Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010

Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 (H.R. 6072/S. 3708) Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 (H.R. 5) Preserving Access to Life-Saving Medications Act (S. 296)

Client expense: $12,500 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

42 CFR Parts 412, et al. Medicare and Medicaid Programs; Electronic Health Record Incentive Program Proposed Rule Meaningful Use Inpatient Prospective Payment System FY 2011 Proposed Rule Inpatient Prospective Payment System FY 2011 Final Rule H.R.6072 and S.3708 - Electronic Health Record Incentives for Multi-campus Hospitals Act of 2010

Client expense: $174,000 · Firm income: Not reported

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

Implementation of Health Reform The Health Information Technology for Economic and Clinical Health Act (HITECH), Regarding Implementation of Act H.R. 4691 - Provisions within Temporary Extension Act of 2010 and H.R. 4213 - The Unemployment Compensation Extension Act of 2010 S. 3708 and H.R. 6072 - Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 H.R. 5209 - Healthy CHOICES Act Issues Related to the Medicare & Medicaid Protection Act of 1987 that Regulate Group Purchasing Organizations Under HHS Medical Device Manufacturers Gag Clause on Hospital Contracting

Client expense: $244,795 · Firm income: Not reported

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

S 2 Middle Class Opportunity Act, Card Check provisions; S 45 MCAP Act, a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; S 77 Children's Mental Health Parity Act, a bill to amend title XXI of the Social Security Act to provide for equal coverage of mental health services under the State Children's Health Insurance Program; HR 241, a bill to amend title 10, United States Code to require the amounts reimbursed to institutional providers of health care services under the TRICARE program to be the same as amounts reimbursed under Medicare, and to require the Secretary of Defense to contract for health care services with at least one teaching hospital in urban areas; HR 298 Improving Children's Doctor Access Act of 2009, a bill to amend title XXI of the Social Security Act to require SCHIP annual reports to include information on the HEDIS measure relating to access to primary care practitioners by individuals eligible for child health assistance under such plans and on State efforts to avoid certain displacement of private health coverage, and to express the sense of Congress that such States should utilize Consumer Assessment of Healthcare Providers and Systems consumer satisfaction surveys to measure access by such individuals to physicians; HR 468 and S 245 Retooling the Health Care Workforce for an Aging America Act of 2009, a bill to expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States; HR 676 United States National Health Care Act or the Expanded and Improved Medicare for All Act, a bill to provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes; HR 688 and S 326 Kids First Act, a bill to amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program through fiscal year 2013, and for other purposes; Tricare letter sent to DOD from Sen. Ben Nelson urging DoD to revise the rule, expand the transition to the new payment system, offer other adjustments to cushion the financial blow on certain hospitals, and conduct a detailed analysis of its impact on the field; S 391 Healthy Americans Act, a bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away; HR 914 Physician Workforce Enhancement Act of 2009, a bill to amend title VII of the Public Health Service Act to establish a loan program for eligible hospitals to establish residency training programs; HR 936 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of lifesaving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, emergency needs, and information technology; S 408 Wakefield Act, a bill to amend the Public Health Service Act to provide a means for continued improvement in emergency medical services for children; HR 1086 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009; a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; HR 1101 Midwifery Care Access and Reimbursement Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for reimbursement of certified midwife services and to provide for more equitable reimbursement rates for certified nurse-midwife services; HR 1296 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1411 United States Primary and Preventive Health Care Corps Act of 2009, a bill to amend the Public Health Service Act to establish a Primary and Public Health Scholarship Program; HR 1460 Nurses Higher Education and Loan Repayment Act, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 1494 Nursing Home Emergency Assistance Act, a bill to ensure that a private for-profit nursing home affected by a major disaster receives the same reimbursement as a public nursing home affected by a major disaster; HR 1558 and S 623 Preexisting Condition Patient Protection Act of 2009, to prohibit health insurers from denying coverage to people with pre-existing conditions; S 616 Enhancing Safety in Medicine Utilizing Leading Advanced Simulation Technologies to Improve Outcomes Now Act of 2009, a bill to amend the Public Health Service Act to authorize medical simulation enhancement programs, and for other purposes; HR 1581 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 628 Conrad State 30 Improvement Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities; HR 1614 and S 652 Community Coalitions for Access and Quality Improvement Act of 2009, a bill to authorize the Secretary of Health and Human Services to make grants to community health coalitions to assist in the development of integrated health care delivery; HR 1691 and S 688 Breast Cancer Patient Protection Act of 2009, 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; HR 1699 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; S 703 American Health Security Act of 2009, a bill to provide for health care for every American and to control the cost and enhance the quality of the health care system; HR 1745 Family Health Care Accessibility Act of 2009, a bill to amend the Public Health Service Act to provide liability protections for volunteer practitioners at health centers under section 330 of such Act; S 733 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of life saving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, and emergency needs; Letter to HHS about the action plan to prevent Healthcare associated infections; Provided information to members of Congress about the Quality and Patient Safety Transparency initiatives by state; Working with Rep. Nathan Deal to get legislation introduced on provider price transparency; HR 1670 and S 683 Community Choice Act of 2009, to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports and which would allow disabled Medicaid recipients to receive care in their homes rather than in nursing homes; HR 2003 and S 830 Children's Hospitals Education Equity Act, a bill to modify the definition of children's hospital for purposes of making payments to children's hospitals that operate graduate medical education programs; HR 1998 Health Care Safety Net Enhancement Act of 2009, a bill to improve access to emergency medical services; HR 2043 Nurse Education, Expansion, and Development Act of 2009, a bill to amend the Public Health Service Act to authorize capitation grants to increase the number of nursing faculty and students; HR 2066 Graduate Psychology Education Act of 2009, a bill to amend the Public Health Service Act to promote mental and behavioral health services for underserved populations; S 890 Health Information Technology (IT) Public Utility Act of 2009, a bill to provide for the use of improved health information technology with respect to certain safety net health care providers; HR 2176 Nursing and Allied Health Education Preservation Act of 2009, to amend title XVIII of the Social Security Act to continue the ability of hospitals to supply a needed workforce of nurses and allied health professionals by preserving funding for hospital operated nursing and allied health education programs; HR 2218 Parental Consent Act of 2009, a bill to prohibit the use of Federal funds for any universal or mandatory mental health screening program; S 957 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; S 958 MediKids Health Insurance Act of 2009, a bill to amend the Social Security Act to guarantee comprehensive health care coverage for all children born after 2009; HR 2231 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; HR 2233 Health Empowerment Zone Act of 2009, a bill to authorize the Secretary of Health and Human Services to designate health empowerment zones; S 966 and HR 2252 National Health Care Quality Act, a bill to improve the Federal infrastructure for health care quality improvement in the United States; HR 2249 Health Care Price Transparency Promotion Act of 2009, a bill to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs; HR 2251 and S 973 Resident Physician Shortage Reduction Act of 2009, to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; S 979 and HR 2360 SHOP Act, a bill to amend the Public Health Service Act to establish a nationwide health insurance purchasing pool for small businesses and the self-employed that would offer a choice of private health plans and make health coverage more affordable, predictable, and accessible; HR 2273 Nurse Staffing Standards for Patient Safety and Quality Care Act of 2009, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; S 999 Child Health Care Crisis Relief Act of 2009, a bill to increase the number of well-trained mental health service professionals (including those based in schools) providing clinical mental health care to children and adolescents; S 1001 Health Promotion FIRST Act, a bill to provide for increased research, coordination and expansion of health promotion programs through the Department of Health and Human Services; HR 2350 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; HR 2369 Improving the Quality of Mental and Substance Use Health Care Act of 2009, a bill to improve mental and substance use health care; S 1020 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 1022 Nurses' Higher Education and Loan Repayment Act of 2009, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 2381 Nurse and Health Care Worker Protection Act of 2009, a bill to direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and all other health care workers by establishing a safe patient handling and injury prevention standard, and for other purposes; HR 2388 Physician Availability Act of 2009, a bill to assure that the services of a nonemergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds; S 1028 Strengthening America's Public Health System Act, a bill to amend the Public Health Service Act to improve the Nation's surveillance and reporting for diseases and conditions; S 1031 National Nursing Shortage Reform and Patient Advocacy Act, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; HR 2427 and S 1050 Informed Consumer Choices in Health Care Act of 2009, a bill to amend title XXVII of the Public Health Service Act to establish Federal standards for health insurance forms, quality, fair marketing, and honesty in out-of-network coverage in the group and individual health insurance markets, to improve transparency and accountability in those markets, and to establish a Federal Office of Health Insurance Oversight to monitor performance in those markets; S 1104 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse- Managed Health Clinic Investment program; HR 2536 Emergency Nursing Supply Relief Act, to provide relief for the shortage of nurses in the United States; HR 2691 a bill to provide assistance to adolescents and young adults with serious mental health disorders as they transition to adulthood ; S 1173 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; S 1174 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; S 1176 Allied Health Reinvestment Act, a bill to amend the Public Health Service Act to promote and improve the allied health professionals; HR 2744 Equal Rights for Health Care Act Title 42, a bill to prohibit discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, sexual orientation, gender identity, or disability status; HR 2754 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; S 1220 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; HR 2785 Health Care Paperwork Reduction and Fraud Prevention Act of 2009, a bill to reduce the amount of paperwork and improve payment policies for health care services, to prevent fraud and abuse through health care provider education; HR 2804Ensuring Continuous Coverage under SCHIP Act of 2009, a bill to amend title XXI of the Social Security Act to require 12-month continuous coverage under the State Children's Health Insurance Program; HR 2810 Public Health Workforce Investment Act of 2009, a bill to amend the Public Health Service Act to establish various programs for the recruitment and retention of public health workers and to eliminate critical public health workforce shortages in Federal, State, local, and tribal public health agencies and health centers; HR 2816 States' Right To Innovate in Health Care Act of 2009, a bill to amend the Social Security Act to provide grants and flexibility through demonstration projects for States to provide universal, comprehensive, cost-effective systems of health care coverage, with simplified administration; HR 2824 Doctor-Patient Relationship and Research Protection Act, to enhance the conduct and support of federally funded comparative effectiveness research relating to health care; HR 2891 Access to Frontline Health Care Act of 2009, a bill to amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish a Frontline Providers Loan Repayment Program; HR 2925 Communities Building Access Act, a bill to amend the Public Health Service Act to provide for community projects that will reduce the number of individuals who are uninsured with respect to health care; HR 2930 Primary Care Training Enhancement Act, a bill to enhance the primary care workforce through modifications to the medical residency training programs and use of qualified teaching health centers and through State primary care scholarship and loan repayment programs; S 1278 Consumers Health Care Act of 2009, a bill to establish the Consumers Choice Health Plan, a public health insurance plan that provides an affordable and accountable health insurance option for consumers; HR 2937 and S 1305 MRSA Infection Prevention and Patient Protection Act, a bill to prevent health care facility-acquired infections; HR 2948 Healthcare Improvements for Generating High Performance (HIGH Performance) Act of 2009, a bill to amend title IX of the Public Health Service Act to provide for the implementation of best practices in the delivery of health care in the United States; HR 2957 Rural Health Access Act of 2009, a bill to amend the Public Health Service Act to reauthorize the National Health Service Corps Scholarship and Loan Repayment Programs; S 1299 Worker Infection Protection Act, a bill to protect health care workers and first responders, including police, firefighters, emergency medical personnel, and other workers at risk of workplace exposure to infectious agents and drug resistant infections; Hatch amendment # 21 requiring the IOM to make recommendations to Congress on how to reduce unnecessary hospital readmissions; HR 2975 Medical Practice Protection Act of 2009, a bill to improve the medical care by reducing the excessive burden imposed by the civil liability system on the health care delivery system; HR 3000 Josephine Butler United States Health Service Act, a bill to establish a United States Health Service to provide high quality comprehensive health care for all Americans and to overcome the deficiencies in the present system of health care delivery; HR 3002 and S 1259 PATIENTS Act of 2009, a bill to protect all patients by prohibiting the use of data obtained from comparative effictiveness research accounts to deny coverage of items or services under Federal health care programs and to ensure that comparative effectiveness research accounts for advancements in personalized medicine and differences in patient treatment response; S 1355 Rural Health Clinic Patient Access and Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas; S 1403 Strengthen Social Work Training Act of 2009, a bill to amend title VII of the Public Health Service Act to ensure that social work students or social work schools are eligible for support under certain programs that would assist individuals in pursuing health careers or for grants for training projects in geriatrics, and to establish a social work training program; S 1404 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act of 2009, a bill to implement demonstration projects at federally qualified community health centers to promote universal access to family-centered, evidence-based behavioral health interventions that prevent child maltreatment and promote family well-being by addressing parenting practices and skills for families from diverse socio-economic, cultural, racial, ethnic, and other backgrounds; HR3134 Healthcare Innovation Zone Program Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; H.R.3148, a bill to amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings; H.R.3151 and S 1585 Rural Access to Nurse Anesthesia Services Act of 2009, a bill to permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals notwithstanding the reclassification of such hospitals as urban hospitals, including hospitals located in ``Lugar counties'', and for on-call and standby costs for such services; H.R.3185 and S1569, a bill to amend title XVIII of the Social Security Act to provide payment to hospitals for costs of expanded advanced practice nurse training programs; H.R. 3191 Positive Aging Act of 2009, a bill to amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes; H.R. 3199 Emergency Medic Transition (EMT) Act of 2009 , a bill to amend the Public Health Service Act to provide grants to State emergency medical service departments to provide for the expedited training and licensing of veterans with prior medical training; H.R. 3200 America's Affordable Health Choices Act of 2009, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending; H.R. 3217 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; H.R. 3218 Improving Health Care for All Americans Act, a bill to provide a refundable tax credit for medical costs, to expand access to health insurance coverage through individual membership associations (IMAs), and to assist in the establishment of high risk pools; H.R.3234 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; H.R. 3242 Women's Health Office Act of 2009, a bill to improve the health of women through the establishment of Offices of Women's Health within the Department of Health and Human Services; S.1459 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; H.R. 3391 NO TITLE, a bill to allow for the continuation of critical access hospital designation for certain hospitals in geographic areas experiencing population growth; H.R. 3400 Empowering Patients First Act, a bill to provide for incentives to encourage health insurance coverage; HR 3472 a bill to provide for health insurance coverage premium discounts for healthy behavior and improvements toward healthy behavior; HR 3483 Steps Toward Access and Reform (STAR) Act of 2009, a bill to reform the medical liability system, improve access to health care for rural and indigent patients, enhance access to affordable prescription drugs; S 1572, a bill to provide for a point of order against any legislation that eliminates or reduces the ability of Americans to keep their health plan or their choice of doctor or that decreases the number of Americans enrolled in private health insurance, while increasing the number of Americans enrolled in government-managed health care; HR 3652 Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009, a bill to amend the Public Health Service Act and title XVIII of the Social Security Act to make the provision of technical services for medical imaging examinations and radiation therapy treatments safer, more accurate, and less costly; S 1720 Health Professions and Primary Care Reinvestment Act, a bill to amend title VII of the Public Health Service Act to provide improved training and primary care; HR 3664 Healthcare Innovation Zone Pilot Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; S 1730 Fairness in Health Insurance Act, a bill to provide for minimum loss ratios for health insurance coverage; S 1734 Medical Liability Reform Act of 2009, a bill to reduce the cost of health care and ensure patient access to doctors by ending excessive malpractice verdicts through common-sense lawsuit reform; S 1742 Women's Hospitals Education Equity Act, a bill to amend the Public Health Service Act to provide assistance for graduate medical education funding for women's hospitals; Comment letter expressing concerns taht ONC's certification criteria for EHR eliminates flexibility CMS established in rule for achieving meaningful use; HR 4626 Health Insurance Industry Fair Competition Act, to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; HR 4851 Continuing Extension Act of 2010, to provide a temporary extension of certain programs; Meetings with CMS and HHS to encourage reimbursement under the National Disaster Medical System for hospitals that provided services to victims of the Haitian earthquake; HR 4700 The Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing; HR 4803 The Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information; HR 6072 and S 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 6376 to amend title XVIII of the Social Security Act with respect to physician supervision of therapeutic hospital outpatient services; HR 6095 to amend title XVIII of the Social Security Act to preserve integrated care for durable medical equipment under the competitive bidding program for qualified hospital-related DME entities; S 3653 Healthcare Bureacrats Elimination Act, A bill to remove unelected, unaccountable bureaucrats from seniors' personal health decisions by repealing the IPAB.

Client expense: $5,390,000 · Firm income: Not reported

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

Implementation of HR 4872 Health Care and Education Reconciliation Act of 2010 Implementation of HR 3590 Patient Protection and Affordable Care Act Regulatory issues related to the Electronic Health Record Incentive Program S 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 HR 6072 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 Medicare Imputed Rural Floor

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), Office of Management & Budget (OMB), SENATE

Health Reform Implementation The President and Congress passed plans to institute comprehensive reform of the health care delivery and payments systems in the United States. (Senate Health, Education, Labor, and Pensions Bill, Senate Finance Bill, House Tri-Committee Bill, HR 3962, and HR 3590) HITECH Act - Implementation of meaningful use and privacy and security provisions in HITECH Act of 2009. HR 6072 - Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 - To amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals. S. 3708 - Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 - To amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals. Group Purchasing Organization Regulations Policy proposals have been discussed in the context of health reform that would result in additional federal regulation of Group Purchasing Organizations. Medical Liability Reform Numerous policy proposals have been developed that would seek to reform the federal medical liability laws. Healthcare Acquired Conditions/Infections There are a number of government activities related to reducing the number of healthcare acquired conditions or infections. Medical Loss Ratios A provision of the health reform legislation of 2010 required that health insurance plans meet a minimum threshold of premium dollars spent on actually medical care. Johanns Amendment Amendment #4596 to Small Business Bill Would have returned the 1099 issuance threshold to $5,000 and would pay for this change of law by lowering the threshold for obtaining an exemption from the health reform laws personal responsibility mandate. Senator Mike Enzi Resolution of Disapproval on Grandfathered Health Insurance Plans Senator Mike Enzi (R-WY) introduced a resolution of disapproval to overturn the grandfathering clause of the healthcare reform law.

Client expense: $580,000 · Firm income: Not reported

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

Requested of Senate and House to cosponsor Electronic Health Records Incentives for Multi-Campus Hospitals Act of 2010. Requested support for H.R 6072 and S. 3708, the Electronic Health Records Incentives for Multi-Campus Hospitals Act of 2010. The legislation would ensure that federal incentive payments would be available to all hospitals in a multi-campus system. Requested cosponsorship of S. 307, the Critical Access Hospital Flexibility Act of 2009, Critical Access Hospitals will be provided flexibility in how they measure patient census in a given 12-month period, allowing them to flex to fit the health care needs of their communities.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6072, S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, all provisions H.R. 3590, the Patient Protection and Affordable Care Act, Section 9006 H.R. 3590, the Patient Protection and Affordable Care Act, Section 5101--National Health Care Workforce Commission nomination H.R. 3590, the Patient Protection and Affordable Care Act, Section 4001--Advisory Group on Prevention, Health Promotion, and Integrative and Public Health nomination

Client expense: Not reported · Firm income: $44,500

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

H.R. 6072, S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, all provisions H.R. 3590, the Patient Protection and Affordable Care Act, Section 9006 H.R. 3590, the Patient Protection and Affordable Care Act, Section 5101--National Health Care Workforce Commission nomination H.R. 3590, the Patient Protection and Affordable Care Act, Section 4001--Advisory Group on Prevention, Health Promotion, and Integrative and Public Health nomination

Client expense: $54,022 · Firm income: Not reported

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

H.R. 6072, S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, all provisions H.R. 3590, the Patient Protection and Affordable Care Act, Section 9006 H.R. 3590, the Patient Protection and Affordable Care Act, Section 5101--National Health Care Workforce Commission nomination H.R. 3590, the Patient Protection and Affordable Care Act, Section 4001--Advisory Group on Prevention, Health Promotion, and Integrative and Public Health nomination

Client expense: Not reported · Firm income: $5,500

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

H.R. 6072 and S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 Medicare IPPS FY 2011 Proposed and Final Rules Medicare and Medicaid Electronic Health Reform Incentive Program Proposed and Final Regulations H.R. 5712 Physician Payment and Therapy Relief Act (one month doc fix) H.R. 4994 Medicare and Medicaid Extenders Act H.R. 3082 Continuing Appropriations and Surface Transportation Extensions Act, 2011 (continuing resolution; became P.L. 111-322) P.L. 148 Patient Protection and Affordable Care Act P.L. 152 Health Care and Education Reconciliation Act S. 3653 Health Care Bureaucrats Elimination Act (repeal IPAB) H.R. 6376, To amend Title XVIII of the Social Security Act with respect to physician supervision of therapeutic hospital outpatient services.

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), SENATE

H.R.6072 and S.3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 Medicare IPPS FY 2011 Proposed and Final Rules Medicare and Medicaid Electronic Health Reform Incentive Program Proposed and Final Regulations H.R.5712 Physician Payment and Therapy Relief Act (one month doctor fix) H.R.4994 Medicare and Medicaid Extenders Act H.R.3082 Continuing Appropriations and Surface Transportation Extensions Act, 2011 (continuing resolution; became P.L. 111-322) P.L.148 Patient Protection and Affordable Care Act P.L.152 Health Care and Education Reconciliation Act S.3653 Health Care Bureaucrats Elimination Act (repeal IPAB) H.R.6376 to amend Title XVIII of the Social Security Act with respect to physician supervision of therapeutic hospital outpatient services.

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

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

H.R.914, Physician Workforce Enhancement Act of 2009, Physician workforce related issues. H.R.1468, Medical Justice Act of 2009, Medical liability related issues. H.R.936/S.733, National Trauma Center Stabilization Act of 2009, Emergency readiness and trauma related issues. General monitoring on Not-for-profit hospitals charity care and community benefits. S.391, Healthy Americans Act, Health care reform. H.R.193, AmeriCare Health Insurance Act of 2009, Health care reform. H.R.2251/S.973, Resident Physician Shortage Reduction Act of 2009, Physician workforce related issues. Health care reform, Hospital related issues and initiatives. S.1640, Take Back Your Health Act of 2009, Hospital related issues and initiatives. Public Law 110-343, Patient Protection and Affordable Care Act, Hospital related issues and initiatives. Public Law 111-148, The Patient Protection and Affordable Care Act, Hospital related issues and initiatives. Public Law 111-152, Health Care and Education Reconciliation Act of 2010, Hospital related issues and initiatives. H.R.4213, American Jobs and Closing Tax Loopholes Act of 2010, Medicare payment related issues; and Build America Bonds program issues. H.R.6005, Ensuring Equality fo rearly EHR Adoption Act, Hospital Information Technology issues. S.3708/H.R.6072, Electronic Health Record Incentives for Multi Campus Hospitals Act, Hospital Information Technology issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 6072; S 3708 Supportive of legislation / language that would allow each hospital within multicampus systems to receive federal incentive payments for health information technology (HIT).

Client expense: $43,607 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3590 The Patient Protection and Affordable Care Act. All provisions related to health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers, and individuals. H.R. 4851 The Continuing Extension Act of 2010 - All provisions related to Medicare physician payments, and physician and hospital eligibility for health care information technology/electronic health records incentive payments. H.R. 2251 and S.973 Resident Shortage Reduction Act of 2009. All provisions related to graduate medical education. S. 1776 Medicare Physician Fairness Act of 2009. All provisions concerning the Medicare Physician Fee Schedule. H.R. 4691 Temporary Extension Act of 2010 - All provisions related to Medicare physician payments. H.R. 4213 The American Workers, State, and Business Relief Act of 2010. All provisions related to Medicare physician payments and Medicaid Federal Medical Assistance Payments (FMAP) to states associated with the American Recovery and Reinvestment Act of 2009. H.R. 3962 Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 Medical and health care policy matters concerning post-Katrina disaster assistance for New Orleans area hospitals, and health care/Medicaid reform initiatives in Louisiana including adjustments and extensions related to Medicaid Federal Medical Assistance Payments (FMAP) for states associated with the American Recovery and Reinvestment Act of 2009. Medicare and Medicaid incentive payments for physicians and hospitals associated with the use of electronic health records. H.R. 6072 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010. All provisions concerning Medicare and Medicaid incentive payments for physicians and hospitals associated with the use of electronic health records. S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010. All provisions concerning Medicare and Medicaid incentive payments for physicians and hospitals associated with the use of electronic health records. H.R. 5712 Veterans', Seniors', and Children's Health Technical Corrections Act of 2010 H.R. 1586 Education, Jobs and Medicaid Funding Bill/FAA Air Transportation Modernization and Safety Improvement Act. All provisions related to Medicaid. H.R. 5712 The Physician Payment and Therapy Relief Act of 2010. All provisions concerning the Medicare Phyusician Fee Schedule. H.R. 4994 Medicare and Medicaid Extenders Act of 2010. All provisions concerning the Medicare Phyusician Fee Schedule and graduate medical education. H.R. 6427 Medicare Phyhsician Payment Update Extension Act. All provisions concerning the Medicare Phyusician Fee Schedule.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), SENATE

H.R. 3590 The Patient Protection and Affordable Care Act. All provisions related to health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers, and individuals. H.R. 4851 The Continuing Extension Act of 2010 - All provisions related to Medicare physician payments, and physician and hospital eligibility for health care information technology/electronic health records incentive payments. H.R. 2251 and S.973 Resident Shortage Reduction Act of 2009. All provisions related to graduate medical education. S. 1776 Medicare Physician Fairness Act of 2009. All provisions concerning the Medicare Physician Fee Schedule. H.R. 4691 Temporary Extension Act of 2010 - All provisions related to Medicare physician payments. H.R. 4213 The American Workers, State, and Business Relief Act of 2010. All provisions related to Medicare physician payments and Medicaid Federal Medical Assistance Payments (FMAP) to states associated with the American Recovery and Reinvestment Act of 2009. H.R. 3962 Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 Medical and health care policy matters concerning post-Katrina disaster assistance for New Orleans area hospitals, and health care/Medicaid reform initiatives in Louisiana including adjustments and extensions related to Medicaid Federal Medical Assistance Payments (FMAP) for states associated with the American Recovery and Reinvestment Act of 2009. H.R. 6072 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010. All provisions concerning Medicare and Medicaid incentive payments for physicians and hospitals associated with the use of electronic health records. S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010. All provisions concerning Medicare and Medicaid incentive payments for physicians and hospitals associated with the use of electronic health records. H.R. 5712 Veterans', Seniors', and Children's Health Technical Corrections Act of 2010 H.R. 1586 Education, Jobs and Medicaid Funding Bill/FAA Air Transportation Modernization and Safety Improvement Act. All provisions related to Medicaid. H.R. 4994 Medicare and Medicaid Extenders Act of 2010. All provisions related to Medicare physician payments and graduate medical education. H.R. 6427 Medicare Phyhsician Payment Update Extension Act. All provisions related to Medicare physician payments. S. 3686 Departments of Labor, Health and Human Services and Education, and Related Agencies Appropriations Act, 2011. All provisions related to biomedical education and research. H.R. 3081 Continuing Appropriations Act, 2011. All provisions related to biomedical education and research. H.R. 5712 The Physician Payment and Therapy Relief Act of 2010. All provisions related to Medicare physician payments.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), SENATE

Home health care access protection act, S. 3315 Home health care access protection act, H.R. 5803 Appropriations for St. Anthony Hospital, Oklahoma City; St. Marys Hospital, Janesville, WI; St. Clare Hospital, Baraboo, WI Electronic health record incentives for multi-campus hospitals act of 2010, S. 3708 Electronic health record incentives for multi-campus hospitals act of 2010, H.R. 6072 Opposed recommendations of the National Commission on Fiscal Responsibility and Reform not to fund the Malcolm Baldrige National Quality Program.

Client expense: $62,558 · Firm income: Not reported

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

Hospital Group Purchasing - Conducted outreach and education efforts on the value provided to hospitals by group purchasing organizations. Tracked the release of reports from the Senate Finance Committee and the Government Accountability Office on hospital group purchasing. Health Care Information Technology - tracked regulations that would determine if hospitals would be considered meaningful users of electronic health records and advocated for legislative changes that would allow incentive payments to providers in multi-campus settings (H.R. 6072, S. 3708). Opposed possible expansion of current Health Insurance Portability and Accountability Act requirements for the privacy of health information. Unique Device Identification - Advocated for the release of regulations establishing a unique device identification system for medical devices as required by the Food and Drug Amendments Act of 2006. 340B (of the Public Health Services Act) Drug Pricing Program - tracked technical changes to provisions in the Patient Protection and Affordable Care Act that would allow children's hospitals access to 340B pricing for orphan drugs included in H.R. 5712.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), SENATE

H.R. 6072/S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 201--all provisions

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Geographic Reclassification - Senate Amendment included in HR3590; HR2753; Health Care Reform Medicare/Medicaid provisions - Implementation of PL111-148; Inpatient Prospective Payment SYstem proposed changes for FY2011; HIT Funding and Meaningful Use - H.R.6072 and S. 3708

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 (H.R. 6072/S. 3708)

Client expense: $12,500 · Firm income: Not reported

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)

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

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

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

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)).

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

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

Implementation of HR 3590 Patient Protection and Affordable Care Act - IMPLEMENTATION ISSUES; Healthcare and Education Reconciliation Act of 2010; S 3708, HR 6072 - Electronic Health Records Incentives for Multi Campus Hospitals Act of 2010; HR 4872 PPACA implementation issues; Inpatient Prospective Payment System Re-evaluation; HR 4213 (extenders package concerning FMAP, DOC-Fix)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

FY2011 Labor-HHS-Ed Appropriations bill FY2011 DOD Appropriations bill HR 6072, S3708 Multi- Campus Hospital Act of 2010 HR 6072, S3708 Multi- Campus Hospital Act of 2010

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Supported legislation to ensure that multiple hospitals with common provider numbers received separate electronic health record reimbursements (S. 3708 and H.R. 6072) and that the home health agencies are not arbitrarily reduced in their reimbursements (S.3315 and H.R. 5803).

Client expense: $67,500 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Please see attached addendum for General Lobbying Issue Area: HCR - Health Issues "Good faith compliance standard," reasonable effective dates for compliance with PL 111-148 State oversight of premium increases: S 3708 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; include benefits for individuals as well as populations Dependent health insurance coverage; IRS guidelines on dependent coverage; pre-existing conditions for children; guaranteed issue for children under the age of 19; child-only policies Rescissions and Routine Administrative Functions; internal claims and appeals/ external review; open enrollment period; adverse selection implications Affordable private health care; insurer fees; 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 medical home; health disparities; wellness; chronic care management; comparative effectiveness research; improved delivery system of health care; evidence based care; healthcare delivery system reforms; childhood obesity Health information technology standards; health information privacy; electronic health records; ICD-10 "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; individual mandate

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health Reform Implementation The President and Congress passed plans to institute comprehensive reform of the health care delivery and payments systems in the United States. (Senate Health, Education, Labor, and Pensions Bill, Senate Finance Bill, House Tri-Committee Bill, HR 3962, and HR 3590) HITECH Act - Implementation of meaningful use and privacy and security provisions in HITECH Act of 2009. HR 6072 - Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 - To amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals. S. 3708 - Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 - To amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals. Group Purchasing Organization Regulations Policy proposals have been discussed in the context of health reform that would result in additional federal regulation of Group Purchasing Organizations. Medical Liability Reform Numerous policy proposals have been developed that would seek to reform the federal medical liability laws. Healthcare Acquired Conditions/Infections There are a number of government activities related to reducing the number of healthcare acquired conditions or infections. Medical Loss Ratios A provision of the health reform legislation of 2010 required that health insurance plans meet a minimum threshold of premium dollars spent on actually medical care. Johanns Amendment Amendment #4596 to Small Business Bill Would have returned the 1099 issuance threshold to $5,000 and would pay for this change of law by lowering the threshold for obtaining an exemption from the health reform laws personal responsibility mandate. Senator Mike Enzi Resolution of Disapproval on Grandfathered Health Insurance Plans Senator Mike Enzi (R-WY) introduced a resolution of disapproval to overturn the grandfathering clause of the healthcare reform law.

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

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

Implementation of Health Reform The Health Information Technology for Economic and Clinical Health Act (HITECH), regarding implementation of Act H.R. 4691 and H.R. 4213 -- Provisions within Tax Extenders Package S. 3708 and H.R. 6072 -- Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 H.R. 5209 - Healthy CHOICES Act Issues related to the Medicare & Medicaid Protection Act of 1987 that regulate Group Purchasing Organizations under HHS Medical Device Manufacturers Gag Clause on Hospital Contracting

Client expense: $287,120 · Firm income: Not reported

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

Requested support of House and Senate letters to the Centers for Medicare and Medicaid Services (CMS) to take patient severity into account when implementing the Medicare Inpatient Prospective Payment System (IPPS) regulation for Fiscal Year (FY) 2011. Requested support for H.R 6072 and S. 3708, the Electronic Health Records Incentives for Multi-Campus Hospitals Act of 2010. The legislation would ensure that federal incentive payments would be available to all hospitals in a multi-campus system. Requested cosponsorship of S. 307, the Critical Access Hospital Flexibility Act of 2009, Critical Access Hospitals will be provided flexibility in how they measure patient census in a given 12-month period, allowing them to flex to fit the health care needs of their communities.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Implementation of HR 4872 Health Care and Education Reconciliation Act of 2010 Implementation of HR 3590 Patient Protection and Affordable Care Act Regulatory issues related to the Electronic Health Record Incentive Program S 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 HR 6072 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 Medicare Imputed Rural Floor

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), Office of Management & Budget (OMB), SENATE

42 CFR Parts 412, et al. Medicare and Medicaid Progs; Electronic Health Record Incentive Prog. Proposed Rule Meaningful Use Inpatient Prospective Payment System FY 2011 Proposed Rule Inpatient Prospective Payment System FY 2011 Final Rule H R 6072 and S 3708 - Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010

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

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

H.R. 6072, S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, all provisions H.R. 3590, the Patient Protection and Affordable Care Act, Section 9006 H.R. 3590, the Patient Protection and Affordable Care Act, Section 5101--National Health Care Workforce Commission nomination H.R. 3590, the Patient Protection and Affordable Care Act, Section 4001--Advisory Group on Prevention, Health Promotion, and Integrative and Public Health nomination

Client expense: $125,312 · Firm income: Not reported

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

H.R. 6072, S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, all provisions H.R. 3590, the Patient Protection and Affordable Care Act, Section 9006 H.R. 3590, the Patient Protection and Affordable Care Act, Section 5101--National Health Care Workforce Commission nomination H.R. 3590, the Patient Protection and Affordable Care Act, Section 4001--Advisory Group on Prevention, Health Promotion, and Integrative and Public Health nomination

Client expense: Not reported · Firm income: Not reported

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

H.R. 6072, S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, all provisions H.R. 3590, the Patient Protection and Affordable Care Act, Section 9006 H.R. 3590, the Patient Protection and Affordable Care Act, Section 5101--National Health Care Workforce Commission nomination H.R. 3590, the Patient Protection and Affordable Care Act, Section 4001--Advisory Group on Prevention, Health Promotion, and Integrative and Public Health nomination

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

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

H.R.4213 - American Workers, State, and Business Relief Act of 2010 House Substitute Amendment to H.R.4213 Senate Amendment to House Substitute Amendment to H.R.4213 H.R.3962 - Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 IPPS FY 2011 Proposed and Final Rules Medicare and Medicaid Electronic Health Reform Incentive Program Proposed and Final Regulations P.L.148 - Patient Protection and Affordable Care Act P.L.152 - Health Care and Education Reconciliation Act H.R.6072 and S.3708 - Electronic Health Record iNcentives for Multi-Campus Hospitals Act of 2010

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), SENATE

S 2 Middle Class Opportunity Act, Card Check provisions; S 4 Comprehensive Health Reform Act of 2009, a bill to guarantee affordable, quality health coverage for all Americans, and for other purposes; S 45 MCAP Act, a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; S 77 Children's Mental Health Parity Act, a bill to amend title XXI of the Social Security Act to provide for equal coverage of mental health services under the State Children's Health Insurance Program; HR 241a bill to amend title 10, United States Code, to require the amounts reimbursed to institutional providers of health care services under the TRICARE program to be the same as amounts reimbursed under Medicare, and to require the Secretary of Defense to contract for health care services with at least one teaching hospital in urban areas; HR 298 Improving Children's Doctor Access Act of 2009, a bill to amend title XXI of the Social Security Act to require SCHIP annual reports to include information on the HEDIS measure relating to access to primary care practitioners by individuals eligible for child health assistance under such plans and on State efforts to avoid certain displacement of private health coverage, and to express the sense of Congress that such States should utilize Consumer Assessment of Healthcare Providers and Systems consumer satisfaction surveys to measure access by such individuals to physicians; S 179 Health Information Technology Act of 2009, a bill to improve quality in health care by providing incentives for adoption of modern information technology; HR 468 and S 245 Retooling the Health Care Workforce for an Aging America Act of 2009, a bill to expand, train, and support all sectors of the health care workforce to care for the growing population of older individuals in the United States; HR 676 United States National Health Care Act or the Expanded and Improved Medicare for All Act, a bill to provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes; HR 688 and S 326 Kids First Act, a bill to amend title XXI of the Social Security Act to reauthorize the State Children's Health Insurance Program through fiscal year 2013, and for other purposes; Tricare letter sent to DOD from Sen. Ben Nelson urging DoD to revise the rule, expand the transition to the new payment system, offer other adjustments to cushion the financial blow on certain hospitals, and conduct a detailed analysis of its impact on the field; S 391 Healthy Americans Act, a bill to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away; HR 914 Physician Workforce Enhancement Act of 2009, a bill to amend title VII of the Public Health Service Act to establish a loan program for eligible hospitals to establish residency training programs; HR 936 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of lifesaving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, emergency needs, and information technology; HR 956 HealthCARE Act of 2009, a bill to expand the number of individuals and families with health insurance coverage, and for other purposes; S 408 Wakefield Act, a bill to amend the Public Health Service Act to provide a means for continued improvement in emergency medical services for children; HR 1085 Health Insurance Coverage Protection Act, a bill to impose a limitation on lifetime aggregate limits imposed by health plans; HR 1086 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009; a bill to improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system; HR 1101 Midwifery Care Access and Reimbursement Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for reimbursement of certified midwife services and to provide for more equitable reimbursement rates for certified nurse-midwife services; S 441 Quality Reform Expansion and Savings Act of 2009, a bill to encourage the development of coordinated quality reforms to improve health care delivery and reduce the cost of care in the health care system; S 444 National Health Information Technology and Privacy Advancement Act of 2009, a bill to provide for the establishment of a health information technology and privacy system; S 486 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1253 Health Insurance Restrictions and Limitations Clarification Act of 2009, a bill 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; HR 1296 Access for All America Act, a bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs; HR 1411 United States Primary and Preventive Health Care Corps Act of 2009, a bill to amend the Public Health Service Act to establish a Primary and Public Health Scholarship Program; HR 1460 Nurses Higher Education and Loan Repayment Act, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 1494 Nursing Home Emergency Assistance Act, a bill to ensure that a private for-profit nursing home affected by a major disaster receives the same reimbursement as a public nursing home affected by a major disaster; HR 1558 and S 623 Preexisting Condition Patient Protection Act of 2009, to prohibit health insurers from denying coverage to people with pre-existing conditions; S 616 Enhancing Safety in Medicine Utilizing Leading Advanced Simulation Technologies to Improve Outcomes Now Act of 2009, a bill to amend the Public Health Service Act to authorize medical simulation enhancement programs, and for other purposes; HR 1581 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 628 Conrad State 30 Improvement Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities; HR 1614 and S 652 Community Coalitions for Access and Quality Improvement Act of 2009, a bill to authorize the Secretary of Health and Human Services to make grants to community health coalitions to assist in the development of integrated health care delivery; HR 1691 and S 688 Breast Cancer Patient Protection Act of 2009, 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; HR 1699 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; S 698 State-Based Health Care Reform Act, a bill to ensure the provision of high-quality health care coverage for uninsured individuals through State health care coverage pilot projects that expand coverage and access and improve quality and efficiency in the health care system; S 703 American Health Security Act of 2009, a bill to provide for health care for every American and to control the cost and enhance the quality of the health care system; HR 1745 Family Health Care Accessibility Act of 2009, a bill to amend the Public Health Service Act to provide liability protections for volunteer practitioners at health centers under section 330 of such Act; S 733 National Trauma Center Stabilization Act of 2009, a bill to ensure the continued and future availability of life saving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, and emergency needs; Letter to HHS about the action plan to prevent Healthcare associated infections; Provided information to members of Congress about the Quality and Patient Safety Transparency initiatives by state; Working with Rep. Nathan Deal to get legislation introduced on provider price transparency; HR 1670 and S 683 Community Choice Act of 2009, to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports and which would allow disabled Medicaid recipients to receive care in their homes rather than in nursing homes; HR 2003 and S 830 Children's Hospitals Education Equity Act, a bill to modify the definition of children's hospital for purposes of making payments to children's hospitals that operate graduate medical education programs; HR 1998 Health Care Safety Net Enhancement Act of 2009, a bill to improve access to emergency medical services; HR 2043 Nurse Education, Expansion, and Development Act of 2009, a bill to amend the Public Health Service Act to authorize capitation grants to increase the number of nursing faculty and students; HR 2066 Graduate Psychology Education Act of 2009, a bill to amend the Public Health Service Act to promote mental and behavioral health services for underserved populations; S 890 Health Information Technology (IT) Public Utility Act of 2009, a bill to provide for the use of improved health information technology with respect to certain safety net health care providers; HR 2176 Nursing and Allied Health Education Preservation Act of 2009, to amend title XVIII of the Social Security Act to continue the ability of hospitals to supply a needed workforce of nurses and allied health professionals by preserving funding for hospital operated nursing and allied health education programs; HR 2218 Parental Consent Act of 2009, a bill to prohibit the use of Federal funds for any universal or mandatory mental health screening program; S 957 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; S 958 MediKids Health Insurance Act of 2009, a bill to amend the Social Security Act to guarantee comprehensive health care coverage for all children born after 2009; HR 2231 Public Health Emergency Response Act of 2009, a bill to amend the Public Health Service Act to ensure that victims of public health emergencies have meaningful and immediate access to medically necessary health care services; HR 2233 Health Empowerment Zone Act of 2009, a bill to authorize the Secretary of Health and Human Services to designate health empowerment zones; S 966 and HR 2252 National Health Care Quality Act, a bill to improve the Federal infrastructure for health care quality improvement in the United States; HR 2249 Health Care Price Transparency Promotion Act of 2009, a bill to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs; HR 2251 and S 973 Resident Physician Shortage Reduction Act of 2009, to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; S 979 and HR 2360 SHOP Act, a bill to amend the Public Health Service Act to establish a nationwide health insurance purchasing pool for small businesses and the self-employed that would offer a choice of private health plans and make health coverage more affordable, predictable, and accessible; HR 2273 Nurse Staffing Standards for Patient Safety and Quality Care Act of 2009, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; S 999 Child Health Care Crisis Relief Act of 2009, a bill to increase the number of well-trained mental health service professionals (including those based in schools) providing clinical mental health care to children and adolescents; S 1001 Health Promotion FIRST Act, a bill to provide for increased research, coordination and expansion of health promotion programs through the Department of Health and Human Services; HR 2350 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; HR 2369 Improving the Quality of Mental and Substance Use Health Care Act of 2009, a bill to improve mental and substance use health care; S 1020 Patient-Focused Critical Care Enhancement Act, a bill to optimize the delivery of critical care medicine and expand the critical care workforce; S 1022 Nurses' Higher Education and Loan Repayment Act of 2009, a bill to amend the Public Health Service Act to establish a graduate degree loan repayment program for nurses who become nursing school faculty members; HR 2381 Nurse and Health Care Worker Protection Act of 2009, a bill to direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and all other health care workers by establishing a safe patient handling and injury prevention standard, and for other purposes; HR 2388 Physician Availability Act of 2009, a bill to assure that the services of a nonemergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds; S 1028 Strengthening America's Public Health System Act, a bill to amend the Public Health Service Act to improve the Nation's surveillance and reporting for diseases and conditions; S 1031 National Nursing Shortage Reform and Patient Advocacy Act, a bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals; HR 2427 and S 1050 Informed Consumer Choices in Health Care Act of 2009, a bill to amend title XXVII of the Public Health Service Act to establish Federal standards for health insurance forms, quality, fair marketing, and honesty in out-of-network coverage in the group and individual health insurance markets, to improve transparency and accountability in those markets, and to establish a Federal Office of Health Insurance Oversight to monitor performance in those markets; HR 2520 Patients' Choice Act, a bill to provide comprehensive solutions for the health care system of the United States; HR 2535 Blueprint for Health Act of 2009, a bill to establish a Blueprint for Health in order to create a comprehensive system of care incorporating medical homes to improve the delivery and affordability of health care through disease prevention, health promotion, and education about and better management of chronic conditions; S 1104 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; HR 2536 Emergency Nursing Supply Relief Act, to provide relief for the shortage of nurses in the United States; HR 2691 a bill to provide assistance to adolescents and young adults with serious mental health disorders as they transition to adulthood ; S 1173 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; S 1174 Preserving Patient Access to Primary Care Act of 2009, a bill to amend the Public Health Service Act and the Social Security Act to increase the number of primary care physicians and primary care providers and to improve patient access to primary care services; S 1176 Allied Health Reinvestment Act, a bill to amend the Public Health Service Act to promote and improve the allied health professionals; HR 2744 Equal Rights for Health Care Act Title 42, a bill to prohibit discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, sexual orientation, gender identity, or disability status; HR 2754 Nurse-Managed Health Clinic Investment Act of 2009, a bill to amend the Public Health Service Act to establish the Nurse-Managed Health Clinic Investment program; HR 2778 Health Equity and Accountability through Research Act of 2009, a bill to amend the Public Health Service Act to redesignate the National Center on Minority Health and Health Disparities as the National Institute for Minority Health and Health Disparities; S 1220 Patient Access to Critical Lab Tests Act, a bill to require that certain complex diagnostic laboratory tests performed by an independent laboratory after a hospital outpatient encounter or inpatient stay during which the specimen involved was collected shall be treated as services for which payment may be made directly to the laboratory under part B of title XVIII of the Social Security Act; HR 2785 Health Care Paperwork Reduction and Fraud Prevention Act of 2009, a bill to reduce the amount of paperwork and improve payment policies for health care services, to prevent fraud and abuse through health care provider education; HR 2804Ensuring Continuous Coverage under SCHIP Act of 2009, a bill to amend title XXI of the Social Security Act to require 12-month continuous coverage under the State Children's Health Insurance Program; HR 2810 Public Health Workforce Investment Act of 2009, a bill to amend the Public Health Service Act to establish various programs for the recruitment and retention of public health workers and to eliminate critical public health workforce shortages in Federal, State, local, and tribal public health agencies and health centers; HR 2816 States' Right To Innovate in Health Care Act of 2009, a bill to amend the Social Security Act to provide grants and flexibility through demonstration projects for States to provide universal, comprehensive, cost-effective systems of health care coverage, with simplified administration; HR 2824 Doctor-Patient Relationship and Research Protection Act, to enhance the conduct and support of federally funded comparative effectiveness research relating to health care; HR 2891 Access to Frontline Health Care Act of 2009, a bill to amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish a Frontline Providers Loan Repayment Program; HR 2925 Communities Building Access Act, a bill to amend the Public Health Service Act to provide for community projects that will reduce the number of individuals who are uninsured with respect to health care; HR 2930 Primary Care Training Enhancement Act, a bill to enhance the primary care workforce through modifications to the medical residency training programs and use of qualified teaching health centers and through State primary care scholarship and loan repayment programs; S 1278 Consumers Health Care Act of 2009, a bill to establish the Consumers Choice Health Plan, a public health insurance plan that provides an affordable and accountable health insurance option for consumers; HR 2937 and S 1305 MRSA Infection Prevention and Patient Protection Act, a bill to prevent health care facility-acquired infections; HR 2948 Healthcare Improvements for Generating High Performance (HIGH Performance) Act of 2009, a bill to amend title IX of the Public Health Service Act to provide for the implementation of best practices in the delivery of health care in the United States; HR 2957 Rural Health Access Act of 2009, a bill to amend the Public Health Service Act to reauthorize the National Health Service Corps Scholarship and Loan Repayment Programs; S 1299 Worker Infection Protection Act, a bill to protect health care workers and first responders, including police, firefighters, emergency medical personnel, and other workers at risk of workplace exposure to infectious agents and drug resistant infections; Hatch amendment # 21 requiring the IOM to make recommendations to Congress on how to reduce unnecessary hospital readmissions; HR 2975 Medical Practice Protection Act of 2009, a bill to improve the medical care by reducing the excessive burden imposed by the civil liability system on the health care delivery system; HR 3000 Josephine Butler United States Health Service Act, a bill to establish a United States Health Service to provide high quality comprehensive health care for all Americans and to overcome the deficiencies in the present system of health care delivery; HR 3002 and S 1259 PATIENTS Act of 2009, a bill to protect all patients by prohibiting the use of data obtained from comparative effictiveness research accounts to deny coverage of items or services under Federal health care programs and to ensure that comparative effectiveness research accounts for advancements in personalized medicine and differences in patient treatment response; S 1355 Rural Health Clinic Patient Access and Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas; S. 1403 Strengthen Social Work Training Act of 2009, a bill to amend title VII of the Public Health Service Act to ensure that social work students or social work schools are eligible for support under certain programs that would assist individuals in pursuing health careers or for grants for training projects in geriatrics, and to establish a social work training program; S. 1404 Supporting Child Maltreatment Prevention Efforts in Community Health Centers Act of 2009, a bill to implement demonstration projects at federally qualified community health centers to promote universal access to family-centered, evidence-based behavioral health interventions that prevent child maltreatment and promote family well-being by addressing parenting practices and skills for families from diverse socioeconomic, cultural, racial, ethnic, and other backgrounds; HR3134 Healthcare Innovation Zone Program Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; H.R.3148, a bill to amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings; H.R.3151 and S 1585 Rural Access to Nurse Anesthesia Services Act of 2009, a bill to permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals notwithstanding the reclassification of such hospitals as urban hospitals, including hospitals located in ``Lugar counties'', and for on-call and standby costs for such services; H.R.3158 Place Based Health Care Act of 2009, a bill to reform health care delivery by providing incentives for place-based health care, which seeks to bring health services to the patient by locating community health centers, federally qualified health centers, and community integrated health centers in or near settings that already serve a particular target population, such as schools, workplaces, and senior services facilities; H.R.3185 and S1569, a bill to amend title XVIII of the Social Security Act to provide payment to hospitals for costs of expanded advanced practice nurse training programs; H.R. 3191 Positive Aging Act of 2009, a bill to amend the Public Health Service Act to provide for integration of mental health services and mental health treatment outreach teams, and for other purposes; H.R. 3199 Emergency Medic Transition (EMT) Act of 2009 , a bill to amend the Public Health Service Act to provide grants to State emergency medical service departments to provide for the expedited training and licensing of veterans with prior medical training; H.R. 3200 America's Affordable Health Choices Act of 2009, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending; H.R. 3217 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; H.R. 3218 Improving Health Care for All Americans Act, a bill to provide a refundable tax credit for medical costs, to expand access to health insurance coverage through individual membership associations (IMAs), and to assist in the establishment of high risk pools; H.R.3234 Community-Based Health Care Retraining Act, a bill to establish a demonstration project to train unemployed workers for employment as health care professionals; H.R. 3242 Women's Health Office Act of 2009, a bill to improve the health of women through the establishment of Offices of Women's Health within the Department of Health and Human Services; S.1459 Health Care Choice Act of 2009, a bill to amend the Public Health Service Act to provide for cooperative governing of individual health insurance coverage offered in interstate commerce; S. 1479 NO TITLE, a bill to provide for the treatment of certain hospitals; H.R. 3391 NO TITLE, a bill to allow for the continuation of critical access hospital designation for certain hospitals in geographic areas experiencing population growth; H.R. 3400 Empowering Patients First Act, a bill to provide for incentives to encourage health insurance coverage; H.R.3421 Medical Debt Relief Act of 2009, a bill to exclude from consumer credit reports medical debt that has been in collection and has been fully paid or settled; HR 3472 a bill to provide for health insurance coverage premium discounts for healthy behavior and improvements toward healthy behavior; HR 3483 Steps Toward Access and Reform (STAR) Act of 2009, a bill to reform the medical liability system, improve access to health care for rural and indigent patients, enhance access to affordable prescription drugs, and for other purposes S 1572, a bill to provide for a point of order against any legislation that eliminates or reduces the ability of Americans to keep their health plan or their choice of doctor or that decreases the number of Americans enrolled in private health insurance, while increasing the number of Americans enrolled in government-managed health care; S 1679 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; HR 3652 Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009, a bill to amend the Public Health Service Act and title XVIII of the Social Security Act to make the provision of technical services for medical imaging examinations and radiation therapy treatments safer, more accurate, and less costly; S 1720 Health Professions and Primary Care Reinvestment Act, a bill to amend title VII of the Public Health Service Act to provide improved training and primary care; HR 3664 Healthcare Innovation Zone Pilot Act of 2009, a bill to direct the Secretary of Health and Human Services to establish a Healthcare Innovation Zone pilot program; S 1730 Fairness in Health Insurance Act, a bill to provide for minimum loss ratios for health insurance coverage; S 1734 Medical Liability Reform Act of 2009, a bill to reduce the cost of health care and ensure patient access to doctors by ending excessive malpractice verdicts through common-sense lawsuit reform; Senate Finance Committee Americas Healthy Future Act of 2009, Senate Finance Committee health reform bill with provisions on coverage, disease prevention and wellness, delivery system reform, health care quality and efficiency, transparency and program integrity, and financing; Meeting with FTC, senate congressional staff re barriers to clinical integration; HR 3590 Patient Protection and Affordable Care Act, the merged product of the health reform bills from the Senate Finance and Health, Education, Labor and Pensions (HELP) committees; HR 3962 Affordable Health Care for America Act, a bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes; HR 3700 Health Care Bill of Rights Act, a bill to establish requirements for any health reform legislation enacted by the Congress or the President during the 111th Congress; HR 3713 American Health Care Solutions Act of 2009, a bill to provide bipartisan solutions to lower health costs, increase access to affordable coverage, and give patients more choices and control; S 1742 Women's Hospitals Education Equity Act, a bill to amend the Public Health Service Act to provide assistance for graduate medical education funding for women's hospitals; Comments to CMS proposed rule defining meaningful use of electronic Health Records concern that the rules will severely limit hospitals' ability to access federal financing for health information technology and put many hospitals at risk for Medicare payment penalties beginning in 2015; FDA Grants Hospitals 18 Months to Replace Steris System 1 Processor; HR 4626 Health Insurance Industry Fair Competition Act, to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; HR 4851 Continuing Extension Act of 2010, to provide a temporary extension of certain programs; Meetings with CMS and HHS to encourage reimbursement under the National Disaster Medical System for hospitals that provided services to victims of the Haitian earthquake; HR 4700 The Transparency in All Health Care Pricing Act of 2010, to provide for transparency in health care pricing; HR 4803 The Patients Right to Know Act, to ensure health care consumer and provider access to certain health benefits plan information and to amend title XIX of the Social Security Act to provide transparency in hospital price and quality information; HR 6072 and S 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010, to amend titles XVIII and XIX of the Social Security Act to clarify the application of EHR payment incentives in cases of multi-campus hospitals; HR 6376 to amend title XVIII of the Social Security Act with respect to physician supervision of therapeutic hospital outpatient services

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

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

Requested congressional funding support for Geisinger biobank expansion and electronic ICU project. Requested no funding cuts to NCCCP NIH community cancer program. Urged moderation of IPPS "coding offset" in IPPS rule and support for legislation (HR 6072 & S 3708) for EHR "multi-campus" issue. Submitted written comments on FCC rural broadband grant. Discussed with Beacon Community Grant leadership future opportunities for Geisinger HIT involvement.

Client expense: $25,358 · Firm income: Not reported

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

H.R.914, Physician Workforce Enhancement Act of 2009, Physician workforce related issues. H.R.1468, Medical Justice Act of 2009, Medical liability related issues. H.R.936/S.733, National Trauma Center Stabilization Act of 2009, Emergency readiness and trauma related issues. General monitoring on Not-for-profit hospitals charity care and community benefits. S.391, Healthy Americans Act, Health care reform. H.R.193, AmeriCare Health Insurance Act of 2009, Health care reform. H.R.2251/S.973, Resident Physician Shortage Reduction Act of 2009, Physician workforce related issues. Health care reform, Hospital related issues and initiatives. S.1640, Take Back Your Health Act of 2009, Hospital related issues and initiatives. Public Law 110-343, Patient Protection and Affordable Care Act, Hospital related issues and initiatives. Public Law 111-148, The Patient Protection and Affordable Care Act, Hospital related issues and initiatives. Public Law 111-152, Health Care and Education Reconciliation Act of 2010, Hospital related issues and initiatives. H.R.4213, American Jobs and Closing Tax Loopholes Act of 2010, Medicare payment related issues; and Build America Bonds program issues. H.R.6005, Ensuring Equality fo rearly EHR Adoption Act, Hospital Information Technology issues. S.3708/H.R.6072, Electronic Health Record Incentives for Multi Campus Hospitals Act, Hospital Information Technology issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4213 American Workers, State, and Business Relief Act of 2010 House Substitute Amendment to H.R. 4213 Senate Amendment to House Substitute Amendment to H.R. 4213 H.R. 3962 Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 IPPS FY 2011 Proposed and Final Rules Medicare and Medicaid Electronic Health Reform Incentive Program Proposed and Final Reguations P.L 148 Patient Protection and Affordable Care Act P.L. 152 Health Care and Education Reconciliation Act H.R. 6072 and S. 3708 Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010

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), SENATE

HR 4213 Anerican Workers, State, and Business Relief Act of 2010 House Substitute Amendment to HR 4213 Senate Amendment to House Subsitute Amendment to HR 4213 HR 3962 Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 IPPS FY 2011 Proposed Rule IPPS FY 2011 Final Rule Meaningful Use of Electronic Medical Records Rule PL 148 Patient Protection and Affordable Care Act PL 152 Health Care and Education Reconciliation Act HR 6072 S 3708

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 4213 Anerican Workers, State, and Business Relief Act of 2010 House Substitute Amendment to HR 4213 Senate Amendment to House Subsitute Amendment to HR 4213 HR 3962 Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 IPPS FY 2011 Proposed Rule IPPS FY 2011 Final Rule Meaningful Use of Electronic Medical Records Rule PL 148 Patient Protection and Affordable Care Act PL 152 Health Care and Education Reconciliation Act HR 6072 S 3708

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE