Health Insurance Rate Authority Act of 2010

See attached addendum for General Lobbying Issue Area: HRC - Health Care Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act". parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care and Education Affordability Reconcilation Act of 2010", parts pertaining to health care reform, reasonable effective dates for compliance with insurance reforms, affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority, national insurance exchange, grandfathering. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872. Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs.

Client expense: $320,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HRC - Health Care Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act". parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care and Education Affordability Reconcilation Act of 2010", parts pertaining to health care reform, reasonable effective dates for compliance with insurance reforms, affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority, national insurance exchange, grandfathering. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872. Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs.

Client expense: $360,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR 4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; HR 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical home; Health Disparities; Wellness; Chronic Care management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE

See attached addendum for General Lobbying Issue Area: HCR Healthcare State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Rescissions and Routine Administrative Functions: Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality: Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity. Health Information Technology Standards: Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform: Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate

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

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

H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act (Burgess) disclosure of coverage exclusions; (cont.) H.R. 1583, Insurance Industry Competition Act (DeFazio) McCarran-Ferguson reforms; H.R. 1691, Breast Cancer Patient Protection Act (DeLauro) hospital stays for breast cancer patients; H.R. 3217, Health Care Choice Act (Shadegg) national marketplace; H.R. 3584, Health Care Consumer Protection Act (Forbes) reinstatement of coverage upon payment of overdue premiums; H.R. 3590, Patient Protection and Affordable Care Act (Reid) health insurance cooperatives, multi-state plans, insurance market reforms, health insurance exchanges, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance, federal rate review process, restrictions on rescissions, health care choice compacts, appeals procedures, disclosure requirements, high risk pool program; H.R. 3596, Health Insurance Industry Antitrust Enforcement Act (Conyers) McCarran-Ferguson reforms; H.R. 4078, Long-Term Care Insurance Disclosure Act (Perriello) model disclosure form for long-term care insurance; H.R. 4563, Cancer Screening Coverage Act (Maloney) coverage requirement for cancer screening; H.R. 4626, Health Insurance Industry Fair Competition Act (Perriello) McCarran-Ferguson reforms; H.R. 4757, Health Insurance Rate Authority Act (Schakowsky) federal rate review process; H.R. 4872, Health Care and Education Reconciliation Act (Spratt) changes to individual coverage requirement, grandfathered plans, immediate insurance reforms, premium assistance, CLASS Act, coverage issues, quality improvements, delivery system reforms; H.R. 5000, Dental Coverage Value and Transparency Act (Andrews) requirements for dental coverage; H.R. 5664, High Risk Pool Fairness Act (Ellsworth ) high risk pools; H.R. 5761 (Melancon) effective date for prohibition on rescissions; H.R. 5808 (Woolsey) government-run plan; H.R. 5844, Fairness in Medigap Options Act (Rothman) guarantee issue and open enrollment for Medigap policies; H.R. 5890, Long-Term Care Insurance Reform Act (Doggett) regulation of LTC insurance; H.R. 6066, Preventing Social Security Fraud Act (Sanchez) requirements for private disability insurers; H.R. 6368, Federal Employee Disability Insurance Act (Holmes-Norton) supplemental disability insurance for federal employees; S. 688, Breast Cancer Patient Protection Act (Snowe) hospital stays for breast cancer patients; S. 1177, Confidence in Long-Term Care Insurance Act (Kohl) LTC consumer protections; S. 1459, Health Care Choice Act (DeMint) national marketplace; S. 1626, Long Term Care Insurance Integrity Act (Klobuchar) third party review of LTCI disputed claims; S. 1636, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms for LTC insurance; S. 1681, Health Insurance Industry Antitrust Enforcement Act (Leahy) McCarran-Ferguson reforms; S. 3078, Health Insurance Rate Authority Act (Feinstein) federal rate review process; S. 3685 Insurance Competition and Transparency Act (Pryor) FTC authority; S. 3793, Job Creation and Tax Cuts Act (Baucus) health coverage tax credit; and S. 3958, Empowering States to Innovate Act, (Wyden-Brown) state innovation waivers. INS (Regulatory) Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials; implementation of the Mental Health Parity Act requirements; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; internal claims and appeals and external review processes; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits rescissions; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; and other issues relating to health care reform implementation.

Client expense: $1,980,000 · 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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs

Client expense: $1,700,000 · Firm income: Not reported

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

H.R. 3590, Patient Protection and Affordability Care Act - Lobbied in support of health care legislation and implementation of certain provisions related to affordable quality health care and expand access to long-term services and supports. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of health care law which makes improvements, such as closing the Part D coverage gap, in the Patient Protection and Affordable Care Act and implementation of certain provisions. H.R. 4757/S.3078 Health Insurance Rate Authority Act - Discussed bill that would require the Secretary of Health and Human Services (HHS) to establish a uniform process for the review of potentially unreasonable increases in rates for health insurance coverage, including premiums.

