Empowered at Home Act of 2009

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

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

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

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

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

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

- Systemic Risk Regulator - Insurance Regulation - Office of Insurance Information - HR 1721/ S 697, "A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance" a/k/a "Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - S 434, "A bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes" a/k/a "Empowered at Home Act", regarding all provisions. - HR 897, "To amend the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long-term care needs" a/k/a "Long-Term Care and Retirement Security Act of 2009", regarding all provisions. - HR 1880, "To establish a system of regulation and supervision for insurers, insurance agencies, and insurance producers chartered or licensed under Federal law that ensures the stability and financial integrity of those insurers, agencies, and producers and that protects policyholders and other consumers served by such insurers, agencies, or producers", a/k/a "The National Insurance Consumer Protection Act", regarding all provisions. - HR 2609, "To establish an Office of Insurance Information in the Department of the Treasury", a/k/a "Insurance Information Act of 2009", regarding all provisions. -HR 2554, "To reform the National Association of Registered Agents and Brokers, and for other purposes", regarding all provisions. - HR 1721/S 697, "A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes", a/k/a "Community Living Assistance Services and Supports Act", regarding all provisions. - S 1177, "A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes", a/k/a "Long-Term Care Insurance Act of 2009", regarding all provisions. - HR 2096, "To amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance", a/k/a "The Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - The Administration's Regulatory Reform Proposal, regarding all provisions. - HR 4173, "To provide for financial regulatory reform, to protect consumers and investors, to enhance Federal understanding of insurance issues, to regulate the over-the-counter derivatives markets, and for other purposes", a/k/a "Wall Street Reform & Consumer Protection Act of 2009", regarding Title VI and Title I Subtitle G. - HR 3126, "To establish the Consumer Financial Protection Agency, and for other purposes", a/k/a, "Consumer Financial Protection Agency Act of 2009", regarding all provisions. - "Restoring American Financial Stability Act", regarding all provisions.

Client expense: $1,240,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), U.S. Trade Representative (USTR)

S. 683 and H.R. 1670, Community Choice Act, provisions providing independence for individuals with disabilities, and the Community First Choice Option proposal for Medicaid. P.L. 109-171, implementation of the Deficit ReductionAct, provisions dealing with Medicaid. H.R. 868, Direct Support Professionals Fairness and Security Act. Implementation of Medicaid Section 1917 (d) regarding trusts and transfer of asset rules. The Empowered at Home Act of 2009, H.R. 2688 and S. 434, to amend the Medicaid Section 1915 (i) Home and Community Based Services Option. Implementation of the Olmstead decision regarding community integration. Health Care Reform, including numerous long term services and supports provisions. Federal Medical Assistance Percentage (FMAP increase. S. 493 and H.R. 1205, Achieving a Better Life Experience Act of 2009. Home and Community Based Services Waiver (Section 1915(c)) and Option (Section 1915 (i)).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Election Assistance Commission (EAC), Equal Employment Opportunity Commission (EEOC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), President of the U.S., SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office

**see addendum page H.R. 3590 - The Patient Protection and Affordable Care Act, care coordination, long-term care H.R. 4872 - The Health Care and Education Affordability Reconciliation Act of 2010, care coordination, long-term care S. 434 - Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and cummunity based services under the Medicaid Program, and for other purposes.

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

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

Lobbied for introduction of legislation that would end the age cap in the earned income tax credit. (no bill) Discussed Auto-IRA, a bill that would require an automatic workplace retirement savings plan for an estimated 50 million employees; legislation that would end the age cap in the earned income tax credit; legislation that would expand the savers credit so that more modest income individuals can benefit from it; and on the inappropriate application of withholding tables that implement Make Work Pay to pension and other retirement income. (no bill) Discussed income weatherization; modernizing the poverty measure; and modernizing the asset tests that are used to determine eligibility for federal benefits. (no bill) Discussed tax assistance funding. (no bill) S. 434, Empowerment at Home Act (includes caregiver tax credit) - Discussed tax credits for caregivers. H.R.1159 - To amend the Internal Revenue code of 1989 to provide special rules for investments lost in a fraudulent Ponzi-type scheme. Discussed legislation to grant tax relief to victims of Ponzi-type schemes. H.R. 4213, the Tax Extenders Act of 2009 - Advocated for the adoption of the Sanders Amendment (S.AMDT.3353) to provide an emergency benefit of $250 to seniors, veterans and persons with disabilities in 2010 to compensate for the lact of cost-of-living adjustment for such year. H.R. 4849, the Small Business and Infrastructure Jobs Tax Act of 2010 - Discussed the potential inclusion of 401(k) fee disclosure and pension funding relief provisions within the bill. Ultimately, these provisions were not included in the legislation.

Client expense: $3,970,000 · Firm income: Not reported

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

S.330/H.R.684, Medicare Prescription Drug Savings and Choice Act of 2009 - Discussed legislation which would create a government-operated Medicare prescription drug plan. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). S.683/H.R.1670, Community Choice Act - Supported Community First Choice Option version of this legislation in health care reform. S.245/H.R. 468/S.434/H.R.2688, Retooling the Health Care Workforce for an Aging America Act and possible amendments, in healthcare reform, including Family Caregiving provisions. S.113/H.R.2560, Empowered at Home Act and the Independence at Home Act - Discussed long-term care and chronic care legislation that AARP endorsed and provisions included in health reform legislation. S.631/H.R.2223, Patient Safety and Abuse Prevention Act - Support for legislation in healthcare reform on criminal background checks for employees of long-term care providers and specific bill provisions. S. 697/H.R.1721, Class Act - Discussed provisions of CLASS in House and Senate health reform bills and urged inclusion of CLASS in Senate and House HCR legislation. S.1131/H.R.2560 Independence at Home Act - Discussed AARP's support for this Medicare care coordination bill; and it's inclusion in health reform legislation. Discussed healthcare coverage for the 50-64 year old population, age rating, and closing the doughnut hole. S.1133/H.R. 2580, Empowering Medicare Patient Choices Act - Discussed legislation that would promote patient decision aids to help people make informed, evidence-based decisions about health care treatment options. H.R. 2773/S 1295, Medicare Transitional Care Act of 2009 - Discussed legislation that would reduce unnecessary hospital readmissions, improve quality for Medicare beneficiaries, and reduce wasteful spending in Medicare; worked to incorporate bill and its elements into health reform legislation. S. 960, Medicare Early Access Act of 2009 - Support for legislation to let Americans aged 55-64 who are otherwise without access to group or public coverage buy into Medicare. H.R. 2700, Prescription Coverage Now Act of 2009 - Discussed legislation that would assist low-invome individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. S. 1185, Medicare Financial Stability for Beneficiaries Act of 2009 - Discussed legislation that would ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs. H.R. 2716, Medicare Savings Program Improvement Act of 2009 - Discussed legislation that would provide financial stability for older Americans and people with disabilities through improvements in the Medicare Savings Program. Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population (no bill). S.750 Caring for an Aging America Act - Discussed as possible amendment to health reform bill. S.1257/H.R.2852 Project 2020: Building the Promise of Home and Community Based Services Act - Lobbied in support of legislation. Discussed ideas to improve medicare for medicare beneficiaries. (no bill) Discussed Medicare physician payment issues and SGR. (no bill) S. 2128, Prevent Healthcare Fraud Act - Discussed Medicare Fraud. Discussed idea of an annual physical for Medicare beneficiaries (no bill). S.1009 Medicare Care Transitions Program Act - Discussed provisions of Medicare Care Transitions Program Act. S.975 Seniors and Taxpayers Obligation and Protection Act - Lobbied in support of legislation. S.1256 Home and Community Balanced Incentives Act - Discussed inclusion of this legislation in health reform legislation and advocated for amendment in Senate healthcare reform legislation. H.R. 3631, Medicare Premium Fairness Act - Lobbied to pass legislation to allow premiums for Medicare Part B to remain at 2009 levels for all beneficiaries. S. 2926, the Economic Fairness for Seniors Act - Discussed the implications of legislation to provide $250 in economic relief to seniors, veterans and the disabled in response to the lack of a COLA in 2010; allow Medicare Part B premiums to remain at 2009 levels for all beneficiaries and to study the use of a new Consumer Price Index for use in calculating future Social Security COLAs. H.R. 3590, Patient Protection and Affordable Care Act - Lobbied in support of health care legislation that would reform the health care system to provide affordable quality health care, reduce drug costs and expand access to long-term services and supports. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of health care legislation to make improvements in the Patient Protection and Affordable Care Act. H.R. 3200 America's Affordable Health Choices Act/S. 1679, Americas Health Choices Act/ S.1796, America's Healthy Future Act - Discussed need for affordable quality healthcare, delivery system reform, ending age discrimination in the health insurance industry, "ending rating by health condition or any proxy," closing the doughnut hole, creating a pathway for generic biologics, allowing and funding states to provide home and community based services, creating a transitional benefit in medicare and expanding the asset limit to qualify for low-income programs in medicare, and modifying medicare advantage. House Amendment to Senate Amendment to H.R. 2847 "Jobs for Main Street Act" - Discussed redirection of some TARP funds to extend unemployment insurance and COBRA eligibility and FMAP assistance to state governments.

Client expense: $3,970,000 · Firm income: Not reported

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

Lobbied for introduction of legislation that would end the age cap in the earned income tax credit. (no bill) Discussed Auto-IRA, a bill that would require an automatic workplace retirement savings plan for an estimated 50 million employees; legislation that would end the age cap in the earned income tax credit; legislation that would expand the savers credit so that more modest income individuals can benefit from it; and on the inappropriate application of withholding tables that implement Make Work Pay to pension and other retirement income. (no bill) Discussed income weatherization; modernizing the poverty measure; and modernizing the asset tests that are used to determine eligibility for federal benefits. (no bill) Discussed tax assistance funding. (no bill) S. 434, Empowerment at Home Act (includes caregiver tax credit) - Discussed tax credits for caregivers. H.R.1159 - To amend the Internal Revenue code of 1989 to provide special rules for investments lost in a fraudulent Ponzi-type scheme. Discussed legislation to grant tax relief to victims of Ponzi-type schemes. H.R. 4213, the Tax Extenders Act of 2009 - Advocated for the adoption of the Sanders Amendment (S.AMDT.3353) to provide an emergency benefit of $250 to seniors, veterans and persons with disabilities in 2010 to compensate for the lact of cost-of-living adjustment for such year. H.R. 4849, the Small Business and Infrastructure Jobs Tax Act of 2010 - Discussed the potential inclusion of 401(k) fee disclosure and pension funding relief provisions within the bill. Ultimately, these provisions were not included in the legislation.

