1307, 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, and for other purposes. Home and community-based services under Medicaid - HR 2688, 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. Part D enrollment - HR 3152, 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. Part D exceptions process, HR 3418, To amend part D of title XVIII of the Social Security Act to apply the exceptions process for tiered formulary drugs to specialty tier drugs. Part B premiums - HR 3631, 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. Government-operated Part D plan, dual eligibles - S 1634, A bill to amend titles XVIII and XIX of the Social Security Act to protect and improve the benefits provided to dual eligible individuals under the Medicare and Medicaid programs. Guaranteed-isse MediGap, Medicare Advantage enrollment - S 1669, A bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy.

Client expense: Not reported · Firm income: $100,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 2718 -- Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 opposing creation of independent MedPAC with authority to make changes to Medicare program without approval of Congress H.R. 2844, the Medicare Payment Improvement Act of 2009 Opposing establishment of value index for Medicare physician reimbursement H.R 2502 -- Comparative Effectiveness Research Act of 2009 supporting the establishing an independent institute for comparative effective research that focuses on clinical not cost effectiveness H.R. 2962, the Integrity in Medicare Advanced Diagnostic Imaging Act of 2009 opposing limits on physician ownership and self-referral of diagnostic imaging equipment/services. HR 3200 Americas Affordable Health Choices Act healthcare reform including: Medicare physician payment reform, independent Medicare Commission, surgical workforce, graduate medical education, medical liability reform, emergency-trauma care improvements, budget-neutral primary care bonus payments, physician resource use outliers, comparative effectiveness research, physician quality improvement programs, accountable care organizations, medical student loan debt forgiveness, reimbursement for imaging, public health insurance option, eliminating preexisting condition insurance clauses, expanding coverage of the uninsured, physician ownership of specialty hospitals, physician-industry relationships S. 1110 -- Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 opposing creation of independent MedPAC with authority to make changes to Medicare program without approval of Congress S. 1213 -- Patient-Centered Outcomes Research Act of 2009 -- supporting the establishing an independent institute for comparative effective research that focuses on clinical not cost effectiveness S. 1380 -- Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 opposing creation of independent MedPAC with authority to make changes to Medicare program without approval of Congress S. 1679, Affordable Health Choices Act -- healthcare reform including: Medicare physician payment reform, independent Medicare Commission, surgical workforce, graduate medical education, medical liability reform, emergency-trauma care improvements, budget-neutral primary care bonus payments, physician resource use outliers, comparative effectiveness research, physician quality improvement programs, accountable care organizations, medical student loan debt forgiveness, reimbursement for imaging, public health insurance option, eliminating preexisting condition insurance clauses, expanding coverage of the uninsured, physician ownership of specialty hospitals, physician-industry relationships S. 1796, Americans Healthy Future Act -- healthcare reform including: Medicare physician payment reform, independent Medicare Commission, surgical workforce, graduate medical education, medical liability reform, emergency-trauma care improvements, budget-neutral primary care bonus payments, physician resource use outliers, comparative effectiveness research, physician quality improvement programs, accountable care organizations, medical student loan debt forgiveness, reimbursement for imaging, public health insurance option, eliminating preexisting condition insurance clauses, expanding coverage of the uninsured, physician ownership of specialty hospitals, physician-industry relationships

Client expense: $55,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 2718 -- Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 opposing creation of independent MedPAC with authority to make changes to Medicare program without approval of Congress H.R. 2844, the Medicare Payment Improvement Act of 2009 Opposing establishment of value index for Medicare physician reimbursement H.R 2502 -- Comparative Effectiveness Research Act of 2009 supporting the establishing an independent institute for comparative effective research that focuses on clinical not cost effectiveness H.R. 2962, the Integrity in Medicare Advanced Diagnostic Imaging Act of 2009 opposing limits on physician ownership and self-referral of diagnostic imaging equipment/services. HR 3200 Americas Affordable Health Choices Act healthcare reform including: Medicare physician payment reform, independent Medicare Commission, surgical workforce, graduate medical education, medical liability reform, emergency-trauma care improvements, budget-neutral primary care bonus payments, physician resource use outliers, comparative effectiveness research, physician quality improvement programs, accountable care organizations, medical student loan debt forgiveness, reimbursement for imaging, public health insurance option, eliminating preexisting condition insurance clauses, expanding coverage of the uninsured, physician ownership of specialty hospitals, physician-industry relationships S. 1110 -- Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 opposing creation of independent MedPAC with authority to make changes to Medicare program without approval of Congress S. 1213 -- Patient-Centered Outcomes Research Act of 2009 -- supporting the establishing an independent institute for comparative effective research that focuses on clinical not cost effectiveness S. 1380 -- Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 opposing creation of independent MedPAC with authority to make changes to Medicare program without approval of Congress S. 1679, Affordable Health Choices Act -- healthcare reform including: Medicare physician payment reform, independent Medicare Commission, surgical workforce, graduate medical education, medical liability reform, emergency-trauma care improvements, budget-neutral primary care bonus payments, physician resource use outliers, comparative effectiveness research, physician quality improvement programs, accountable care organizations, medical student loan debt forgiveness, reimbursement for imaging, public health insurance option, eliminating preexisting condition insurance clauses, expanding coverage of the uninsured, physician ownership of specialty hospitals, physician-industry relationships S. 1796, Americans Healthy Future Act -- healthcare reform including: Medicare physician payment reform, independent Medicare Commission, surgical workforce, graduate medical education, medical liability reform, emergency-trauma care improvements, budget-neutral primary care bonus payments, physician resource use outliers, comparative effectiveness research, physician quality improvement programs, accountable care organizations, medical student loan debt forgiveness, reimbursement for imaging, public health insurance option, eliminating preexisting condition insurance clauses, expanding coverage of the uninsured, physician ownership of specialty hospitals, physician-industry relationships

Client expense: $55,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Americas Healthy Future Act (Baucus) Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform; H.R. 684, Medicare Prescription Drug Savings and Choice Act (Berry) Part D reforms (cont.) H.R. 904, Medicaid Prescription Drug Rebate Equalization Act (Stupak) Medicaid drug costs; H.R. 1407, Medicare Part D Home and Community Services Copayment Equity Act (Doggett) Part D cost sharing; H.R. 1670, Community Choice Act (Davis) Medicaid coverage; H.R. 1832, Medicare Prescription Drug Affordability Act (Wexler) Part D reforms; H.R. 2501, Medicare Cost Contract Extension and Refinement Act (Pomeroy) Medicare cost plans; H.R. 2686, Medicare Advantage Payments (Israel) Medicare Advantage benchmark adjustments; H.R. 2688, Empowered at Home Act (Pallone) home and community-based services under Medicaid; H.R. 2700, Prescription Coverage Now Act (Doggett) low-income assistance under Medicare Part D; H.R. 2718, MedPAC Reform Act (Cooper) implementation of Medicare payment policies; H.R. 2758, Medicare Specialty Care Improvement and Protection Act (Kind) Medicare Advantage special needs plans; H.R. 2860, Medicare Drug Savings Through Choice Act (Murphy) Part D reforms; H.R. 3152, Helping Seniors Choose their Medicare Drug Plan Act (Holt) Part D enrollment; H.R. 3200, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; H.R. 3418, Medicare Prescription Drug Cost Equalization Act (Ellsworth) Part D exceptions process; H.R. 3631, Medicare Premium Fairness Act (Titus) Part B premiums; S. 75, Generics First Act (Kohl) Part D reforms; S. 266, Medicare Prescription Drug Gap Reduction Act (Nelson) Part D reforms; S. 330, Medicare Prescription Drug Savings and Choice Act (Durbin) Part D reforms; S. 534, Home and Community Services Copayment Equity Act (Nelson) Part D reforms; S. 547, Drug Rebate Equalization Act (Bingaman) Medicaid drug costs; S. 677, REPAIR Act (Ensign) means-testing Part D premiums; S. 683, Community Choice Act (Harkin) Medicaid coverage; S. 960, Medicare Early Access Act (Rockefeller) Medicare buy-in option; S. 1079, Medicare Cost Contract Extension and Refinement Act (Klobuchar) Medicare cost plans; S. 1307, Medicare Specialty Care Improvement and Protection Act (Feingold) Medicare Advantage special needs plans;S. 1380, MedPAC Reform Act (Rockefeller) implementation of Medicare payment policies; S. 1634, Medicare Prescription Drug Coverage Improvement Act (Rockefeller) government operated Part D plan, dual eligibles; S. 1669, Equal Access to Medicare Options Act (Kerry) guaranteed issue Medigap, Medicare Advantage enrollment MMM (Regulatory Issues) Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology and data issues, (including audit and encounter data issues), bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits), application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff, measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, compliance/fraud and abuse training, and Medicare/Medicaid integration and contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education program; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues, MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, grievance and appeals processes, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost/rebate issues affecting Medicaid health plans; health plan-related State Childrens Health Insurance Program (SCHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including documentation of citizenship requirements, state benefit flexibility options, and Medicaid managed care organization provider tax issues; standards for electronic prescribing; and health information technology standards and policies.

Client expense: $2,410,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of

Americas Healthy Future Act (Baucus) Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform; H.R. 3200, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; S. 1380, MedPAC Reform Act (Rockefeller) implementation of Medicare payment policies;

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

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

Americas Healthy Future Act (Baucus) Medicare Advantage, Part D, special needs plans, Medicaid issues including eligibility expansion and prescription drug rebates, Medigap restrictions, Medicare FFS payment reform; H.R. 3200, Americas Affordable Health Choices Act (Dingell) Medicare Advantage, Part D, special needs plans, Medicaid issues including MCO provider taxes and eligibility expansion, Medigap open enrollment, Medicare FFS payment reform; S. 1380, MedPAC Reform Act (Rockefeller) implementation of Medicare payment policies;

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

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