Client expense: $9,120,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

H.R. 3590, Patient Protection and Affordability Care Act - Lobbied in support of health care legislation and implementation of certain provisions related to affordable quality health care and expand access to long-term services and supports. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of health care law which makes improvements, such as closing the Part D coverage gap, in the Patient Protection and Affordable Care Act and implementation of certain provisions. H.R. 4757/S.3078 Health Insurance Rate Authority Act - Discussed bill that would require the Secretary of Health and Human Services (HHS) to establish a uniform process for the review of potentially unreasonable increases in rates for health insurance coverage, including premiums.

Client expense: $9,120,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148. State Oversight of Premium Increases: S. 3078 and H.R. 4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; H.R. 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individual as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; BCBS commitment to cover individuals up to age 26 on their parent health insurance; H.R. 5200 "FEHBP Dependent Coverage Extension Act." Pre-Existing Condition Exclusions: Pre-existing condition for children; guaranteed issue for children under the age of 19. Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Rescissions and Patient Protections: Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits. Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Healthcare; Evidence Based Care; Healthcare Delivery System Reforms. Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings/Accounts/Medical Savings Accounts; Individual Mandate; MEWAs. H.R. 2517 "Domestic Partnership Benefits and Obligations Act of 2009".

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; HR 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs

Client expense: $222,329 · Firm income: Not reported

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

S. 1796, to provide affordable, quality health care for all Americans and reduce the growth in health care spending HR 1558 To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and health insurance coverage in the group and individual markets H.R. 2520 to provide comprehensive solutions for the health care system of the United States, and for other purposes HR 3200 America's Affordable Health Choices Act of 2009 H.R.3590: An act entitled The Patient Protection and Affordable Care Act. H.R.3962: To provide affordable, quality health care for all Americans and reduce the growth in health care spending. HR 4757 to provide for the establishment of a health insurance rate authority to establish limits on premium rating HR 4872 The bill makes a number of health-related financing and revenue changes to the Patient Protection and Affordable Care Act enacted by H.R.3590 and modifies higher education assistance provisions S 623 To amend title I of the Employee Retirement Income Security Act of 1974, title XXVII of the Public Service Act, and the Internal Revenue Code of 1986 to prohibit preexisting condition exclusions in group health plans and in health insurance coverage in the group and individual markets S 803 A bill to amend the Internal Revenue Code of 1986 to provide a tax credit to employers for the costs of implementing wellness programs, and for other purposes. S. 1099 to provide comprehensive solutions for the health care system of the United States, and for other purposes S. 1679 the Affordable Health Choices Act -- An original bill to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce. S. 1796, to provide affordable, quality health care for all Americans and reduce the growth in health care spending S. 3078 to provide for the establishment of a health insurance rate authority to establish limits on premium rating