Client expense: $3,970,000 · Firm income: Not reported

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

S.330/H.R.684, Medicare Prescription Drug Savings and Choice Act of 2009 - Discussed legislation which would create a government-operated Medicare prescription drug plan. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). S.683/H.R.1670, Community Choice Act - Supported Community First Choice Option version of this legislation in health care reform. S.245/H.R. 468/S.434/H.R.2688, Retooling the Health Care Workforce for an Aging America Act and possible amendments, in healthcare reform, including Family Caregiving provisions. S.113/H.R.2560, Empowered at Home Act and the Independence at Home Act - Discussed long-term care and chronic care legislation that AARP endorsed and provisions included in health reform legislation. S.631/H.R.2223, Patient Safety and Abuse Prevention Act - Support for legislation in healthcare reform on criminal background checks for employees of long-term care providers and specific bill provisions. S. 697/H.R.1721, Class Act - Discussed provisions of CLASS in House and Senate health reform bills and urged inclusion of CLASS in Senate and House HCR legislation. S.1131/H.R.2560 Independence at Home Act - Discussed AARP's support for this Medicare care coordination bill; and it's inclusion in health reform legislation. Discussed healthcare coverage for the 50-64 year old population, age rating, and closing the doughnut hole. S.1133/H.R. 2580, Empowering Medicare Patient Choices Act - Discussed legislation that would promote patient decision aids to help people make informed, evidence-based decisions about health care treatment options. H.R. 2773/S 1295, Medicare Transitional Care Act of 2009 - Discussed legislation that would reduce unnecessary hospital readmissions, improve quality for Medicare beneficiaries, and reduce wasteful spending in Medicare; worked to incorporate bill and its elements into health reform legislation. S. 960, Medicare Early Access Act of 2009 - Support for legislation to let Americans aged 55-64 who are otherwise without access to group or public coverage buy into Medicare. H.R. 2700, Prescription Coverage Now Act of 2009 - Discussed legislation that would assist low-invome individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. S. 1185, Medicare Financial Stability for Beneficiaries Act of 2009 - Discussed legislation that would ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs. H.R. 2716, Medicare Savings Program Improvement Act of 2009 - Discussed legislation that would provide financial stability for older Americans and people with disabilities through improvements in the Medicare Savings Program. Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population (no bill). S.750 Caring for an Aging America Act - Discussed as possible amendment to health reform bill. S.1257/H.R.2852 Project 2020: Building the Promise of Home and Community Based Services Act - Lobbied in support of legislation. Discussed ideas to improve medicare for medicare beneficiaries. (no bill) Discussed Medicare physician payment issues and SGR. (no bill) S. 2128, Prevent Healthcare Fraud Act - Discussed Medicare Fraud. Discussed idea of an annual physical for Medicare beneficiaries (no bill). S.1009 Medicare Care Transitions Program Act - Discussed provisions of Medicare Care Transitions Program Act. S.975 Seniors and Taxpayers Obligation and Protection Act - Lobbied in support of legislation. S.1256 Home and Community Balanced Incentives Act - Discussed inclusion of this legislation in health reform legislation and advocated for amendment in Senate healthcare reform legislation. H.R. 3631, Medicare Premium Fairness Act - Lobbied to pass legislation to allow premiums for Medicare Part B to remain at 2009 levels for all beneficiaries. S. 2926, the Economic Fairness for Seniors Act - Discussed the implications of legislation to provide $250 in economic relief to seniors, veterans and the disabled in response to the lack of a COLA in 2010; allow Medicare Part B premiums to remain at 2009 levels for all beneficiaries and to study the use of a new Consumer Price Index for use in calculating future Social Security COLAs. H.R. 3590, Patient Protection and Affordable Care Act - Lobbied in support of health care legislation that would reform the health care system to provide affordable quality health care, reduce drug costs and expand access to long-term services and supports. H.R. 4872, Health Care and Education Reconciliation Act - Lobbied in support of health care legislation to make improvements in the Patient Protection and Affordable Care Act. H.R. 3200 America's Affordable Health Choices Act/S. 1679, Americas Health Choices Act/ S.1796, America's Healthy Future Act - Discussed need for affordable quality healthcare, delivery system reform, ending age discrimination in the health insurance industry, "ending rating by health condition or any proxy," closing the doughnut hole, creating a pathway for generic biologics, allowing and funding states to provide home and community based services, creating a transitional benefit in medicare and expanding the asset limit to qualify for low-income programs in medicare, and modifying medicare advantage. House Amendment to Senate Amendment to H.R. 2847 "Jobs for Main Street Act" - Discussed redirection of some TARP funds to extend unemployment insurance and COBRA eligibility and FMAP assistance to state governments.

Client expense: $3,970,000 · Firm income: Not reported

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

Medicare/Part B Premium Hold Harmless. H.R. 3631: Provisions extending the current "hold harmless" policy to all Medicare enrollees to ensure 2010 Part B monthly premiums remain at the current rate. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590: provisions related to reducing Medicare Advantage plan payments, reducing the coverage gap in Part D, requiring wealthier Medicare beneficiaries to pay a greater share of the cost of their premiums under Medicare Parts B and D, permitting the Department of Health and Human Services to negotiate drug prices for the Part D program, simplifying plan benefit designs under Part C, expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS), improving the process for reassigning LIS beneficiaries to new plans, expanding coverage of prevention services establishing a Medicare Commission, providing expanded Medicaid coverage for home and community-based services, expanding Medicaid coverage of attendant and other home services and supports, establishing a new national insurance program for long-term supports and services, authorizing funding to provide language services to limited English proficiency beneficiaries, authorizing the collection of data regarding disparities in the provision of care, providing safeguards and subsidies to assure affordability of health coverage for seniors, preserving state benefit laws and requirements, reducing permitted age rating ratio for insurance premiums, inclusion of patient-centered quality reporting requirements for providers, creating new claims reviews processes and provider certification, requiring reporting by practitioners of gifts received from pharmaceutical and medical device manufacturers. Medicare/Commission. P.L. 111-148, P.L. 111-152, H.R. 4872: creating an independent commission authorized to establish Medicare payment and policy designed to reduce Medicare spending growth. Medicare/Prescription Drug Plan. S. 330, H.R. 684: authorizing the establishment of a Medicare-operated prescription drug plan; S. 266: authorizing the Secretary of Health and Human Services to negotiate lower prescription drug prices. Medicare/Part D Generics. S. 75: requiring the use of generics where available unless the brand name drug is determined to be medically necessary. Medicare/Part D cost-sharing. S. 1630: establishing limits on required beneficiary cost-sharing under Part D drug plans. Medicare/Part D dual eligibles. P.L. 111-148, P.L. 111-152, H.R. 4872, S. 1634: removing enrollment barriers for low-income beneficiaries and establishing a Medicare-operated prescription drug plan. Medicare/Combating Waste, Fraud, Abuse. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 27: relating to provisions to combat waste, fraud, and abuse within Medicare; H.R. 203: increasing civil and criminal penalties for acts involving fraud and abuse and increasing the surety bond amount for suppliers of durable medical equipment. Medicare/Therapy Caps. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, H.R. 43, S. 46: repealing or extending exceptions to outpatient rehabilitation therapy caps. Medicare/Private Contracts. H.R. 164: prohibiting denial of Social Security benefits to persons who elect not to participate in Medicare. Medicare/Hearing Coverage. H.R. 504: authorizing coverage of hearing aids and auditory rehabilitation services under Medicare Part B. Medicare/Dental Coverage. H.R. 870: authorizing coverage under Part B for medically necessary dental procedures. Medicare/Rural Improvements. H.R. 902/S. 382: provision authorizing improvements to services provided to beneficiaries residing in rural areas. Medicare/Shingles Vaccine. H.R. 1038: extending Part B coverage to the shingles vaccine. Medicare/Home Health. H.R. 1094: authorizing home health care agencies to assign the most appropriate skilled service to make the initial assessment visit under a Medicare home health plan of care for rehabilitation services. Medicare/Health Care Vouchers. H.R. 1118: authorizing Medicare-eligible seniors to elect to receive vouchers for a health savings account, premiums for a high deductible health insurance plan, or both, in lieu of regular Medicare benefits and suspending Medicare late enrollment penalties between ages 65 and 70. Medicare/Skilled Nursing Facilities. H.R. 1125, S. 647: provisions related to requiring the reporting of expenditures for nursing services at skilled nursing facilities and requiring disclosure of corporate ownership. Medicare/Prevention. H.R. 1213: provisions authorizing ultrasound screening for abdominal aortic aneurysms to at-risk Medicare beneficiaries between the ages of 65 and 75 without the requirement of a prior initial preventive physical examination; H.R. 1894, S. 769: expanding access to bone mass measurement benefits under Part B. Medicare/Part B Drug Payments. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, H.R. 1392: relating to appropriate Part B payment amounts for drugs and biologicals. Medicare/Low Income Prescription Drug Benefits. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, H.R. 1407, S. 534: authorizing a reduction in cost-sharing under Part D for non-institutionalized, full-benefit dual eligible individuals. Medicare/Disability Benefits. S. 700, H.R. 1708, H.R. 2881: phasing-out the 24-month waiting period for disabled individuals to become eligible for Medicare benefits and eliminating the waiting period for individuals with life-threatening conditions. Medicare/Prescription Drugs for kidney transplants. H.R. 1458, S. 565: provision related to continued coverage for immunosuppressive drugs furnished to beneficiaries that have received kidney transplants and whose entitlement to coverage would otherwise expire. Medicare/Intravenous Drugs. H.R. 1765, S.701: relating to the payment for intravenous immune globulin (IVIG) for the treatment of primary immune deficiency diseases in a patient's home and for certain disposable pumps as durable medical equipment in place of non-disposable pumps. Medicare/Home Infusion Therapy. H.R. 574, S.254: extending Medicare coverage to home infusion therapy. Medicare/Physical Therapy Services. H.R. 1829: authorizing physical therapists to evaluate and treat Medicare beneficiaries without physician referral. Medicare/Part D Premiums. H.R. 1832: limiting Part D premium increases to no more than the Social Security cost-of-living adjustment and requiring the Secretary of Health and Human Services to negotiate lower prescription drug prices. Medicare/Cancer Hospice and Palliative Care. H.R. 1844: provisions authorizing coverage of comprehensive cancer care planning, establishing a Medicare hospice care demonstration, and authorizing grant programs for cancer palliative care and symptom management, provider education, and related research. Medicare/Hospice and Advanced Care Planning. S. 1150, H.R. 2911: provisions related to changing hospice payments and providing advance care planning resources. Medicare/Physician-Manufacturer Transparency. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, S. 301: increasing the transparency of the relationship between physicians and the manufacturers of drugs, devices, biologicals, and medical supplies. Medicare/Care Coordination Services. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, S. 1131, H.R. 2560: provisions establishing pilot care coordination programs. Medicaid/Home and Community-based Long Term Care. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, S. 434, S.1257, H.R. 28552: provisions to remove barriers to providing home and community-based services including providing a state option to provide home and community-based services to individuals for whom such services are likely to prevent, delay, or decrease the likelihood of an individual's need for institutionalized care and authorizing the implementation of assistance grants for states electing to provide home and community-based services under Medicaid; provisions to provide a single point of entry to long term services; provisions to support nursing home diversion programs. Medicaid/Community-based Attendant Services and Supports. P.L. 111-148, P.L. 111-152, H.R. 4872, H.R. 3590, S. 683, H.R. 1670: authorizing coverage of community-based attendant services and supports under Medicaid, increasing funding and establishing a demonstration program for beneficiaries dually eligible for Medicare and Medicaid. P.L. 110-275, P.L. 108-173: implementation of regulations and guidance relating to beneficiary eligibility, enrollment, and effectiveness of exceptions and appeals processes under Medicare Parts C and D.

Client expense: $350,000 · Firm income: Not reported

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

- Systemic Risk Regulator - Insurance Regulation - Office of Insurance Information - HR 1721/ S 697, "A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance" a/k/a "Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - S 434, "A bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes" a/k/a "Empowered at Home Act", regarding all provisions. - HR 897, "To amend the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long-term care needs" a/k/a "Long-Term Care and Retirement Security Act of 2009", regarding all provisions. - HR 1880, "To establish a system of regulation and supervision for insurers, insurance agencies, and insurance producers chartered or licensed under Federal law that ensures the stability and financial integrity of those insurers, agencies, and producers and that protects policyholders and other consumers served by such insurers, agencies, or producers", a/k/a "The National Insurance Consumer Protection Act", regarding all provisions. - HR 2609, "To establish an Office of Insurance Information in the Department of the Treasury", a/k/a "Insurance Information Act of 2009", regarding all provisions. -HR 2554, "To reform the National Association of Registered Agents and Brokers, and for other purposes", regarding all provisions. - HR 1721/S 697, "A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes", a/k/a "Community Living Assistance Services and Supports Act", regarding all provisions. - S 1177, "A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes", a/k/a "Long-Term Care Insurance Act of 2009", regarding all provisions. - HR 2096, "To amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance", a/k/a "The Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - The Administration's Regulatory Reform Proposal, regarding all provisions. - HR 4173, "To provide for financial regulatory reform, to protect consumers and investors, to enhance Federal understanding of insurance issues, to regulate the over-the-counter derivatives markets, and for other purposes", a/k/a "Wall Street Reform & Consumer Protection Act of 2009", regarding Title VI and Title I Subtitle G. - HR 3126, "To establish the Consumer Financial Protection Agency, and for other purposes", a/k/a, "Consumer Financial Protection Agency Act of 2009", regarding all provisions. - "Restoring American Financial Stability Act of 2009", regarding all provisions (Bill not yet introduced).

Client expense: $1,210,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), U.S. Trade Representative (USTR)

S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 1988 Conflicted Investment Advice Prohibition Act of 2009. Issue: Investment Advice. H.R.1984 - 401(k) Fair Disclosure for Retirement Security Act of 2009. Issue: Retirement plan fee disclosure. H.R. 2989 401 (K) Fair Disclosure and Pension Security Act of 2009. Issue: Retirement Plan Fee Disclosure S. 697/ HR 1721 Community Living Assistance Services and Supports Act. Issue: reform of LTC financing. H.R. 897 The Long Term Care and Retirement Security Act of 2009. Issue: LTC in cafeteria and FSA and above the line deductions for LTC premiums. S. 434 Empowered at Home Act of 2009. Issue: Allows above the line tax deduction for LTC premiums. Allows LTC to be offered in cafeteria/ FSA plans. S. 391 Healthy Americans Act. Issue: private health insurance including LTC. H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit S. 401 - Defined Contribution Fee Disclosure Act Issue: 401(k) fee disclosure H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2792 Retirement Savings Transparency Act. Issue: Plan fee disclosure. H.R. 2733/S. 1389 Fixed Indexed Annuities and Insurance Products Classification Act of 2009. Issue: Clarify exemption for fixed indexed annuities. S 702/ HR 2096 Long Term Care Affordability and Security Act of 2009. Issue: allows long term care insurance to be offered in employer sponsored cafeteria plans and FSA. S. 1679, Affordable Health Choices Act. Issue: Long Term Care financing with in health reform. S. 1177 Confidence in Long Term Care Insurance Act of 2009. Issue: Consumer protection for long term care. H.R. 3200: Americas Affordable Health Choices Act of 2009. Issue: Long Term Care financing within health reform. S. _______: Americas Healthy Future Act. Issue: Long Term Care financing within heath reform. No bill number yet. S. 1226: Long Term Care Insurance Integrity Act of 2009. Issue: Long Term Care. S. 1636 Long Term Care Insurance Consumer Right-To-Know Act of 2009. Issue: Long Term Care consumer protections. S. 1661/S. 906/H.R. 3551 Senior Investment Protection Act of 2009. Issue: Suitability in insurance product sales to seniors and the sale of annuities. H.R. 2779 Defined Contribution Plan Fee Transparency Act of 2009. Issue: 401(k) Plan Fee Disclosure.

Client expense: $1,760,318 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 1988 Conflicted Investment Advice Prohibition Act of 2009. Issue: Investment Advice. H.R.1984 - 401(k) Fair Disclosure for Retirement Security Act of 2009. Issue: Retirement plan fee disclosure. H.R. 2989 401 (K) Fair Disclosure and Pension Security Act of 2009. Issue: Retirement Plan Fee Disclosure S. 697/ HR 1721 Community Living Assistance Services and Supports Act. Issue: reform of LTC financing. H.R. 897 The Long Term Care and Retirement Security Act of 2009. Issue: LTC in cafeteria and FSA and above the line deductions for LTC premiums. S. 434 Empowered at Home Act of 2009. Issue: Allows above the line tax deduction for LTC premiums. Allows LTC to be offered in cafeteria/ FSA plans. S. 391 Healthy Americans Act. Issue: private health insurance including LTC. H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit S. 401 - Defined Contribution Fee Disclosure Act Issue: 401(k) fee disclosure H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2792 Retirement Savings Transparency Act. Issue: Plan fee disclosure. H.R. 2733/S. 1389 Fixed Indexed Annuities and Insurance Products Classification Act of 2009. Issue: Clarify exemption for fixed indexed annuities. S 702/ HR 2096 Long Term Care Affordability and Security Act of 2009. Issue: allows long term care insurance to be offered in employer sponsored cafeteria plans and FSA. S. 1679, Affordable Health Choices Act. Issue: Long Term Care financing with in health reform. S. 1177 Confidence in Long Term Care Insurance Act of 2009. Issue: Consumer protection for long term care. H.R. 3200: Americas Affordable Health Choices Act of 2009. Issue: Long Term Care financing within health reform. S. _______: Americas Healthy Future Act. Issue: Long Term Care financing within heath reform. No bill number yet. S. 1226: Long Term Care Insurance Integrity Act of 2009. Issue: Long Term Care. S. 1636 Long Term Care Insurance Consumer Right-To-Know Act of 2009. Issue: Long Term Care consumer protections. S. 1661/S. 906/H.R. 3551 Senior Investment Protection Act of 2009. Issue: Suitability in insurance product sales to seniors and the sale of annuities. H.R. 2779 Defined Contribution Plan Fee Transparency Act of 2009. Issue: 401(k) Plan Fee Disclosure. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. H. R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H. R. 4173 Wall Street Reform and Consumer Protection Act. Issue: Exclusion of retirement plans from CFPA and suitability in insurance product sales to seniors and sales of annuities. H.R. 3590-The Patient Protection and Affordable Care Act. Issue: Long Term Care financing within heath reform.

Client expense: $1,908,166 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 1988 Conflicted Investment Advice Prohibition Act of 2009. Issue: Investment Advice. H.R.1984 - 401(k) Fair Disclosure for Retirement Security Act of 2009. Issue: Retirement plan fee disclosure. H.R. 2989 401 (K) Fair Disclosure and Pension Security Act of 2009. Issue: Retirement Plan Fee Disclosure S. 697/ HR 1721 Community Living Assistance Services and Supports Act. Issue: reform of LTC financing. H.R. 897 The Long Term Care and Retirement Security Act of 2009. Issue: LTC in cafeteria and FSA and above the line deductions for LTC premiums. S. 434 Empowered at Home Act of 2009. Issue: Allows above the line tax deduction for LTC premiums. Allows LTC to be offered in cafeteria/ FSA plans. S. 391 Healthy Americans Act. Issue: private health insurance including LTC. H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit S. 401 - Defined Contribution Fee Disclosure Act Issue: 401(k) fee disclosure H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2792 Retirement Savings Transparency Act. Issue: Plan fee disclosure. H.R. 2733/S. 1389 Fixed Indexed Annuities and Insurance Products Classification Act of 2009. Issue: Clarify exemption for fixed indexed annuities. S 702/ HR 2096 Long Term Care Affordability and Security Act of 2009. Issue: allows long term care insurance to be offered in employer sponsored cafeteria plans and FSA. S. 1679, Affordable Health Choices Act. Issue: Long Term Care financing with in health reform. S. 1177 Confidence in Long Term Care Insurance Act of 2009. Issue: Consumer protection for long term care. H.R. 3200: Americas Affordable Health Choices Act of 2009. Issue: Long Term Care financing within health reform. S. _______: Americas Healthy Future Act. Issue: Long Term Care financing within heath reform. No bill number yet. S. 1226: Long Term Care Insurance Integrity Act of 2009. Issue: Long Term Care. S. 1636 Long Term Care Insurance Consumer Right-To-Know Act of 2009. Issue: Long Term Care consumer protections. S. 1661/S. 906/H.R. 3551 Senior Investment Protection Act of 2009. Issue: Suitability in insurance product sales to seniors and the sale of annuities. H.R. 2779 Defined Contribution Plan Fee Transparency Act of 2009. Issue: 401(k) Plan Fee Disclosure. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. H. R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H. R. 4173 Wall Street Reform and Consumer Protection Act. Issue: Exclusion of retirement plans from CFPA and suitability in insurance product sales to seniors and sales of annuities. H.R. 3590-The Patient Protection and Affordable Care Act. Issue: Long Term Care financing within heath reform.

Client expense: $1,908,166 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

H.R. 83 - Homeowners Insurance Protection Act of 2009; entire bill H.R. 1264 - Multiple Peril Insurance Act of 2009; provisions relating to NFIP and wind coverage H.R. 1583 - Insurance Industry Competition Act of 2009; entire bill H.R. 1880 - National Insurance Consumer Protection Act; entire bill H.R. 2554 - National Association of Registered Agents and Brokers (NARAB) Reform; entire bill H.R. 2555 - Homeowners Defense Act; entire bill H.R. 2609 Federal Insurance Office Act of 2009; entire bill H.R. 3059 - Access to Repair Parts Act; entire bill H.R. 3139 - National Flood Insurance Program Extension Act of 2009; entire bill H.R. 3326 Department of Defense Appropriations Act, 2010; provisions relating to national flood insurance program extension, COBRA, and unemployment coverage S. 434 - Empowered at Home Act of 2009; entire bill S. 702 - Long-Term Care Affordability and Security Act of 2009; entire bill S. 1177 - Confidence in Long-Term Care Insurance Act of 2009; entire bill S. 1368 Access to Repair Parts Act; entire bill

Client expense: $440,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

H.R. 519: ELDER CAREGIVER SUPPORT AND INFORMATION ENHANCEMENT ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE APPROPRIATIONS FOR LONG TERM CARE INFORMATION CLEARINGHOUSE H.R. 897: LONG TERM CARE AND RETIREMENT SECURITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE IN CAFETERIA PLANS AND FLEXIBLE SPENDING ARRANGEMENTS, AND ABOVE THE LINE DEDUCTIONS FOR LONG TERM CARE PREMIUMS HR 1721/S. 697: COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS ACT; PROVISIONS RELATED TO REFORM OF LONG TERM CARE FINANCING H.R. 1961: SAVINGS FOR AMERICAN FAMILIES FUTURE ACT OF 2009; PROVISIONS RELATED TO SAVERS' CREDIT H.R.1984: 401(K) FAIR DISCLOSURE FOR RETIREMENT SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 1988: CONFLICTED INVESTMENT ADVICE PROHIBITION ACT OF 2009; PROVISIONS RELATED TO INVESTMENT ADVICE H.R. 2021: SAVINGS RECOVERY ACT OF 2009; PROVISIONS RELATED TO SAVERS CREDIT HR 2096/S 702: LONG TERM CARE AFFORDABILITY AND SECURITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE IN CAFETERIA PLANS AND FLEXIBLE SPENDING ARRANGEMENTS H.R. 2733/S. 1389: FIXED INDEXED ANNUITIES AND INSURANCE PRODUCTS CLASSIFICATION ACT OF 2009; PROVISIONS RELATED TO CLARIFICATION FOR FIXED ANNUITIES REGULATION H.R. 2748: RETIREMENT SECURITY NEEDS LIFETIME PAY ACT OF 2009; PROVISIONS RELATED TO TAX INCENTIVE FOR ANNUITIES H.R. 2779: DEFINED CONTRIBUTION PLAN FEE TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE H.R. 2792: RETIREMENT SAVINGS TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO PLAN FEE DISCLOSURE H.R. 2989: 401 (K) FAIR DISCLOSURE AND PENSION SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 3200: AMERICA'S AFFORDABLE HEALTH CHOICES ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE FINANCING WITHIN HEALTH CARE REFORM H.R. 3551 /S. 1661/S. 906: SENIOR INVESTMENT PROTECTION ACT OF 2009; PROVISIONS RELATED TO PRODUCT SALES TO SENIORS, AND ANNUITIES SALES H.R. 3590: THE PATIENT PROTECTION AND AFFORDABLE CARE ACT; PROVISIONS RELATED TO LONG TERM CARE AND SUPPLEMENTAL PRODUCTS FINANCING AND TAX WITHIN HEALTH REFORM H.R. 4126: RETIREMENT FAIRNESS ACT OF 2009; PROVISIONS RELATED TO MODIFICATION OF 401(K) PLAN RULES H.R. 4173: WALL STREET REFORM AND CONSUMER PROTECTION ACT OF 2009; PROVISIONS RELATED TO THE EXCLUSION OF RETIREMENT BENEFITS FROM CONSUMER FINANCIAL PROTECTION AGENCY, SUITIBILITY OF INSURANCE PRODUCT SALES TO SENIORS, AND SALE OF ANNUITIES S. 391: HEALTHY AMERICANS ACT; PROVISIONS RELATED TO PRIVATE HEALTH INSURANCE INCLUDING LONG TERM CARE S. 401: DEFINED CONTRIBUTION FEE DISCLOSURE ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE S. 434: EMPOWERED AT HOME ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE PREMIUMS, TAX DEDUCTIONS AND LONG TERM CARE IN CAFETERIA PLANS AND FLEXABLE SPENDING ARRANGEMENTS S. 1177: CONFIDENCE IN LONG TERM CARE INSURANCE ACT OF 2009; PROVISIONS RELATED TO CONSUMER PROTECTION IN LONG TERM CARE S. 1297: RETIREMENT SECURITY FOR LIFE ACT OF 2009; PROVISIONS RELATED TO NON-QUALIFIED ANNUITIES TAX INCENTIVES S. 1626: LONG TERM CARE INSURANCE INTEGRITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE S. 1679: AFFORDABLE HEALTH CHOICES ACT; PROVISIONS RELATED TO LONG TERM CARE FINANCING S. 1636: LONG TERM CARE INSURANCE CONSUMER RIGHT-TO-KNOW ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE CONSUMER PROTECTIONS S. 1796: AMERICAS HEALTHY FUTURE ACT; PROVISIONS RELATED TO LONG TERM CARE FINANCING S. 2832: LIFETIME INCOME DISCLOSURE ACT; PROVISIONS RELATED TO ANNUITY ILLUSTRATION ON BENEFIT STATEMENTS

Client expense: $350,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

**see addendum page H.R. 3200, America's Affordable Health Choices Act of 2009, care coordination, disability waiting period, long-term care S. 1679, Affordable Health Choices Act, care coordination, disability waiting period, long-term care S. 1796 - Americas Health Future Act of 2009, dementia assessment, care coordination, disability waiting period, long-term care H.R. 3590 The Patient Protection and Affordable Care Act S. 434 - Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community based services under the Medicaid Program, and for other purposes.

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

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

S.330/H.R.684, Medicare Prescription Drug Savings and Choice Act of 2009 - Discussed legislation which would create a government-operated Medicare prescription drug plan. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). S.683/H.R.1670, Community Choice Act - Supported Community First Choice Option version of this legislation in health care reform. S.245/H.R. 468/S.434/H.R.2688, Retooling the Health Care Workforce for an Aging America Act and possible amendments, in healthcare reform, including Family Caregiving provisions. S.113/H.R.2560, Empowered at Home Act and the Independence at Home Act - Discussed long-term care and chronic care legislation that AARP endorsed and including provisions in health reform legislation. S.631/H.R.2223, Patient Safety and Abuse Prevention Act - Support for legislation and amendment on criminal background checks for employees of long-term care providers and specific bill provisions. S. 697/H.R.1721, Class Act - Discussed provisions of CLASS in House and Senate health reform bills and urged inclusion of CLASS in Senate and House HCR legislation. S.1131/H.R.2560 Independence at Home Act - Discussed AARP's support for this Medicare care coordination bill; and urged it's inclusion in health reform legislation. Discussed healthcare coverage for the 50-64 year old population age rating and closing the doughnut hole. S.1133/H.R. 2580, Empowering Medicare Patient Choices Act - Discussed legislation that would promote patient decision aids to help people make informed, evidence-based decisions about health care treatment options. H.R. 2773/S 1295, Medicare Transitional Care Act of 2009 - Discussed legislation that would reduce unnecessary hospital readmissions, improve quality for Medicare beneficiaries, and reducing wasteful spending in Medicare; worked to incorporate bill and its elements into health reform legislation. S. 960, Medicare Early Access Act of 2009 - To let Americans aged 55-64 who are otherwise without access to grup or public coverage buy into Medicare. H.R. 2700, Prescription Coverage Now Act of 2009 - Discussed legislation that would assist low-invome individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. S. 1185, Medicare Financial Stability for Beneficiaries Act of 2009 - Discussed legislation that would ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs. H.R. 2716, Medicare Savings Program Improvement Act of 2009 - Discussed legislation that would provide financial stability for older Americans and people with disabilities through improvements in the Medicare Savings Program. Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population (no bill). H.R. 3293, Labor, HHS, Education and related agencies Appropriations bill for FY2010-Lobbied for funding for SSA, Older Americans Act programs, Lifespan Respite Care Act, Nursing Education/Workforce Development, National Corporation for Community Service (Kennedy Serve America Act). S.750 Caring for an Aging America Act - Discussed possible amendment to health reform bill. S.1257/H.R.2852 Project 2020: Building the Promise of Home and Community Based Services Act - Lobbied in support of legislation. Discussed ideas to improve medicare for medicare beneficiaries. (no bill) Discussed Medicare physician payment issues and SGR. (no bill) S. 2128, Prevent Healthcare Fraud Act - Discussed Medicare Fraud. Discussed idea of an annual physical for Medicare beneficiaries (no bill). S.1009 Medicare Care Transitions Program Act - Discussed provisions of Medicare Care Transitions Program Act. S.975 Seniors and Taxpayers Obligation and Protection Act - Lobbied in support of legislation. Discussed proposals to address LTC and HCBS in the context of health care reform. (no bill) S.1256 Home and Community Balanced Incentives Act - Discussed inclusion of this legislation in health reform legislation and advocated for amendment in Senate healthcare reform legislation. H.R. 3631, Medicare Premium Fairness Act - Lobbied to pass legislation to allow premiums for Medicare Part B to remain at 2009 levels for all beneficiaries. H.R. 3200 America's Affordable Health Choices Act/S. 1679, Americas Health Choices Act, America's Healthy Future Act (no Senate bill)- Discussed need for affordable quality healthcare, delivery system reform, ending age discrimination in the health insurance industry, "ending rating by health condition or any proxy," closing the doughnut hole, creating a pathway for generic biologics, allowing and funding states to provide home and community based services, creating a transitional benefit in medicare and expanding the asset limit to qualify for low-income programs in medicare, and modifying medicare advantage. S. 2926, Economic Fairness for Seniors Act - Discussed legislation that would allow premiums for Medicare Part B to remain at 2009 levels for all beneficiaries, provide social security beneficiaries with $250 in economic relief in response to the lack of cost of living adjustment for 2010, and convert from the CPI-W to the CPI-E. H.J.Res. 64, Third Continuing Resolution, FY 2010; not enacted - Lobbied for various items to be excepted from lower funding levels during the term of the Continuing Resolution. H.R. 3326, Division B, Defense Appropriations bill for FY 2010 - Lobbied for SNAP participation changes, extension of unemployment benefits and COBRA eligibility, delay in cuts to Medicare physician payments. H.R. 2996, Division B, Interior Appropriations bill lobbied for various items to be excepted from lower funding levels during the term of the Continuing Resolution. House Amendment to Senate Amendment to H.R. 2847 "Jobs for Main Street Act" - Discussed redirection of some TARP funds to extend unemployment insurance and COBRA eligibility and FMAP assistance to state governments. Discussed support for the inclusion of Puerto Rico and the territories in the proposed Health Insurance Exchange, increasing Medicaid funds to Puerto Rico seniors in Medicare Part B. (no bill) Discussed support for the inclusion of Puerto Rico and the territories in the proposed Health Insurance Exchange, increasing Medicaid funds to Puerto Rico and the territories, and the auto-enrollment of Puerto Rico seniors in Medicare Part B. (no bill)

Client expense: $5,950,000 · Firm income: Not reported

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

Lobbied for introduction of legislation that would end the age cap in the earned income tax credit. (no bill) Discussed Auto-IRA, a bill that would require an automatic workplace retirement savings plan for an estimated 50 million employees; legislation that would end the age cap in the earned income tax credit; legislation that would expand the savers credit so that more modest income individuals can benefit from it; and on the inappropriate application of withholding tables that implement Make Work Pay to pension and other retirement income. (no bill) Discussed income weatherization; modernizing the poverty measure; and modernizing the asset tests that are used to determine eligibility for federal benefits. (no bill) Discussed tax assistance funding. (no bill) S. 434, Empowerment at Home Act (includes caregiver tax credit) - Discussed tax credits for caregivers. H.R.3170/S.1432 Financial Services and General Government Appropriations bill for FY 2010 - Lobbied for funding for the IRS Tax Counseling for the Elderly and other taxpayer assistance programs. H.R.1159 - To amend the Internal Revenue code of 1989 to provide special rules for investments lost in a fraudulent Ponzi-type scheme. Discussed legislation to grant tax relief to victims of Ponzi-type schemes.

Client expense: $5,950,000 · Firm income: Not reported

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

Lobbied for introduction of legislation that would end the age cap in the earned income tax credit. (no bill) Discussed Auto-IRA, a bill that would require an automatic workplace retirement savings plan for an estimated 50 million employees; legislation that would end the age cap in the earned income tax credit; legislation that would expand the savers credit so that more modest income individuals can benefit from it; and on the inappropriate application of withholding tables that implement Make Work Pay to pension and other retirement income. (no bill) Discussed income weatherization; modernizing the poverty measure; and modernizing the asset tests that are used to determine eligibility for federal benefits. (no bill) Discussed tax assistance funding. (no bill) S. 434, Empowerment at Home Act (includes caregiver tax credit) - Discussed tax credits for caregivers. H.R.3170/S.1432 Financial Services and General Government Appropriations bill for FY 2010 - Lobbied for funding for the IRS Tax Counseling for the Elderly and other taxpayer assistance programs. H.R.1159 - To amend the Internal Revenue code of 1989 to provide special rules for investments lost in a fraudulent Ponzi-type scheme. Discussed legislation to grant tax relief to victims of Ponzi-type schemes.

Client expense: $5,950,000 · Firm income: Not reported

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

S.330/H.R.684, Medicare Prescription Drug Savings and Choice Act of 2009 - Discussed legislation which would create a government-operated Medicare prescription drug plan. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). S.683/H.R.1670, Community Choice Act - Supported Community First Choice Option version of this legislation in health care reform. S.245/H.R. 468/S.434/H.R.2688, Retooling the Health Care Workforce for an Aging America Act and possible amendments, in healthcare reform, including Family Caregiving provisions. S.113/H.R.2560, Empowered at Home Act and the Independence at Home Act - Discussed long-term care and chronic care legislation that AARP endorsed and including provisions in health reform legislation. S.631/H.R.2223, Patient Safety and Abuse Prevention Act - Support for legislation and amendment on criminal background checks for employees of long-term care providers and specific bill provisions. S. 697/H.R.1721, Class Act - Discussed provisions of CLASS in House and Senate health reform bills and urged inclusion of CLASS in Senate and House HCR legislation. S.1131/H.R.2560 Independence at Home Act - Discussed AARP's support for this Medicare care coordination bill; and urged it's inclusion in health reform legislation. Discussed healthcare coverage for the 50-64 year old population age rating and closing the doughnut hole. S.1133/H.R. 2580, Empowering Medicare Patient Choices Act - Discussed legislation that would promote patient decision aids to help people make informed, evidence-based decisions about health care treatment options. H.R. 2773/S 1295, Medicare Transitional Care Act of 2009 - Discussed legislation that would reduce unnecessary hospital readmissions, improve quality for Medicare beneficiaries, and reducing wasteful spending in Medicare; worked to incorporate bill and its elements into health reform legislation. S. 960, Medicare Early Access Act of 2009 - To let Americans aged 55-64 who are otherwise without access to grup or public coverage buy into Medicare. H.R. 2700, Prescription Coverage Now Act of 2009 - Discussed legislation that would assist low-invome individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. S. 1185, Medicare Financial Stability for Beneficiaries Act of 2009 - Discussed legislation that would ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs. H.R. 2716, Medicare Savings Program Improvement Act of 2009 - Discussed legislation that would provide financial stability for older Americans and people with disabilities through improvements in the Medicare Savings Program. Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population (no bill). H.R. 3293, Labor, HHS, Education and related agencies Appropriations bill for FY2010-Lobbied for funding for SSA, Older Americans Act programs, Lifespan Respite Care Act, Nursing Education/Workforce Development, National Corporation for Community Service (Kennedy Serve America Act). S.750 Caring for an Aging America Act - Discussed possible amendment to health reform bill. S.1257/H.R.2852 Project 2020: Building the Promise of Home and Community Based Services Act - Lobbied in support of legislation. Discussed ideas to improve medicare for medicare beneficiaries. (no bill) Discussed Medicare physician payment issues and SGR. (no bill) S. 2128, Prevent Healthcare Fraud Act - Discussed Medicare Fraud. Discussed idea of an annual physical for Medicare beneficiaries (no bill). S.1009 Medicare Care Transitions Program Act - Discussed provisions of Medicare Care Transitions Program Act. S.975 Seniors and Taxpayers Obligation and Protection Act - Lobbied in support of legislation. Discussed proposals to address LTC and HCBS in the context of health care reform. (no bill) S.1256 Home and Community Balanced Incentives Act - Discussed inclusion of this legislation in health reform legislation and advocated for amendment in Senate healthcare reform legislation. H.R. 3631, Medicare Premium Fairness Act - Lobbied to pass legislation to allow premiums for Medicare Part B to remain at 2009 levels for all beneficiaries. H.R. 3200 America's Affordable Health Choices Act/S. 1679, Americas Health Choices Act, America's Healthy Future Act (no Senate bill)- Discussed need for affordable quality healthcare, delivery system reform, ending age discrimination in the health insurance industry, "ending rating by health condition or any proxy," closing the doughnut hole, creating a pathway for generic biologics, allowing and funding states to provide home and community based services, creating a transitional benefit in medicare and expanding the asset limit to qualify for low-income programs in medicare, and modifying medicare advantage. S. 2926, Economic Fairness for Seniors Act - Discussed legislation that would allow premiums for Medicare Part B to remain at 2009 levels for all beneficiaries, provide social security beneficiaries with $250 in economic relief in response to the lack of cost of living adjustment for 2010, and convert from the CPI-W to the CPI-E. H.J.Res. 64, Third Continuing Resolution, FY 2010; not enacted - Lobbied for various items to be excepted from lower funding levels during the term of the Continuing Resolution. H.R. 3326, Division B, Defense Appropriations bill for FY 2010 - Lobbied for SNAP participation changes, extension of unemployment benefits and COBRA eligibility, delay in cuts to Medicare physician payments. H.R. 2996, Division B, Interior Appropriations bill lobbied for various items to be excepted from lower funding levels during the term of the Continuing Resolution. House Amendment to Senate Amendment to H.R. 2847 "Jobs for Main Street Act" - Discussed redirection of some TARP funds to extend unemployment insurance and COBRA eligibility and FMAP assistance to state governments. Discussed support for the inclusion of Puerto Rico and the territories in the proposed Health Insurance Exchange, increasing Medicaid funds to Puerto Rico seniors in Medicare Part B. (no bill) Discussed support for the inclusion of Puerto Rico and the territories in the proposed Health Insurance Exchange, increasing Medicaid funds to Puerto Rico and the territories, and the auto-enrollment of Puerto Rico seniors in Medicare Part B. (no bill)

Client expense: $5,950,000 · Firm income: Not reported

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

The Direct Support Professional Fairness and Security Act of 2009 (H.R. 868) --supported bill Community Living Assistance Services and Supports Act of 2009: (H.R. 1791 and S. 627) -- supported bill Community Choice Act of 2009:( H.R. 1670 and S. 683) -- supported bill Empowered at Home Act of 2009: (H.R. 2688 and S. 434) --- supported bill --discussed extension of Recovery Act FMAP increase with House and Senate staff and possible legislative vehicles

Client expense: $44,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 683 and H.R. 1670, Community Choice Act, provisions providing independence for individuals with disabilities, and the Community First Choice Option proposal for Medicaid. P.L. 109-171, implementation of the Deficit ReductionAct, provisions dealing with Medicaid. H.R. 868, Direct Support Professionals Fairness and Security Act. Implementation of Medicaid Section 1917 (d) regarding trusts and transfer of asset rules. The Empowered at Home Act of 2009, H.R. 2688 and S. 434, to amend the Medicaid Section 1915 (i) Home and Community Based Services Option. Implementation of the Olmstead decision regarding community integration. Health Care Reform, including numerous long term services and supports provisions. Federal Medical Assistance Percentage (FMAP increase. S. 493 and H.R. 1205, Achieving a Better Life Experience Act of 2009. Home and Community Based Services Waiver (Section 1915(c)) and Option (Section 1915 (i)).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Education, Dept of, Election Assistance Commission (EAC), Equal Employment Opportunity Commission (EEOC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), President of the U.S., SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office

See attachment. RET Fourth Quarter Report 2009 H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 897 The Long Term Care and Retirement Security Act of 2009. Issue: LTC in cafeteria and FSA and above the line deductions for LTC premiums. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit H.R. 1984 - 401(k) Fair Disclosure for Retirement Security Act of 2009. Issue: Retirement plan fee disclosure. H.R. 1988 Conflicted Investment Advice Prohibition Act of 2009. Issue: Investment Advice. H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2733/S. 1389 Fixed Indexed Annuities and Insurance Products Classification Act of 2009. Issue: Clarify exemption for fixed indexed annuities. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 2779 Defined Contribution Plan Fee Transparency Act of 2009. Issue: 401(k) Plan Fee Disclosure. H.R. 2792 Retirement Savings Transparency Act. Issue: Plan fee disclosure. H.R. 2989 401 (K) Fair Disclosure and Pension Security Act of 2009. Issue: Retirement Plan Fee Disclosure H.R. 3200: Americas Affordable Health Choices Act of 2009. Issue: Long Term Care financing within health reform. H.R. 3590-The Patient Protection and Affordable Care Act. Issue: Long Term Care financing within heath reform. H. R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H. R. 4173 Wall Street Reform and Consumer Protection Act. Issue: Exclusion of retirement plans from CFPA and suitability in insurance product sales to seniors and sales of annuities. S. 391 Healthy Americans Act. Issue: private health insurance including LTC. S. 401 - Defined Contribution Fee Disclosure Act Issue: 401(k) fee disclosure S. 434 Empowered at Home Act of 2009. Issue: Allows above the line tax deduction for LTC premiums. Allows LTC to be offered in cafeteria/ FSA plans. S. 697/ HR 1721 Community Living Assistance Services and Supports Act. Issue: reform of LTC financing. S 702/ HR 2096 Long Term Care Affordability and Security Act of 2009. Issue: allows long term care insurance to be offered in employer sponsored cafeteria plans and FSA. S. 1177 Confidence in Long Term Care Insurance Act of 2009. Issue: Consumer protection for long term care. S. 1226: Long Term Care Insurance Integrity Act of 2009. Issue: Long Term Care. S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. S. 1636 Long Term Care Insurance Consumer Right-To-Know Act of 2009. Issue: Long Term Care consumer protections. S. 1661/S. 906/H.R. 3551 Senior Investment Protection Act of 2009. Issue: Suitability in insurance product sales to seniors and the sale of annuities. S. 1679, Affordable Health Choices Act. Issue: Long Term Care financing with in health reform. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. S. _______: Americas Healthy Future Act. Issue: Long Term Care financing within heath reform. No bill number yet.

Client expense: $1,040,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- Systemic Risk Regulator - Insurance Regulation - Office of Insurance Information - HR 1721/ S 697, "A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance" a/k/a "Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - S 434, "A bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes" a/k/a "Empowered at Home Act", regarding all provisions. - HR 897, "To amend the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long-term care needs" a/k/a "Long-Term Care and Retirement Security Act of 2009", regarding all provisions. - HR 1880, "To establish a system of regulation and supervision for insurers, insurance agencies, and insurance producers chartered or licensed under Federal law that ensures the stability and financial integrity of those insurers, agencies, and producers and that protects policyholders and other consumers served by such insurers, agencies, or producers", a/k/a "The National Insurance Consumer Protection Act", regarding all provisions. - HR 2609, "To establish an Office of Insurance Information in the Department of the Treasury", a/k/a "Insurance Information Act of 2009", regarding all provisions. -HR 2554, "To reform the National Association of Registered Agents and Brokers, and for other purposes", regarding all provisions. - HR 1721/S 697, "A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes", a/k/a "Community Living Assistance Services and Supports Act", regarding all provisions. - S 1177, "A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes", a/k/a "Long-Term Care Insurance Act of 2009", regarding all provisions. - HR 2096, "To amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance", a/k/a "The Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - The Administration's Regulatory Reform Proposal, regarding all provisions. - HR 4173, "To provide for financial regulatory reform, to protect consumers and investors, to enhance Federal understanding of insurance issues, to regulate the over-the-counter derivatives markets, and for other purposes", a/k/a "Wall Street Reform & Consumer Protection Act of 2009", regarding Title VI and Title I Subtitle G. - HR 3126, "To establish the Consumer Financial Protection Agency, and for other purposes", a/k/a, "Consumer Financial Protection Agency Act of 2009", regarding all provisions. - "Restoring American Financial Stability Act of 2009", regarding all provisions (Bill not yet introduced).

Client expense: $1,210,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), U.S. Trade Representative (USTR)

S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 1988 Conflicted Investment Advice Prohibition Act of 2009. Issue: Investment Advice. H.R.1984 - 401(k) Fair Disclosure for Retirement Security Act of 2009. Issue: Retirement plan fee disclosure. H.R. 2989 401 (K) Fair Disclosure and Pension Security Act of 2009. Issue: Retirement Plan Fee Disclosure S. 697/ HR 1721 Community Living Assistance Services and Supports Act. Issue: reform of LTC financing. H.R. 897 The Long Term Care and Retirement Security Act of 2009. Issue: LTC in cafeteria and FSA and above the line deductions for LTC premiums. S. 434 Empowered at Home Act of 2009. Issue: Allows above the line tax deduction for LTC premiums. Allows LTC to be offered in cafeteria/ FSA plans. S. 391 Healthy Americans Act. Issue: private health insurance including LTC. H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit S. 401 - Defined Contribution Fee Disclosure Act Issue: 401(k) fee disclosure H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2792 Retirement Savings Transparency Act. Issue: Plan fee disclosure. H.R. 2733/S. 1389 Fixed Indexed Annuities and Insurance Products Classification Act of 2009. Issue: Clarify exemption for fixed indexed annuities. S 702/ HR 2096 Long Term Care Affordability and Security Act of 2009. Issue: allows long term care insurance to be offered in employer sponsored cafeteria plans and FSA. S. 1679, Affordable Health Choices Act. Issue: Long Term Care financing with in health reform. S. 1177 Confidence in Long Term Care Insurance Act of 2009. Issue: Consumer protection for long term care. H.R. 3200: Americas Affordable Health Choices Act of 2009. Issue: Long Term Care financing within health reform. S. _______: Americas Healthy Future Act. Issue: Long Term Care financing within heath reform. No bill number yet. S. 1226: Long Term Care Insurance Integrity Act of 2009. Issue: Long Term Care. S. 1636 Long Term Care Insurance Consumer Right-To-Know Act of 2009. Issue: Long Term Care consumer protections. S. 1661/S. 906/H.R. 3551 Senior Investment Protection Act of 2009. Issue: Suitability in insurance product sales to seniors and the sale of annuities. H.R. 2779 Defined Contribution Plan Fee Transparency Act of 2009. Issue: 401(k) Plan Fee Disclosure. S. 2832 Lifetime Income Disclosure Act. Issue: Annuity illustration on benefit statements. H. R. 4126 Retirement Fairness Act. Issue: Modification of 401(k) Plan Rules. H. R. 4173 Wall Street Reform and Consumer Protection Act. Issue: Exclusion of retirement plans from CFPA and suitability in insurance product sales to seniors and sales of annuities. H.R. 3590-The Patient Protection and Affordable Care Act. Issue: Long Term Care financing within heath reform.

Client expense: $1,908,166 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

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

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

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

H.R. 519: ELDER CAREGIVER SUPPORT AND INFORMATION ENHANCEMENT ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE APPROPRIATIONS FOR LONG TERM CARE INFORMATION CLEARINGHOUSE H.R. 897: LONG TERM CARE AND RETIREMENT SECURITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE IN CAFETERIA PLANS AND FLEXIBLE SPENDING ARRANGEMENTS, AND ABOVE THE LINE DEDUCTIONS FOR LONG TERM CARE PREMIUMS HR 1721/S. 697: COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS ACT; PROVISIONS RELATED TO REFORM OF LONG TERM CARE FINANCING H.R. 1961: SAVINGS FOR AMERICAN FAMILIES FUTURE ACT OF 2009; PROVISIONS RELATED TO SAVERS' CREDIT H.R.1984: 401(K) FAIR DISCLOSURE FOR RETIREMENT SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 1988: CONFLICTED INVESTMENT ADVICE PROHIBITION ACT OF 2009; PROVISIONS RELATED TO INVESTMENT ADVICE H.R. 2021: SAVINGS RECOVERY ACT OF 2009; PROVISIONS RELATED TO SAVERS CREDIT HR 2096/S 702: LONG TERM CARE AFFORDABILITY AND SECURITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE IN CAFETERIA PLANS AND FLEXIBLE SPENDING ARRANGEMENTS H.R. 2733/S. 1389: FIXED INDEXED ANNUITIES AND INSURANCE PRODUCTS CLASSIFICATION ACT OF 2009; PROVISIONS RELATED TO CLARIFICATION FOR FIXED INDEXED ANNUITIES H.R. 2748: RETIREMENT SECURITY NEEDS LIFETIME PAY ACT OF 2009; PROVISIONS RELATED TO ANNUITIES TAX INCENTIVES H.R. 2779: DEFINED CONTRIBUTION PLAN FEE TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO 401(K) PLAN FEE DISCLOSURE H.R. 2792: RETIREMENT SAVINGS TRANSPARENCY ACT OF 2009; PROVISIONS RELATED TO PLAN FEE DISCLOSURE H.R. 2989: 401 (K) FAIR DISCLOSURE AND PENSION SECURITY ACT OF 2009; PROVISIONS RELATED TO RETIREMENT PLAN FEE DISCLOSURE H.R. 3200: AMERICAS AFFORDABLE HEALTH CHOICES ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE FINANCING WITHIN HEALTH CARE REFORM H.R. 3551 /S. 1661/S. 906: SENIOR INVESTMENT PROTECTION ACT OF 2009; PROVISIONS RELATED TO PRODUCT SALES TO SENIORS, AND ANNUITIES SALES AMERICAS HEALTHY FUTURE ACT (BILL NUMBER NOT YET ASSIGNED); PROVISIONS RELATED TO LONG TERM CARE FINANCING S. 207: HEALTH INSURANCE TAX RELIEF ACT; PROVISIONS RELATED TO ALLOWING LONG TERM CARE INSURANCE IN CAFETERIA PLANS AND FLEXIBLE SPENDING ARRANGEMENTS S. 391: HEALTHY AMERICANS ACT; PROVISIONS RELATED TO PRIVATE HEALTH INSURANCE INCLUDING LONG TERM CARE S. 401: DEFINED CONTRIBUTION FEE DISCLOSURE ACT OF 2009; PROVISIONS RELATED TO 401(K) FEE DISCLOSURE S. 434: EMPOWERED AT HOME ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE PREMIUMS, TAX DEDUCTIONS AND LONG TERM CARE IN CAFETERIA PLANS AND FLEXABLE SPENDING ARRANGEMENTS S. 1177: CONFIDENCE IN LONG TERM CARE INSURANCE ACT OF 2009; PROVISIONS RELATED TO CONSUMER PROTECTION FOR LONG TERM CARE S. 1297: RETIREMENT SECURITY FOR LIFE ACT OF 2009; PROVISIONS RELATED TO NON-QUALIFIED ANNUITIES S. 1626: LONG TERM CARE INSURANCE INTEGRITY ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE S. 1679: AFFORDABLE HEALTH CHOICES ACT; PROVISIONS RELATED TO LONG TERM CARE FINANCING S. 1636: LONG TERM CARE INSURANCE CONSUMER RIGHT-TO-KNOW ACT OF 2009; PROVISIONS RELATED TO LONG TERM CARE CONSUMER PROTECTIONS

Client expense: $600,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Direct Support Professional Fairness and Security Act of 2009 (H.R. 868) --supported bill Designation of the Week of September 13th as National Direct Support Professional Awareness Week -- worked with Senators' Offices to introduce resolution Community Living Assistance Services and Supports Act of 2009: (H.R. 1791 and S. 627) -- supported bill Community Choice Act of 2009:( H.R. 1670 and S. 683) -- supported bill Empowered at Home Act of 2009: (H.R. 2688 and S. 434) --- supported bill

Client expense: $44,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.330/H.R.684, Medicare Prescription Drug Savings and Choice Act of 2009 - Discussed legislation which would create a government-operated Medicare prescription drug plan. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). S.683/H.R.1670, Community Choice Act - Engaged in discussions about the bill, possible changes to advance bill in health reform and it's provisions to balance Medicaid. Discussed chronic care issues and caregiver assessment in Medicaid. Discussed ways to provide better care coordination to dual eligibles and possible legislation (no bill). S.245/H.R. 468/S.434/H.R.468 Retooling the Health Care Workforce for an Aging America Act and possible amendment, the Empowered at Home Act and the Independence at Home Act - Discussed long-term care and chronic care legislation that AARP endorsed and shared endorsement letters. Discussed co-sponsors of Medicaid HCBS legislation. S.631/H.R.2223, Patient Safety and Abuse Prevention Act - Support for legislation and amendment on criminal background checks for employees of long-term care providers and specific bill provisions. S. 697/H.R.1721, Class Act - Discussed this bill and versions marked up in committee. Endorsed provisions in HELP and E&C Committee healthcare reform bills. S.1131/H.R.2560 Independence at Home Act - Endorsed and discussed AARP's support for this Medicare care coordination bill; and House Committee amendment and urged co-sponsorship. Discussed healthcare coverage for the 50-64 year old population age rating and closing the doughnut hole. S.1133/H.R. 2580, Empowering Medicare Patient Choices Act - To promote patient decision aids to help people make informed, evidence-based decisions about health care treatment options. H.R. 2773/S 1295, Medicare Transitional Care Act of 2009 - To reduce unnecessary hospital readmissions, improving quality for Medicare beneficiaries, and reducing wasteful spending in Medicare; endorsed committee amendment; worked to incorporate bill and its elements into health reform legislation. S. 960, Medicare Early Access Act of 2009 - To let Americans aged 55-64 who are otherwise without access to grup or public coverage buy into Medicare. H.R. 2700, Prescription Coverage Now Act of 2009 - To assist low-invome individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. S. 1185, Medicare Financial Stability for Beneficiaries Act of 2009 - To ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs. H.R. 2716, Medicare Savings Program Improvement Act of 2009 - To provide financial stability for older Americans and people with disabilities through improvements in the Medicare Savings Program. Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population (no bill). H.R. 3293, Labor, HHS, Education and related agencies Appropriations bill for FY2010-Lobbied for funding for SSA, Older Americans Act programs, Lifespan Respite Care Act, Nursing Education/Workforce Development, National Corporation for Community Service (Kennedy Serve America Act), among other items (no bill numbers). S.750 Caring for an Aging america Act - Lobbied in support of legislation and discussed possible floor amendment.. S.1257/H.R.2852 Project 2020:Building the Promise of Home and Community Based Services Act - Lobbied in support of legislation. Discussed ideas to improve medicare for medicare beneficiaries. (no bill) Discussed Medicare physician payment issues and SGR. Responded to staff inquiry about AARP position on Medicare fraud bill; referred staff to appropriate AARP staff. Discussed idea of an annual physical for Medicare beneficiaries (no bill). S.1009 Medicare Care Transitions Program Act - Discussed provisions of Medicare Care Transitions Program Act. S.975 Seniors and Taxpayers Obligation and Protection Act - Lobbied in support of legislation. Discussed care coordination for dual eligibles and policy ideas to address this (no bill). Discussed proposals to address LTC and HCBS in the context of health care reform. (no bill) S.1150 Advance Planning and Compassionate Care Act - Endorsed advance care planning legislation. S.1263 Senior Navigation and Planning Act legislation - discussed legislation. S.1256 Home and Community Balanced Incentives Act - Discussed inclusion of this legislation in health reform legislation and urged cosponsors, advocated for amendment in committee. H.R. 3631, Medicare Premium Fairness Act - Lobbied to pass legislation to allow premiums for Medicare Part B to remain at 2009 levels for all beneficiaries. H.R. 3200 America's Affordable Health Choices Act/S. 1679, Americas Health Choices Act, America's Healthy Future Act (no Senate bill)- Discussed need for affordable quality healthcare, delivery system reform, ending age discrimination in the health insurance industry, closing the doughnut hole, creating a pathway for generic biologics, allowing and funding states to provide home and community based services, creating a transitional benefit in medicare and expanding the asset limit to qualify for low-income programs in medicare.

Client expense: $5,680,000 · Firm income: Not reported

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

S.330/H.R.684, Medicare Prescription Drug Savings and Choice Act of 2009 - Discussed legislation which would create a government-operated Medicare prescription drug plan. Provided information on the need for nursing education capacity and the retention of newer and older nurses in the workplace (no bill). S.683/H.R.1670, Community Choice Act - Engaged in discussions about the bill, possible changes to advance bill in health reform and it's provisions to balance Medicaid. Discussed chronic care issues and caregiver assessment in Medicaid. Discussed ways to provide better care coordination to dual eligibles and possible legislation (no bill). S.245/H.R. 468/S.434/H.R.468 Retooling the Health Care Workforce for an Aging America Act and possible amendment, the Empowered at Home Act and the Independence at Home Act - Discussed long-term care and chronic care legislation that AARP endorsed and shared endorsement letters. Discussed co-sponsors of Medicaid HCBS legislation. S.631/H.R.2223, Patient Safety and Abuse Prevention Act - Support for legislation and amendment on criminal background checks for employees of long-term care providers and specific bill provisions. S. 697/H.R.1721, Class Act - Discussed this bill and versions marked up in committee. Endorsed provisions in HELP and E&C Committee healthcare reform bills. S.1131/H.R.2560 Independence at Home Act - Endorsed and discussed AARP's support for this Medicare care coordination bill; and House Committee amendment and urged co-sponsorship. Discussed healthcare coverage for the 50-64 year old population age rating and closing the doughnut hole. S.1133/H.R. 2580, Empowering Medicare Patient Choices Act - To promote patient decision aids to help people make informed, evidence-based decisions about health care treatment options. H.R. 2773/S 1295, Medicare Transitional Care Act of 2009 - To reduce unnecessary hospital readmissions, improving quality for Medicare beneficiaries, and reducing wasteful spending in Medicare; endorsed committee amendment; worked to incorporate bill and its elements into health reform legislation. S. 960, Medicare Early Access Act of 2009 - To let Americans aged 55-64 who are otherwise without access to grup or public coverage buy into Medicare. H.R. 2700, Prescription Coverage Now Act of 2009 - To assist low-invome individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes. S. 1185, Medicare Financial Stability for Beneficiaries Act of 2009 - To ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs. H.R. 2716, Medicare Savings Program Improvement Act of 2009 - To provide financial stability for older Americans and people with disabilities through improvements in the Medicare Savings Program. Advocated for modernizing Medicare funding so that nursing education funds are directed to advanced nurse practice programs to help produce more highly-skilled nurses to care for the Medicare population (no bill). H.R. 3293, Labor, HHS, Education and related agencies Appropriations bill for FY2010-Lobbied for funding for SSA, Older Americans Act programs, Lifespan Respite Care Act, Nursing Education/Workforce Development, National Corporation for Community Service (Kennedy Serve America Act), among other items (no bill numbers). S.750 Caring for an Aging america Act - Lobbied in support of legislation and discussed possible floor amendment.. S.1257/H.R.2852 Project 2020:Building the Promise of Home and Community Based Services Act - Lobbied in support of legislation. Discussed ideas to improve medicare for medicare beneficiaries. (no bill) Discussed Medicare physician payment issues and SGR. Responded to staff inquiry about AARP position on Medicare fraud bill; referred staff to appropriate AARP staff. Discussed idea of an annual physical for Medicare beneficiaries (no bill). S.1009 Medicare Care Transitions Program Act - Discussed provisions of Medicare Care Transitions Program Act. S.975 Seniors and Taxpayers Obligation and Protection Act - Lobbied in support of legislation. Discussed care coordination for dual eligibles and policy ideas to address this (no bill). Discussed proposals to address LTC and HCBS in the context of health care reform. (no bill) S.1150 Advance Planning and Compassionate Care Act - Endorsed advance care planning legislation. S.1263 Senior Navigation and Planning Act legislation - discussed legislation. S.1256 Home and Community Balanced Incentives Act - Discussed inclusion of this legislation in health reform legislation and urged cosponsors, advocated for amendment in committee. H.R. 3631, Medicare Premium Fairness Act - Lobbied to pass legislation to allow premiums for Medicare Part B to remain at 2009 levels for all beneficiaries. H.R. 3200 America's Affordable Health Choices Act/S. 1679, Americas Health Choices Act, America's Healthy Future Act (no Senate bill)- Discussed need for affordable quality healthcare, delivery system reform, ending age discrimination in the health insurance industry, closing the doughnut hole, creating a pathway for generic biologics, allowing and funding states to provide home and community based services, creating a transitional benefit in medicare and expanding the asset limit to qualify for low-income programs in medicare.

Client expense: $5,680,000 · Firm income: Not reported

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

H.R. 83 - Homeowners Insurance Protection Act of 2009; entire bill H.R. 1264 - Multiple Peril Insurance Act of 2009; provisions relating to NFIP and wind coverage H.R. 1583 - Insurance Industry Competition Act of 2009; entire bill H.R. 1880 - National Insurance Consumer Protection Act; entire bill H.R. 2554 - National Association of Registered Agents and Brokers (NARAB) Reform; entire bill H.R. 2555 - Homeowners Defense Act; entire bill H.R. 2609 - Insurance Information Act of 2009; entire bill H.R. 3059 - Access to Repair Parts Act; entire bill H.R. 3139 - National Flood Insurance Program Extension Act of 2009; entire bill S. 434 - Empowered at Home Act of 2009; entire bill S. 702 - Long-Term Care Affordability and Security Act of 2009; entire bill S. 1177 - Confidence in Long-Term Care Insurance Act of 2009; entire bill S. 1368 Access to Repair Parts Act; entire bill

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1670/S 638, Community Choice Act, providing for Medicaid coverage of community-based attendant services for nursing-home-eligible elders and people with disabilities - support and advocate for inclusion in health care reform. S 434, Emplowered at Home Act, to enable more elders and people with disabilities to qualify for Medicaid coverage of adult day services and home- and community-based services - support HR 3200, America's Affordable Health Choices Act - advocating against Medicare reimbursement freeze for nursing homes, home health care providers, and hospice. In favor of research and evaluation before bundling of post-acute care is implemented. S 1257/HR 2852, Project 2020-to establish single entry points into the LTSS system and enhance nursing home diversion programs - support HR 3043, Medicare Adult Day Services Act-provides for Medicare coverage of subsitute adult day services - support S 1004/HR 2307, RE-Aligning Care Act, to link eligible seniors suffering from chronic illnesses with a qualified health professional to coordinate their care - for S1131/HR2560, Independence at Home Act, authorizing voluntary chronic care coordination pilot programs for high-cost Medicare beneficiaries with multiple chronic conditions - support and favor inclusion in health care reform. HR 2773/S 1295, Medicare Transitional Care Act, providing Medicare coverage of transitional services upon discharge from a hospital - support

Client expense: $116,068 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 1988 Conflicted Investment Advice Prohibition Act of 2009. Issue: Investment Advice. H.R.1984 - 401(k) Fair Disclosure for Retirement Security Act of 2009. Issue: Retirement plan fee disclosure. H.R. 2989 401 (K) Fair Disclosure and Pension Security Act of 2009. Issue: Retirement Plan Fee Disclosure S. 697/ HR 1721 Community Living Assistance Services and Supports Act. Issue: reform of LTC financing. H.R. 897 The Long Term Care and Retirement Security Act of 2009. Issue: LTC in cafeteria and FSA and above the line deductions for LTC premiums. S. 434 Empowered at Home Act of 2009. Issue: Allows above the line tax deduction for LTC premiums. Allows LTC to be offered in cafeteria/ FSA plans. S. 391 Healthy Americans Act. Issue: private health insurance including LTC. H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit S. 401 - Defined Contribution Fee Disclosure Act Issue: 401(k) fee disclosure H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2792 Retirement Savings Transparency Act. Issue: Plan fee disclosure. H.R. 2733/S. 1389 Fixed Indexed Annuities and Insurance Products Classification Act of 2009. Issue: Clarify exemption for fixed indexed annuities. S 702/ HR 2096 Long Term Care Affordability and Security Act of 2009. Issue: allows long term care insurance to be offered in employer sponsored cafeteria plans and FSA. S. 1679, Affordable Health Choices Act. Issue: Long Term Care financing with in health reform. S. 1177 Confidence in Long Term Care Insurance Act of 2009. Issue: Consumer protection for long term care. H.R. 3200: Americas Affordable Health Choices Act of 2009. Issue: Long Term Care financing within health reform. S. _______: Americas Healthy Future Act. Issue: Long Term Care financing within heath reform. No bill number yet. S. 1226: Long Term Care Insurance Integrity Act of 2009. Issue: Long Term Care. S. 1636 Long Term Care Insurance Consumer Right-To-Know Act of 2009. Issue: Long Term Care consumer protections. S. 1661/S. 906/H.R. 3551 Senior Investment Protection Act of 2009. Issue: Suitability in insurance product sales to seniors and the sale of annuities. H.R. 2779 Defined Contribution Plan Fee Transparency Act of 2009. Issue: 401(k) Plan Fee Disclosure.

Client expense: $1,760,318 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

**see addendum page H.R. 3200, America's Affordable Health Choices Act of 2009, care coordination, disability waiting period , long-term care S. 1679, Affordable Health Choices Act, care coordination, disability waiting period , long-term care S._ America's Healthy Future Act of 2009, dementia assessment, care coordination, disability waiting period , long-term care S. 434 - Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community based services under the Medicaid Program, and for other purposes.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See attachment. RET Third Quarter Report 2009 H.R. 519 The Elder Caregiver Support and Information Enhancement Act of 2009. Issue: LTC additional appropriations for LTC Information clearinghouse. H.R. 897 The Long Term Care and Retirement Security Act of 2009. Issue: LTC in cafeteria and FSA and above the line deductions for LTC premiums. H.R. 1961 - Savings for American Families Future Act Issue: savers' credit H.R.1984 - 401(k) Fair Disclosure for Retirement Security Act of 2009. Issue: Retirement plan fee disclosure. H.R. 1988 Conflicted Investment Advice Prohibition Act of 2009. Issue: Investment Advice. H.R. 2021 Savings Recovery Act of 2009. Issue: Savers credit. H.R. 2733/S. 1389 Fixed Indexed Annuities and Insurance Products Classification Act of 2009. Issue: Clarify exemption for fixed indexed annuities. H.R. 2748 Retirement Security Needs Lifetime Pay Act of 2009. Issue: Tax Incentive for Annuities. H.R. 2779 Defined Contribution Plan Fee Transparency Act of 2009. Issue: 401(k) Plan Fee Disclosure. H.R. 2792 Retirement Savings Transparency Act. Issue: Plan fee disclosure. H.R. 2989 401 (K) Fair Disclosure and Pension Security Act of 2009. Issue: Retirement Plan Fee Disclosure H.R. 3200: Americas Affordable Health Choices Act of 2009. Issue: Long Term Care financing within health reform. S. 391 Healthy Americans Act. Issue: private health insurance including LTC. S. 401 - Defined Contribution Fee Disclosure Act Issue: 401(k) fee disclosure S. 434 Empowered at Home Act of 2009. Issue: Allows above the line tax deduction for LTC premiums. Allows LTC to be offered in cafeteria/ FSA plans. S. 697/ HR 1721 Community Living Assistance Services and Supports Act. Issue: reform of LTC financing. S 702/ HR 2096 Long Term Care Affordability and Security Act of 2009. Issue: allows long term care insurance to be offered in employer sponsored cafeteria plans and FSA. S. 1177 Confidence in Long Term Care Insurance Act of 2009. Issue: Consumer protection for long term care. S. 1226: Long Term Care Insurance Integrity Act of 2009. Issue: Long Term Care. S. 1297 Retirement Security for Life Act. Issue: Tax Incentive for Non Qualified Annuities. S. 1636 Long Term Care Insurance Consumer Right-To-Know Act of 2009. Issue: Long Term Care consumer protections. S. 1661/S. 906/H.R. 3551 Senior Investment Protection Act of 2009. Issue: Suitability in insurance product sales to seniors and the sale of annuities. S. 1679, Affordable Health Choices Act. Issue: Long Term Care financing with in health reform. S. _______: Americas Healthy Future Act. Issue: Long Term Care financing within heath reform. No bill number yet.

Client expense: $865,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 683 and H.R. 1670, Community Choice Act, provisions providing independence for individuals with disabilities, and the Community First Choice Option proposal for Medicaid. P.L. 109-171, implementation of the Deficit ReductionAct, provisions dealing with Medicaid. H.R. 868, Direct Support Professionals Fairness and Security Act. Legislation dealing with direct support worker issues. Implementation of Medicaid Section 1917 (d) regarding trusts and transfer of asset rules. The Empowered at Home Act of 2009, H.R. 2688 and S. 434, to amend the Medicaid Section 1915 (i) Home and Community Based Services Option. Implementation of the Olmstead decision regarding community integration. Health Care Reform, including long term services and supports. Federal Medical Assistance Percentage (FMAP increase. S. 493 and H.R. 1205, Achieving a Better Life Experience Act of 2009. Home and Community Based Services Waiver (Section 1915(c)) and Option (Section 1915 (i)).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Education, Dept of, Election Assistance Commission (EAC), Equal Employment Opportunity Commission (EEOC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office

Medicare/Part B Premium Hold Harmless. H.R. 3631: Provisions extending the current "hold harmless" policy to all Medicare enrollees to ensure 2010 Part B monthly premiums remain at the current rate. Comprehensive Health Care Reform. H.R. 3200, S. 1679, Senate Finance Committee Mark of Americas Healthy Futures Act: provisions related to reducing Medicare Advantage plan payments, reducing the coverage gap in Part D, requiring wealthier Medicare beneficiaries to pay a greater share of the cost of their premiums under Medicare Part D, reducing the Part A deductible, establishing an out-of-pocket maximum under Medicare, establishing a voluntary comprehensive benefit option under Medicare, authorizing a Medicare-operated Part D drug plan, permitting the Department of Health and Human Services to negotiate drug prices for the Part D program, simplifying plan benefit designs under Parts D and C, expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS), improving the process for reassigning LIS beneficiaries to new plans, expanding coverage of prevention services, integrating mental health services in primary care and community settings, eliminating the 45 percent funding trigger provision, establishing a Medicare Commission, providing Medicaid coverage for home and community-based services, establishing a new national insurance program for long-term supports and services, authorizing funding to provide language services to limited English proficiency beneficiaries, authorizing the collection of data regarding disparities in the provision of care, providing safeguards and subsidies to assure affordability of health coverage for seniors, preserving state benefit laws and requirements, reducing permitted age rating ratio and clarifying the Medicare Secondary Payer statute. Medicare/Commission. S. 1110 and S. 1380: authorizing an enhanced MedPAC as an executive branch commission with authority to implement Medicare payment and policy designed to reduce Medicare spending growth. Medicare/Prescription Drug Plan. S. 330/H.R. 684: authorizing the establishment of a Medicare-operated prescription drug plan; S. 266: authorizing the Secretary of Health and Human Services to negotiate lower prescription drug prices and to use the savings to reduce the coverage gap. Medicare/Part D Generics. S. 75: requiring the use of generics where available unless the brand name drug is determined to be medically necessary. Medicare/Part D cost-sharing. S. 1630: establishing limits on required beneficiary cost-sharing under Part D drug plans. Medicare/Part D dual eligibles. S. 1634: removing enrollment barriers for low-income beneficiaries and establishing a Medicare-operated prescription drug plan. Medicare/Combating Waste, Fraud, Abuse. H.R. 27: relating to additional provisions to combat waste, fraud, and abuse within Medicare; H.R. 203: increasing civil and criminal penalties for acts involving fraud and abuse and increasing the surety bond amount for suppliers of durable medical equipment. Medicare/Therapy Caps. H.R. 43/S. 46: repealing outpatient rehabilitation therapy caps. Medicare/Private Contracts. H.R. 164: prohibiting denial of Social Security benefits to persons who elect not to participate in Medicare. Medicare/Hearing Coverage. H.R. 504: authorizing coverage of hearing aids and auditory rehabilitation services under Medicare Part B. Medicare/Dental Coverage. H.R. 870: authoring coverage under Part B for medically necessary dental procedures. Medicare/Rural Improvements. H.R. 902/S. 382: provision authorizing improvements to services provided to beneficiaries residing in rural areas. Medicare/Shingles Vaccine. H.R. 1038: extending Part B coverage to the shingles vaccine. Medicare/Home Health. H.R. 1094: authorizing home health care agencies to assign the most appropriate skilled service to make the initial assessment visit under a Medicare home health plan of care for rehabilitation services. Medicare/Health Care Vouchers. H.R. 1118: authorizing Medicare-eligible seniors to elect to receive vouchers for a health savings account, premiums for a high deductible health insurance plan, or both, in lieu of regular Medicare benefits and suspending Medicare late enrollment penalties between ages 65 and 70. Medicare/Skilled Nursing Facilities. H.R. 1125, S. 647: provisions related to requiring the reporting of expenditures for nursing services at skilled nursing facilities and requiring disclosure of corporate ownership. Medicare/Prevention. H.R. 1213: provisions authorizing ultrasound screening for abdominal aortic aneurysms to at-risk Medicare beneficiaries between the ages of 65 and 75 without the requirement of a prior initial preventive physical examination; H.R. 1894/S. 769: expanding access to bone mass measurement benefits under Part B. Medicare/Part B Drug Payments. H.R. 1392: relating to appropriate Part B payment amounts for drugs and biologicals. Medicare/Low Income Prescription Drug Benefits. H.R. 1407/S. 534: authorizing a reduction in cost-sharing under Part D for non-institutionalized, full-benefit dual eligible individuals. Medicare/Disability Benefits. S. 700/H.R. 1708, H.R. 2881: phasing-out the 24-month waiting period for disabled individuals to become eligible for Medicare benefits and eliminating the waiting period for individuals with life-threatening conditions. Medicare/Prescription Drugs for kidney transplants. H.R. 1458/S. 565: provision related to continued coverage for immunosuppressive drugs furnished beneficiaries that have received kidney transplants and whose entitlement to coverage would otherwise expire. Medicare/Intravenous Drugs. H.R. 1765/S.701: relating to the payment for intravenous immune globulin (IVIG) for the treatment of primary immune deficiency diseases in a patient's home and for certain disposable pumps as durable medical equipment in place of non-disposable pumps. Medicare/Home Infusion Therapy. H.R. 574/S.254: extending Medicare coverage to home infusion therapy. Medicare/Physical Therapy Services. H.R. 1829: authorizing physical therapists to evaluate and treat Medicare beneficiaries without physician referral. Medicare/Part D Premiums. H.R. 1832: limiting Part D premium increases to no more than the Social Security cost-of-living adjustment and requiring the Secretary of Health and Human Services to negotiate lower prescription drug prices. Medicare/Cancer Hospice and Palliative Care. H.R. 1844: provisions authorizing coverage of comprehensive cancer care planning, establishing a Medicare hospice care demonstration, and authorizing grant programs for cancer palliative care and symptom management, provider education, and related research. Medicare/Hospice and Advanced Care Planning. S. 1150, H.R. 2911: provisions related to changing hospice payments and providing advance care planning resources. Medicare/Physician-Manufacturer Transparency. S. 301: increasing the transparency of the relationship between physicians and the manufacturers of drugs, devices, biologicals, and medical supplies. Medicare/Care Coordination Services. S. 1131, H.R. 2560: provisions establishing pilot care coordination program. Medicaid/Home and Community-based Long Term Care. S. 434, S.1257, H.R. 28552: provisions to remove barriers to providing home and community-based services including providing a state option to provide home and community-based services to individuals for whom such services are likely to prevent, delay, or decrease the likelihood of an individual's need for institutionalized care and authorizing the implementation of assistance grants for states electing to provide home and community-based services under Medicaid; provisions to provide a single point of entry to long term services; provisions to support nursing home diversion programs. Medicaid/Community-based Attendant Services and Supports. S. 683, H.R. 1670: authorizing coverage of community-based attendant services and supports under Medicaid, increasing funding and establishing a demonstration program for beneficiaries dually eligible for Medicare and Medicaid.

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

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

- Systemic Risk Regulator - Insurance Regulation - Office of Insurance Information - HR 1721/ S 697, "A bill to amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance" a/k/a "Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - S 434, "A bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes" a/k/a "Empowered at Home Act", regarding all provisions. - HR 897, "To amend the Internal Revenue Code of 1986 to allow individuals a deduction for qualified long-term care insurance premiums, use of such insurance under cafeteria plans and flexible spending arrangements, and a credit for individuals with long-term care needs" a/k/a "Long-Term Care and Retirement Security Act of 2009", regarding all provisions. - HR 1880, "To establish a system of regulation and supervision for insurers, insurance agencies, and insurance producers chartered or licensed under Federal law that ensures the stability and financial integrity of those insurers, agencies, and producers and that protects policyholders and other consumers served by such insurers, agencies, or producers", a/k/a "The National Insurance Consumer Protection Act", regarding all provisions. - HR 2609, "To establish an Office of Insurance Information in the Department of the Treasury", a/k/a "Insurance Information Act of 2009", regarding all provisions. -HR 2554, "To reform the National Association of Registered Agents and Brokers, and for other purposes", regarding all provisions. - HR 1721/S 697, "A bill to amend the Public Health Service Act to help individuals with functional impairments and their families pay for services and supports that they need to maximize their functionality and independence and have choices about community participation, education, and employment, and for other purposes", a/k/a "Community Living Assistance Services and Supports Act", regarding all provisions. - S 1177, "A bill to improve consumer protections for purchasers of long-term care insurance, and for other purposes", a/k/a "Long-Term Care Insurance Act of 2009", regarding all provisions. - HR 2096, "To amend the Internal Revenue Code of 1986 to allow long-term care insurance to be offered under cafeteria plans and flexible spending arrangements and to provide additional consumer protections for long-term care insurance", a/k/a "The Long-Term Care Affordability and Security Act of 2009", regarding all provisions. - The Administration's Regulatory Reform Proposal, regarding all provisions.

Client expense: $1,020,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Securities & Exchange Commission (SEC), U.S. Trade Representative (USTR)

The Direct Support Professional Fairness and Security Act of 2009 (H.R. 868) --supported bill Designation of the Week of September 13th as National Direct Support Professional Awareness Week -- worked with Senators' Offices to introduce resolution Community Living Assistance Services and Supports Act of 2009: (H.R. 1791 and S. 627) -- supported bill Community Choice Act of 2009:( H.R. 1670 and S. 683) -- supported bill Empowered at Home Act of 2009: (H.R. 2688 and S. 434) --- supported bill

Client expense: $44,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PL 108-173, Medicare Prescription Drug, Improvement & Modernization Act of 2003, all provisions relating to the establishment of a new Part D voluntary prescription drug Benefit program, Medicare coverage of care coordination services for individuals with chronic conditions and eliminating the two-year wiating period for Medicare coverage for people under age 65 with disabilities. HR6331 Medicare Improvements for patients and providers Act of 2008 - all provisions related to beneficiary improvements. S2499, Medicare, Medicaid and SCHIP extension act of 2007 - all provisions relating to Medicare and establishing a Medicare Chronic Care Demonstration Program S. 434 and H.R. 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community based services under the Medicaid Program, ond for other purposes. S.700/H.R.1708 Ending the Medicare Disability Waiting Period Act of 2009, a bill to amend Title II of the Social Security Act to phase out the 24-month wating period for disabled individuals to become eligible for Medicare benefits to eliminate the waiting period for individuals with life threatening conditions, and for other purposes. No Bill # - Care Coordiation legislation to include people with cognitive impairments. No Bill # - Maintaining hospice benefits for people with dementia. No Bill # - Health Care Reform legislation No Bill # - Alzheimer Solution Project Bill S.1131/H.R.2560 - Independence at Home Act. A bill to amend XVIII of the Social Security Act to provide certain high cost Medicare beneficiaries suffering from multiple chronic conditions with access to coordinated, primary care medical services in lower cost treatment settings.

Client expense: $90,000 · Firm income: Not reported

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

Medicare and Medicaid DHS payments--Advocated in support of continued Medicare and Medicaid disproportionate share hospital payments. Medicare--Submitted comments on the proposed changes to Medicare Impatient Prospective Payment System. Medicare issues--advocacy regarding physician supervision for outpatient therapeutic services; readmissions proposals; bundling of provider payments; quality improvements and pay-for-performance. Medicaid issues--advocacy regarding expanding eligibility levels, auto enrollment and presumptive eligibility, and limited co-pays. S. 434--Empowered at Home Act--A bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes. S. 683--Community Choice Act--A bill to amend title XIX of the Social Security Act to provide individuals with disabilities and older Americans with equal access to community-based attendant services and supports, and for other purposes.

Client expense: $240,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), SENATE, Treasury, Dept of, White House Office

HR 27Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the State Children's Health Insurance Program for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465,a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a Centers for Medicare & Medicaid Services Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Senator Schumer and Senator Roberts Letter eliminating IME Cuts CMS to withdraw the Capital IME cut that was included in last years Medicare IPPS rule; Letter to President Obama from Neal/ Tiberi on Capital IME PROTECT AMERICAS TEACHING HOSPITALS, asking him to withdraw a provision in the FY 2010 IPPS rule that would cut reimbursements to teaching hospitals. Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS).Working on legislation to amend the Medicare Recovery Audit Contractor Program. S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare Program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letter to CMS, Physician Supervision for Outpatient Service, Resend policy changes requiring PSO therapeutic Service in and on hospital campus. Withdraw it to minimize legal risk; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009A bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals, and for other purposes HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the Medicare Payment Advisory Commission on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy.

Client expense: $3,490,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office

S. 683 and H.R. 1670, Community Choice Act, provisions providing independence for individuals with disabilities. P.L. 109-171, implementation of the Deficit ReductionAct, provisions dealing with Medicaid. H.R. 868, Direct Support Professionals Fairness and Security Act. Legislation dealing with direct support worker issues. Implementation of Medicaid Section 1917 (d) regarding trusts and transfer of asset rules. The Empowered at Home Act of 2009, to amend the Medicaid Section 1915 (i) Home and Community Based Services Option. Implementation of the Olmstead decision regarding community integration. Health Care Reform, including long term services and supports. Federal Medical Assistance Percentage (FMAP increase. S. 493 and H.R. 1205, Achieving a Better Life Experience Act of 2009. S. 434 and H.R. 2688, Empowered at Home Act. Home and Community Based Services Waiver (Section 1915(c)) and Option (Section 1915 (i)).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Education, Dept of, Election Assistance Commission (EAC), Equal Employment Opportunity Commission (EEOC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office