Client expense: $425,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

Implementation of healthcare reform laws - Executive Branch actions re PL 111-148 and PL 111-152. Repeal Patient Protection and Affordable Health Care Acts (PL 111-148/PL 111-152) - HR 4901, To repeal the Patient Protection and Affordable Care Act; HR 4903, To repeal the Patient Protection and Affordable Care Act; HR 4910, To repeal the Patient Protection and Affordable Care Act and enact the Empowering Patients First Act in order to provide incentives to encourage health insurance coverage; HR 4919, To repeal the Patient Protection and Affordable Care Act; HR 4972, To repeal the Patient Protection and Affordable Care Act; HR 5005, To repeal the Patient Protection and Affordable Care Act; HR 5073, To repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 and enact the OPTION Act of 2009; HR 5216, To repeal the Patient Protection and Affordable Care Act; HR 5421, To repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, repeal the 7.5 percent threshold on the deduction for medical expenses, provide for increased funding for high-risk pools, allow acquiring health insurance across State lines, and allow for the creation of association health plans; HR 5424, Reform Americans Can Afford Act of 2010 ; HR 5444, Private Option Health Care Act; HR 6355, STAT Act of 2010; S 3147, Patient Choice Restoration Act; S 3152, A bill to repeal the Patient Protection and Affordable Care Act. *High risk pools - HR 5664, High-Risk Pool Fairness Act. *Effective date for prohibitionon rescissions - HR 5761, To amend the Patient Protection and Affordable Care Act to expedite the application of the provision prohibiting rescissions of health insurance coverage. *Government-run plan - HR 5808, To amend the Patient Protection and Affordable Care Act to establish a public health insurance option. *Guarantee-issue and open enrollment for Medigap policies - HR 5844, Fairness in Medigap Options Act of 2010. *Regulations of LTC insurance - HR 5890, Long-Term Care Insurance Reform Act of 2010. *Third-party review of LTC insurance disputed claims - S 1626, A bill to require issuers of long term care insurance to establish third party review processes for disputed claims. *Model disclosure forms for LTC insurance - S 1636, A bill to develop a model disclosure form to assist consumers in purchasing long-term care insurance. *Model Disclosure form for long-term care insurance - HR 4078, To require the Secretary of Health and Human Services to develop a national model disclosure form to assist consumers in purchasing long-term care insurance. *Federal rate review process - HR 4757, Health Insurance Rate Authority Act of 2010; S 3078, Health Insurance Rate Authority Act of 2010. *Changes to individual coverage requirement, grandfathered plans, immediate insurance reforms, premium assistance, CLASS Act, coverage issues, quality improvements, delivery system reforms - HR 4872, Health Care and Education Reconciliation Act of 2010. *Requirements for dental coverage - HR 5000, Dental Coverage Value and Transparency Act of 2010. *Requirements for private disability insurers - HR 6066, Preventing Social Security Fraud Act of 2010. *Supplemental disability insurance for Federal employees - HR 6368, Federal Employee Disability Insurance Act of 2010. *FTC authority - S 3685, Insurance Competition and Transparency Act of 2010. *Health coverage tax credit - S 3793, Job Creation and Tax Cuts Act of 2010. *State innovation waivers - S 3958, Empowering States to Innovate Act. *Disclosure of coverage exclusions - HR 1253, To require that limitations and restrictions on coverage under group health plans be timely disclosed to group health plan sponsors and timely communicated to participants and beneficiaries under such plans in a form that is easily understandable. *McCarran Ferguson reforms - HR 1583, To further competition in the insurance industry; S 1681, Health Insurance Industry Antitrust Enforcement Act of 2009. *Recissions, hospital stays for breast cancer patients - HR 1691, To require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations; S 688, A bill to require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations. *Coverage requirement for cancer screening - HR 4563, Cancer Screening Coverage Act of 2009. *MCCarran-Ferguson antitrust exemption - HR 4626, Health Insurance Industry Fair Competition Act. *LTC consumer protections - S 1177, A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes. *National marketplace - HR 3217, Health Care Choice Act of 2009; S 1459, A bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce. *Reinstatement of coverage upon payment of overdue premiums - HR 3584, To amend the Public Health Service Act to require reinstatement upon payment of all premiums due of group or individual health insurance coverage terminated by reason of nonpayment of premiums. *Changes to McCarran-Ferguson Act - HR 3596, To ensure that health insurance issuers and medical malpractice insurance issuers cannot engage in price fixing, bid rigging, or market allocations to the detriment of competition and consumers; S 1681, A bill to ensure that health insurance issuers and medical malpractice insurance issuers cannot engage in price fixing, bid rigging, or market allocations to the detriment of competition and consumers.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs

Client expense: Not reported · Firm income: Not reported

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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate

Client expense: $130,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for general issue area: HCR: Health Issues Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs

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

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

See attached addendum for General Lobbying Issue Area: HRC - Health Care Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act". parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care and Education Affordability Reconcilation Act of 2010", parts pertaining to health care reform, reasonable effective dates for compliance with insurance reforms, affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority, national insurance exchange, grandfathering. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872. Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs.

Client expense: $320,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 3742, Data Security and Breach Notification Act of 2010 regarding HIPAA carve-out; S. 3078 Health Insurance Rate Authority Act - federal rate review process; Implementation of healthcare reform, including issues related to medical loss ratio, preventive services, rate review, claims and appeals, exchanges

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

Implemention of healthcare reform, including comparative effectiveness research/Patient Centered Outcomes Research Institute (PCORI), health insurance cooperatives, multi-state plans, insurance market reforms, health insurance exchanges, benefit packages, medical loss ratios, individual coverage requirement, premium assistance, federal rate review process, restrictions on rescissions, health care choice compacts, appeals procedures, disclosure requirements, high risk pool program; S. 3078 Health Insurance Rate Authority Act - federal rate review process

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Insurance Market Reform: HR 6130 - Strengthening Medicare Anti-Fraud Measure Act of 2010 General Issues: PL 111-148 "good faith compliance standard of HCR Implementation S3078/HR 4757 Rate Authority Act HR 4700 Transparency In All Healthcare Pricing Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs

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

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

Support legislative and regulatory initiatives for the expansion and redistribution of residency slots for hospitals under Section 1886(h)(8)A of the Patient Protection & Affordable Care Act. Support H.R. 6072 and S. 3078 which would enable remote locations of hospitals (multi-campus) to qualify for HIT incentive payments.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor legislation, Labor, HHS, & Education Appropriations FY 2011 bill (3293), Transportation, Housing & Urban Development Appropriations FY 2011 bill (5850). Federal Medical Assistance Percentages (FMAP) program, CAP IME program and Medicaid Outpatient issue. Monitor American Recovery and Reinvestment Act of 2009 (H.R. 1) and America's Affordable Health Choices Act of 2009 (H.R. 3200), Senate HELP Committee mark, v-and Affordable Care Act (H.R.3590), Affordable Health Choices Act (S.1679), America's Healthy Future Act of 2009 (S.1796), Reconciliation Act of 2010 (H.R.4872). Monitor extender issue concerning FMAP (Doc Fix). Electronic Health Record Incentives for Multi Campus Hospitals Act of 2010 (S. 3078, H.R. 6072). Health Care Reform Issues related to insurance coverage for the uninsured and delivery system and reimbursement reforms (the American Health Care Choices Act (S.1679); Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Health Care Act (H.R.3590, P.L. 111-148) Health Care & Education Affordability Reconciliation Act (H.R. 4872, P.L. 111-152); health information technology issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5); H.R. 4851, S. 3153, H.R. 4213; CMS-0033-F, H.R. 6072, S. 3708)). HEALTHCARE ISSUES - 1099 REPEAL, PATIENT PROTECTION AND AFFORDABLE CARE ACT IMPLEMENTATION

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Transportation, Dept of (DOT)

Monitor legislation and advise client as to how it affects them. Labor, HHS, & Education Appropriations FY 2011 C.R, Medical Assistance Percentages (FMAP) program, CAP IME, Patient Protection and Affordable Care Act (H.R.3590), Affordable Health Choices Act (S.1679), America's Healthy Future Act of 2009 (S.1796), Reconciliation Act of 2010 (H.R.4872). Electronic Health Record Incentives for Multi Campus Hospitals Act of 2010 (S. 3078, H.R. 6072), Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. ; 42 CFR 413.79; Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); 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 gain sharing 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)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Transportation, Dept of (DOT)

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successfuly Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148. State Oversight of Premium Increases: S 3078 and HR 4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; HR 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open Enrollment Period; Adverse Selection Implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited. Lifetime and Annual Limits: Lifetime and annual dollar limits on "essential health benefits". Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity. Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs

Client expense: Not reported · Firm income: Not reported

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

HR 4213, Tax Extenders Act premium assistance for unemployed; Implementation of healthcare reform, including issues related to comparative effectiveness research, Patient Centered Outcomes Research Institute (PCORI); medical loss ratio, preventive services, rate review, claims and appeals, exchanges, star quality and frailty adjuster; State Oversight of Premium Increases: S. 3078 and HR 4757, Health Insurance Rate Authority Act of 2010; federal rate review; existing state regulatory functions, federal exchanges, state exchanges; Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited; Medical Loss Ratios: Quality improvement definition; consistent reporting requirements for all insurers; transition for smaller states and plans; include benefits for individuals as well as populations; Dependent Health Coverage: IRS Guidelines on dependent coverage; coverage of individuals up to age 26 on their parents health insurance; Pre-Existing Condition Exclusions: Pre-existing conditions for children; guaranteed issue for children under age of 19; Lifetime and Annual Limits: lifetime and annual limits on essential health benefits; Recissions and Patient Protections: Open Enrollment period; adverse selection implications; Affordable Private Health Care: insurer feees; realistic minimum benefit values; effective individual mandate; healthccare delivery system reforms; small employer tax credits; Health Care Quality: patient-centered primary care/medical home; health disparities; wellness; chronic care management; comparative effectiveness research; improved delivery of health care; evidence based care; healthcare delivery system reforms; Health Information Technology Standards: health information privacy; electronic health records; administrative simplification; ICD10 real time claims adjudication; Insurance Market Reform: individual market reform; small group market reform; guaranteed issue; community rating, health status rating, health savings accounts/medical savings accounts; individual mandate; MEWAs;

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

Implementation of healthcare reform, including issues related to medical loss ratio, preventive services, rate review, claims and appeals, exchanges, star quality and frailty adjuster; S. 1681 / HR 3596, Health Insurance Industry Antitrust Enforcement Act of 2009 - McCarran-Ferguson antitrust exemption; HR 1583, Insurance Industry Competition Act of 2009 - McCarran-Ferguson antitrust exemption; S. 3078, Health Insurance Rate Authority Act - federal rate review process;

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

S. 3742, Data Security and Breach Notification Act of 2010 regarding HIPAA carve-out; S. 3078 Health Insurance Rate Authority Act - federal rate review process; Implementation of healthcare reform, including issues related to medical loss ratio, preventive services, rate review, claims and appeals, exchanges, star quality and frailty adjuster

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Implemention of healthcare reform, including comparative effectiveness research, Patient Centered Outcomes Research Institute (PCORI), health insurance cooperatives, multi-state plans, insurance market reforms, health insurance exchanges, benefit packages, medical loss ratios, CLASS Act, individual coverage requirement, premium assistance, federal rate review process, restrictions on rescissions, health care choice compacts, appeals procedures, disclosure requirements, high risk pool program; S. 1681 / HR 3596, Health Insurance Industry Antitrust Enforcement Act of 2009 - McCarran-Ferguson antitrust exemption; HR 1583, Insurance Industry Competition Act of 2009 - McCarran-Ferguson antitrust exemption; S. 3078 Health Insurance Rate Authority Act - federal rate review process

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

HR 4213, Tax Extenders Act premium assistance for unemployed; S.1490, Personal Data Privacy and Security Act - privacy, identity theft; S, 3307, Healthy, Hunger-Free Kids Act and issues related to childhood obesity recommendations; Implementation of healthcare reform, including issues related to medical loss ratio, preventive services, rate review, claims and appeals, exchanges, star quality and frailty adjuster; State Oversight of Premium Increases: S. 3078 and HR 4757, Health Insurance Rate Authority Act of 2010; federal rate review; existing state regulatory functions, federal exchanges, state exchanges; Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited; Medical Loss Ratios: Quality improvement definition; consistent reporting requirements for all insurers; transition for smaller states and plans; include benefits for individuals as well as populations; Dependent Health Coverage: IRS Guidelines on dependent coverage; coverage of individuals up to age 26 on their parents health insurance; Pre-Existing Condition Exclusions: Pre-existing conditions for children; guaranteed issue for children under age of 19; Lifetime and Annual Limits: lifetime and annual limits on essential health benefits; Recissions and Patient Protections: Open Enrollment period; adverse selection implications; Affordable Private Health Care: insurer feees; realistic minimum benefit values; effective individual mandate; healthccare delivery system reforms; small employer tax credits; Health Care Quality: patient-centered primary care/medical home; health disparities; wellness; chronic care management; comparative effectiveness research; improved delivery of health care; evidence based care; healthcare delivery system reforms; Health Information Technology Standards: health information privacy; electronic health records; administrative simplification; ICD10 real time claims adjudication; Insurance Market Reform: individual market reform; small group market reform; guaranteed issue; community rating, health status rating, health savings accounts/medical savings accounts; individual mandate; MEWAs; Childhood obesity, coverage of pre-existing conditions for children

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

HR 4213, Tax Extenders Act premium assistance for unemployed; S.1490, Personal Data Privacy and Security Act - privacy, identity theft; Implementation of healthcare reform, including issues related to medical loss ratio, preventive services, rate review, claims and appeals, exchanges, star quality and frailty adjuster; State Oversight of Premium Increases: S. 3078 and HR 4757, Health Insurance Rate Authority Act of 2010; federal rate review; existing state regulatory functions, federal exchanges, state exchanges; Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited; Medical Loss Ratios: Quality improvement definition; consistent reporting requirements for all insurers; transition for smaller states and plans; include benefits for individuals as well as populations; Dependent Health Coverage: IRS Guidelines on dependent coverage; coverage of individuals up to age 26 on their parents health insurance; Pre-Existing Condition Exclusions: Pre-existing conditions for children; guaranteed issue for children under age of 19; Lifetime and Annual Limits: lifetime and annual limits on essential health benefits; Rescissions and Patient Protections: Open Enrollment period; adverse selection implications; Affordable Private Health Care: insurer feees; realistic minimum benefit values; effective individual mandate; healthccare delivery system reforms; small employer tax credits; Health Care Quality: patient-centered primary care/medical home; health disparities; wellness; chronic care management; comparative effectiveness research; improved delivery of health care; evidence based care; healthcare delivery system reforms; Health Information Technology Standards: health information privacy; electronic health records; administrative simplification; ICD10 real time claims adjudication; Insurance Market Reform: individual market reform; small group market reform; guaranteed issue; community rating, health status rating, health savings accounts/medical savings accounts; individual mandate; MEWAs

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

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

Implementation of healthcare reform, including issues related to medical loss ratio, preventive services, rate review, claims and appeals, exchanges, star quality and frailty adjuster; S. 1681 / HR 3596, Health Insurance Industry Antitrust Enforcement Act of 2009 - McCarran-Ferguson antitrust exemption; HR 1583, Insurance Industry Competition Act of 2009 - McCarran-Ferguson antitrust exemption; State Oversight of Premium Increases: S. 3078 and HR 4757, Health Insurance Rate Authority Act of 2010; federal rate review; existing state regulatory functions, federal exchanges, state exchanges; Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited; Medical Loss Ratios: Quality improvement definition; consistent reporting requirements for all insurers; transition for smaller states and plans; include benefits for individuals as well as populations; Dependent Health Coverage: IRS Guidelines on dependent coverage; coverage of individuals up to age 26 on their parents health insurance; Pre-Existing Condition Exclusions: Pre-existing conditions for children; guaranteed issue for children under age of 19; Lifetime and Annual Limits: lifetime and annual limits on essential health benefits; Rescissions and Patient Protections: Open Enrollment period; adverse selection implications; Affordable Private Health Care: insurer feees; realistic minimum benefit values; effective individual mandate; healthccare delivery system reforms; small employer tax credits; Health Care Quality: patient-centered primary care/medical home; health disparities; wellness; chronic care management; comparative effectiveness research; improved delivery of health care; evidence based care; healthcare delivery system reforms; Health Information Technology Standards: health information privacy; electronic health records; administrative simplification; ICD10 real time claims adjudication; Insurance Market Reform: individual market reform; small group market reform; guaranteed issue; community rating, health status rating, health savings accounts/medical savings accounts; individual mandate; MEWAs

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

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

Issues related to health reform legislation, including Medicare Advantage, public plan options, and insurance taxes; related to the Patient Protection and Affordable Care Act, H.R. 3580/P.L. 111-148, and the Health Care and Education Reconciliation Act of 2010, H.R. 4872/P.L. 111-152. Issues related to the regulation of health insurance in the Health Insurance Rate Authority Act of 2010, S. 3078.

Client expense: $130,000 · Firm income: Not reported

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

See attached addendum for General Lobbying Issue Area: HRC - Health Care Health Care Reform Bill HR 3590 "Patient Protection and Affordable Care Act". parts pertaining to health care reform; Health Care Reconciliation Bill HR 4872 "The Health Care and Education Affordability Reconcilation Act of 2010", parts pertaining to health care reform, reasonable effective dates for compliance with insurance reforms, affordable premiums (insurer tax, insufficient cost containment, weak mandate, restricted age discounts, insurer fees); federal health insurance rate authority, national insurance exchange, grandfathering. Also, subsequent bills/provisions to clarify implementation of HR 3590/HR 4872. Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies. Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs.

Client expense: $360,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs OPM Legislative Proposal on FEHBP Subrogation and Reimbursement

Client expense: $1,760,000 · Firm income: Not reported

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

Insurance Market Reform: Healthy Choice Act; MLR; Guaranteed Issue; HSAs / Dependent Health Insurance Coverage Comparative Effectiveness Research HR. 3162 - Federal Regulatory functions - Anti-Trust and McCarran-Ferguson State Oversight of Premiums S. 3078 HR. 4757 HR 4700/ Transparency PL-111-148 Implementation "good faith compliance standards"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attached addendum for General Lobbying Issue Area: HCR-Healthcare Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; HR 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Mandate; MEWAs OPM Legislative Proposal on FEHBP Subrogation and Reimbursement

Client expense: $225,109 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1253, Health Insurance Restrictions and Limitations Clarification Act (Burgess) disclosure of coverage exclusions; H.R. 1583, Insurance Industry Competition Act (DeFazio) McCarran-Ferguson reforms (cont.) H.R. 1691, Breast Cancer Patient Protection Act (DeLauro) hospital stays for breast cancer patients; H.R. 1880, National Insurance Consumer Protection Act (Bean) regulatory reform; H.R. 2609, Insurance Information Act (Kanjorski) Federal Office of Insurance Information; H.R. 3217, Health Care Choice Act (Shadegg) national marketplace; H.R. 3584, Health Care Consumer Protection Act (Forbes) reinstatement of coverage upon payment of overdue premiums; H.R. 3596, Health Insurance Industry Antitrust Enforcement Act (Conyers) McCarran-Ferguson reforms; H.R. 4078, Long-Term Care Insurance Disclosure Act (Perriello) model disclosure form for long-term care insurance; H.R. 4563, Cancer Screening Coverage Act (Maloney) coverage requirement for cancer screening; H.R. 4626, Health Insurance Industry Fair Competition Act (Perriello) McCarran-Ferguson reforms; H.R. 4757, Health Insurance Rate Authority Act (Schakowsky) federal rate review process; H.R. 5000, Dental Coverage Value and Transparency Act (Andrews) requirements for dental coverage; H.R. 5297, Small Business Jobs Act (Frank) amendments on employer reporting requirement and individual coverage requirement; H.R. 5664, High Risk Pool Fairness Act (Ellsworth ) high risk pools; H.R. 5761 (Melancon) effective date for prohibition on rescissions; H.R. 5808 (Woolsey) government-run plan; H.R. 5844, Fairness in Medigap Options Act (Rothman) guarantee issue and open enrollment for Medigap policies; H.R. 5853, Fiscal Responsibility and Retirement Security Act (Boustany) delaying implementation of the CLASS program; H.R. 5890, Long-Term Care Insurance Reform Act (Doggett) regulation of LTC insurance; H.R. 5982, Small Business Tax Relief Act (Levin) employer reporting requirements; H.R. 6066, Preventing Social Security Fraud Act (Sanchez) requirements for private disability insurers; H.R. 6368, Federal Employee Disability Insurance Act (Holmes-Norton) supplemental disability insurance for federal employees; S. 688, Breast Cancer Patient Protection Act (Snowe) hospital stays for breast cancer patients; S. 1177, Confidence in Long-Term Care Insurance Act (Kohl) LTC consumer protections; S. 1459, Health Care Choice Act (DeMint) national marketplace; S. 1626, Long Term Care Insurance Integrity Act (Klobuchar) third party review of LTCI disputed claims; S. 1636, Long-Term Care Insurance Consumer Right-to-Know Act (Klobuchar) model disclosure forms for LTC insurance; S. 1681, Health Insurance Industry Antitrust Enforcement Act (Leahy) McCarran-Ferguson reforms; S. 3078, Health Insurance Rate Authority Act (Feinstein) federal rate review process; S. 3685 Insurance Competition and Transparency Act (Pryor) FTC authority; and S. 3793, Job Creation and Tax Cuts Act (Baucus) health coverage tax credit. INS (Regulatory) Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials; implementation of the Mental Health Parity Act requirements; issues related to COBRA subsidy requirements, issues related to genetic nondiscrimination; medical loss ratios; review of rates for reasonableness; health insurance exchanges; pre-existing condition insurance plans; accountable care organizations; internal claims and appeals and external review processes; coverage of preventive services; pre-existing condition exclusions; lifetime and annual dollar limits on benefits rescissions; patient protections; grandfathered health plan provisions; health insurance web portal requirements; dependent coverage; and other issues relating to health care reform implementation.

Client expense: $2,330,000 · 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

H.R. 3590, Patient Protection and Affordability Care Act - Lobbied in support of health care legislation and implementation of certain provisions related to affordable quality health care and expand access to long-term services and supports. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of health care law which makes improvements, such as closing the Part D coverage gap, in the Patient Protection and Affordable Care Act and implementation of certain provisions. H.R. 4757/S.3078 Health Insurance Rate Authority Act - Discussed bill that would require the Secretary of Health and Human Services (HHS) to establish a uniform process for the review of potentially unreasonable increases in rates for health insurance coverage, including premiums.

Client expense: $4,710,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Energy, Dept of, Federal Communications Commission (FCC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, White House Office

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs OPM Legislative Proposal on FEHBP Subrogation and Reimbursement

Client expense: $160,000 · Firm income: Not reported

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

See attached addendum for General Lobbying Issue Area: HCR - Healthcare Successful Insurance Industry Implementation of Health Reforms: good faith compliance standard, reasonable effective dates for compliance with PL 111-148 State Oversight of Premium Increases: S 3078 and HR4757 Health Insurance Rate Authority Act of 2010; federal rate review; HR 4700 Transparency in All Health Care Pricing Act of 2010; existing state regulatory functions; federal exchanges; state exchanges Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individuals as well as populations Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; Pre-existing condition for children; guaranteed issue for children under the age of 19; Child Only Insurance Policies Recissions and Routine Administrative Functions; Internal Claims and Appeals/External Review; Open enrollment period; adverse selection implications Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits; Adequate Insurer Reserve Levels Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits" Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Health Care; Evidence Based Care; Healthcare Delivery System Reforms; Childhood Obesity Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication; Data Sharing; Data Aggregation Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings Accounts/Medical Savings Accounts; Individual Manadate; MEWAs OPM Legislative Proposal on FEHBP Subrogation and Reimbursement

Client expense: $160,000 · Firm income: Not reported

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

Implementation of healthcare reform legislation, health insurance cooperatives, multi-State plans, insurance market reforms, health insurance exchanges, benefit packages, medical loss ratios, CLASS Act, regulatory reform, individual coverage requirement, premium assistance, Federal rate review process restrictions on recissions, healthcare choice compacts, appeals procedures, disclosure requirements, high risk pool program - Executive Branch actions re PL 111-148 and PL 111-152. *Disclosure of coverage exclusions - HR 1253, To require that limitations and restrictions on coverage under group health plans be timely disclosed to group health plan sponsors and timely communicated to participants and beneficiaries under such plans in a form that is easily understandable. *McCarran Ferguson reforms - HR 1583, To further competition in the insurance industry; S 1681, Health Insurance Industry Antitrust Enforcement Act of 2009. *Recissions, hospital stays for breast cancer patients - HR 1691, To require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations; S 688, A bill to require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations. *Coverage requirement for cancer screening - HR 4563, Cancer Screening Coverage Act of 2009. *MCCarran-Ferguson antitrust exemption - HR 4626, Health Insurance Industry Fair Competition Act. *Regulatory reform - HR 1880, To establish a system of regulation and supervision for insurers, insurance agencies, and insurance producers chartered or licensed under Federal law that ensures the stability and financial integrity of those insurers, agencies, and producers and that protects policyholders and other consumers served by such insurers, agencies, or producers. *LTC consumer protections - S 1177, A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes. *Federal office of insurance information - HR 2609, To establish an Office of Insurance Information in the Department of the Treasury. *National marketplace - HR 3217, Health Care Choice Act of 2009; S 1459, A bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce. *Reinstatement of coverage upon payment of overdue premiums - HR 3584, To amend the Public Health Service Act to require reinstatement upon payment of all premiums due of group or individual health insurance coverage terminated by reason of nonpayment of premiums. *Changes to McCarran-Ferguson Act - HR 3596, To ensure that health insurance issuers and medical malpractice insurance issuers cannot engage in price fixing, bid rigging, or market allocations to the detriment of competition and consumers; S 1681, A bill to ensure that health insurance issuers and medical malpractice insurance issuers cannot engage in price fixing, bid rigging, or market allocations to the detriment of competition and consumers. *High risk pools - HR 5664, High-Risk Pool Fairness Act. *Effective date for prohibitionon rescissions - HR 5761, To amend the Patient Protection and Affordable Care Act to expedite the application of the provision prohibiting rescissions of health insurance coverage. *Government-run plan - HR 5808, To amend the Patient Protection and Affordable Care Act to establish a public health insurance option. *Guarantee-issue and open enrollment for Medigap policies - HR 5844, Fairness in Medigap Options Act of 2010. *Delaying implementation of the CLASS program - HR 5853, Fiscal Responsibility and Retirement Security Act. *Regulations of LTC insurance - HR 5890, Long-Term Care Insurance Reform Act of 2010. *Third-party review of LTC insurance disputed claims - S 1626, A bill to require issuers of long term care insurance to establish third party review processes for disputed claims. *Model disclosure forms for LTC insurance - S 1636, A bill to develop a model disclosure form to assist consumers in purchasing long-term care insurance. *Model Disclosure form for long-term care insurance - HR 4078, To require the Secretary of Health and Human Services to develop a national model disclosure form to assist consumers in purchasing long-term care insurance. *Federal rate review process - HR 4757, Health Insurance Rate Authority Act of 2010; S 3078, Health Insurance Rate Authority Act of 2010. *Changes to individual coverage requirement, grandfathered plans, immediate insurance reforms, premium assistance, CLASS Act, coverage issues, quality improvements, delivery system reforms - HR 4872, Health Care and Education Reconciliation Act of 2010. *Requirements for dental coverage - HR 5000, Dental Coverage Value and Transparency Act of 2010. *Employer reporting requirements - HR 5982, Small Business Tax Relief Act of 2010. *Requirements for private disability insurers - HR 6066, Preventing Social Security Fraud Act of 2010. *Supplemental disability insurance for Federal employees - HR 6368, Federal Employee Disability Insurance Act of 2010. *FTC authority - S 3685, Insurance Competition and Transparency Act of 2010. *Health coverage tax credit - S 3793, Job Creation and Tax Cuts Act of 2010.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to health reform legislation, including Medicare Advantage, public plan options, and insurance taxes; related to the Patient Protection and Affordable Care Act, H.R. 3580/P.L. 111-148, and the Health Care and Education Reconciliation Act of 2010, H.R. 4872/P.L. 111-152. Issues related to the regulation of health insurance in the Health Insurance Rate Authority Act of 2010, S. 3078.

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

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

Successful Insurance Industry Implementation of Health Reforms: "good faith compliance standard", reasonable effective dates for compliance with PL 111-148. State Oversight of Premium Increases: S. 3078 and H.R. 4757 "Health Insurance Rate Authority Act of 2010"; federal rate review; H.R. 4700 "Transparency in All Health Care Pricing Act of 2010"; existing state regulatory functions; federal exchanges; state exchanges. Grandfathering Rules: Interim final rule of June 14th; Flexibility to modify items that are not specifically prohibited. Medical Loss Ratios: Quality improvement definition; Consistent reporting requirements for all insurers; Transition for smaller states and Plans; include benefits for individual as well as populations. Dependent Health Insurance Coverage: IRS Guidelines on dependent coverage; BCBS commitment to cover individuals up to age 26 on their parent health insurance; H.R. 5200 "FEHBP Dependent Coverage Extension Act." Pre-Existing Condition Exclusions: Pre-existing condition for children; guaranteed issue for children under the age of 19. Lifetime and Annual Limits: lifetime and annual dollar limits on "essential health benefits". Rescissions and Patient Protections: Open enrollment period; adverse selection implications. Affordable Private Health Care: Insurer Fees; Realistic Minimum Benefit Values; Effective Individual Mandate; Healthcare Delivery System Reforms; Small Employer Tax Credits. Health Care Quality; Patient-centered Primary Care/Medical Home; Health Disparities; Wellness; Chronic Care Management; Comparative Effectiveness Research; Improved Delivery of Healthcare; Evidence Based Care; Healthcare Delivery System Reforms. Health Information Technology Standards; Health Information Privacy; Electronic Health Records; Administrative Simplification; ICD10 Real time claims adjudication. Insurance Market Reform; Individual Market Reform; Small Group Market Reform; Small Business Healthcare; Guaranteed Issue; Community Rating; Health Status Rating; Health Savings/Accounts/Medical Savings Accounts; Individual Mandate; MEWAs. H.R. 2517 "Domestic Partnership Benefits and Obligations Act of 2009".

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4213, American Jobs and Closing Tax Loopholes Act of 2010, Medicare reimbursement rates to physicians; S. 3078, Health Insurance Rate Authority Act of 2010, issues relating to federal medical assistance percentages.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE