Ending the Medicare Disability Waiting Period Act of 2009

H.R. 1670/S. 683, the "Community Choice Act" H.R. 1708/S. 700, the "Ending the Medicare Disability Waiting Period Act of 2009" The "Benefits Rating Acceleration for Veterans Entitlement Act (BRAVE)

Client expense: $85,269 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

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

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

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

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would 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. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. -- Worked with numerous consumer, manufacturer, and supplier groups on crafting legislation that would create a separate benefit category for complex rehab equipment under Medicare. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

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

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

HR 3248/ S 1283: Lifespan Respite Care Act of 2005; HR 4281: Small Business Health Fairness Act; PL 109-365: Older Americans Act Amendments of 2006; Older Americans Act Reauthorization; Healthcare reform policy; HR 2/PL 111-3: CHIP Reauthorization; HR 3267/S 1760: Healthy Start Reauthorization Act of 2007; HR 1017/S 578: Protecting Children's Health in Schools Act; HR 6111: Tax Relief and Health Care Act of 2006; Combating Autism Act; Expanding the Promise for Individuals with Autism Act; FY 2009 and FY 2010 Labor-HHS-Education Appropriations; PL 110-343: Paul Wellstone and Pete Domenici Mental Health Parity Act; HR 2502: Comparative Effectiveness Research Act of 2009; S 1213: Patient Centered Outcomes Research Act of 2009; HR 3200/S 1679: America's Affordable Health Choices Act of 2009; HR 1708/S 700: Ending the Medicare Disability Waiting Period Act of 2009; S 1630: Affordable Access to Prescription Medications Act of 2009; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; HR 4213 American Jobs and Closing Tax Loopholes Act; HR 1347: Concussion Treatment and Care Tools Act of 2010; and PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act.

Client expense: $57,615 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 (medical malpractice reform) H.R. 1468, Medical Justice Act of 2009 (medical malpractice reform) S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act (medical malpractice reform) S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act H.R. 667, the Heroes at Home Act H.R. 2505, the Reaching Rural Veterans Through Telehealth Act H.R. 5025, HITECH Extension for Behavioral Health Services Act of 2010 S.3709, HITECH Extension for Behavioral Health Services Act of 2010 H.R. 5466, SAMHSA Modernization Act of 2010 H.R. 5636, Community Mental Health and Addiction Safety Net Equity Act of 2010 H.R. 5712, Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 H.R. 5295, Healthcare Truth and Transparency Act of 2010 H.R. 4985, Medicare Decisions Accountability Act of 2010 (repeal IPAB) S. 3425, Embedded Mental Health Providers for Reserves Act of 2010 H.R. 5392, Council on Integration of Health Care Education Act of 2010 H.R. 6147, to treat psychologists as physicians under Medicare H.R.6143, Medicare Mental Health Inpatient Equity Act CMS-1504-P: Medicare Program: Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates (August 3, 2010). Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011; Proposed Rule; CMS-1503-P; 75 Federal Register 40,040 (July 13, 2010).

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

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

H.R. 1693/S. 671, Seniors Mental Health Access Improvement Act of 2009 (MFTs and MHCs under Medicare) H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act of 2009 H.R. 5025, HITECH Extension for Behavioral Health Services Act of 2010 S.3709, HITECH Extension for Behavioral Health Services Act of 2010 H.R. 5636, Community Mental Health and Addiction Safety Net Equity Act of 2010 H.R. 5712, Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 H.R. 4985, Medicare Decisions Accountability Act of 2010 (repeal IPAB) H.R. 5290, More Doctors, More Choices Act of 2010 H.R. 6147, to treat psychologists as physicians under Medicare H.R.6143, Medicare Mental Health Inpatient Equity Act CMS-1504-P: Medicare Program: Proposed Changes to the Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates (August 3, 2010). Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011; Proposed Rule; CMS-1503-P; 75 Federal Register 40,040 (July 13, 2010).

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

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

H.R. 1670/S. 683, the "Community Choice Act" H.R. 1708/S. 700, the "Ending the Medicare Disability Waiting Period Act of 2009" The "Benefits Rating Acceleration for Veterans Entitlement Act (BRAVE)" ( Providing for expedition disability ratings for Social Security Disability Insurance)

Client expense: $68,397 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

HR 1558 & S 623: Pre-existing Condition Patient Protection Act HR 1708 & S 700: Ending the Medicare Disability Waiting Period Act of 2009 HR 1085 & S 442: Health Insurance Coverage Protection Act HR 2408 & S 1545: Scleroderma Research and Awareness Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would 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. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratoriumon Medicare therapy caps. Supported HR 4213 to extend federal FMAP assistance to the states until June 2011. Opposed HR 1255, a bill that would make it more difficult for the Protection and Advocacy System to file suits on behalf of people who are confined to institutions. See also Health.

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

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

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

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

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

HR 3248/ S 1283: Lifespan Respite Care Act of 2005; HR 4281: Small Business Health Fairness Act; PL 109-365: Older Americans Act Amendments of 2006; Older Americans Act Reauthorization; Healthcare reform policy; HR 2/PL 111-3: CHIP Reauthorization; HR 3267/S 1760: Healthy Start Reauthorization Act of 2007; HR 1017/S 578: Protecting Children's Health in Schools Act; HR 6111: Tax Relief and Health Care Act of 2006; Combating Autism Act; Expanding the Promise for Individuals with Autism Act; FY 2009 and FY 2010 Labor-HHS-Education Appropriations; PL 110-343: Paul Wellstone and Pete Domenici Mental Health Parity Act; HR 2502: Comparative Effectiveness Research Act of 2009; S 1213: Patient Centered Outcomes Research Act of 2009; HR 3200/S 1679: America's Affordable Health Choices Act of 2009; HR 1708/S 700: Ending the Medicare Disability Waiting Period Act of 2009; S 1630: Affordable Access to Prescription Medications Act of 2009; HR 3590: The Patient Protection and Affordable Care Act; HR 3962: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; HR 4213 American Jobs and Closing Tax Loopholes Act.

Client expense: $70,970 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

P.L. 108-171, Deficit Reduction Act of 2005, extension of FMAP increase. Funding for Lifespan Respite Care Act, provisions that address respite care services for family caregivers of individuals with special needs. Increase Federal Medical Assistance Percentage (FMAP). Implementation of Affordable Coverage Act, P.L. 111-148 and P.L. 111-192, including long term services and supports, and the Community Living Assistance Services and Supports (CLASS Act). S. 700 and H.R. 1708, End the Medicare Disabilities Waiting Period Act. H.R. 868, Direct Support Professional Fairness and Security Act. H.R. 2390, Guidance, Understanding, and Information for Dual-Eligibles (GUIDE) Act of 2009. Health Care and Education Affordability Reconciliation Act, P.L. 111-152.

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), SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office

H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 H.R. 1468, Medical Justice Act of 2009 S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act H.R. 3962, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R. 667, the Heroes at Home Act H.R. 2505, the Reaching Rural Veterans Through Telehealth Act S. 1776, Medicare Physician Fairness Act of 2009 H.R. 5025, HITECH Extension for Behavioral Health Services Act of 2010 H.R. 5466, SAMHSA Modernization Act of 2010 H.R. 5636, Community Mental Health and Addiction Safety Net Equity Act of 2010 H.R. 5712, Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 H.R. 5295, Healthcare Truth and Transparency Act of 2010 H.R. 4985, Medicare Decisions Accountability Act of 2010 S. 3425, Embedded Mental Health Providers for Reserves Act of 2010 H.R. 5392, Council on Integration of Health Care Education Act of 2010 Interim Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Docket No. CMS-2009-0040-0048; 75 Federal Register 5410 (February 2, 2010) HIPAA Privacy Rule Accounting of Disclosures Under the Health Information Technology for Economic and Clinical Health Act; Request for Information; 75 Federal Register 23214 (May 3, 2010)

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

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

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

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

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

H.R. 1670/S. 683, the "Community Choice Act" H.R. 1708/S. 700, the "Ending the Medicare Disability Waiting Period Act of 2009" The "Benefits Rating Acceleration for Veterans Entitlement Act (BRAVE)" (Providing for expediting disability ratings for Social Security Disability Insurance)

Client expense: $85,026 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

HR 1558 & S 623: Pre-existing Condition Patient Protection Act HR 1708 & S 700: Ending the Medicare Disability Waiting Period Act of 2009 HR 1085 & S 442: Health Insurance Coverage Protection Act HR 2408 & S 1545: Scleroderma Research and Awareness Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare/Part B Premium Hold Harmless. H.R. 3631: Provisions extending the current "hold harmless" policy to all Medicare enrollees to ensure 2010 Part B monthly premiums remain at the current rate. Medicare/Private Contracts. H.R. 164: prohibiting denial of Social Security benefits to persons who elect not to participate in Medicare. 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/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.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would 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. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. -- Advocated that Center for Medicare and Medicaid Services (CMS) make Medicare Part D improvements including reassignmentof Low Income Subsity (LIS) recipients who have previously chosen Part D plans based on premium lability, curb waste of unused drugs, address the established price threshold for prescription medications to be included on the Specialty Tier i Part D plans' formularies, address the problems of co-payments and co-insurance and pricing of both specialty tier medications and all medications, create an appeals process for medications placed on specialty tiers, and study the impact of excessive cost-sharing. -- Supported extending the moratorium on Medicare therapy caps. See also Health.

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

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

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

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

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

H.R. 20/S. 324, Melanie Blocker Stokes Mom's Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act H.R. 193, AmeriCare Health Care Act of 2009 H.R. 468/S. 245, Retooling the Health Care Workforce for an Aging America Act of 2009 H.R. 619, to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases H.R. 676, United States National Health Care Act or the Expanded and Improved Medicare for All Act H.R.1011, Community Mental Health Services Improvement Act H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 H.R. 194, MediKids Health Insurance Act of 2009 H.R. 211/S. 211, Calling for 2-1-1 Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 (medical malpractice reform) H.R. 1468, Medical Justice Act of 2009 (medical malpractice reform) S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act (medical malpractice reform) H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 H.R. 914, Physician Workforce Enhancement Act of 2009 H.R. 1457, Geriatrics Loan Forgiveness Act of 2009 H.R. 1932/S. 999 Child Health Care Crisis Relief Act of 2009 H.R. 2537, Mental Health in Schools Act of 2009 H.R. 3090, Health Equality and Accountability Act of 2009 S. 1136/H.R. 3065, Mental Illness Chronic Care Improvement Act S. 391, Healthy Americans Act S. 1110/H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1679, Affordable Health Choices Act H.R. 3191, Positive Aging Act of 2009 H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 3961, Physician Payment Reform Act of 2009 H.R. 1721/S. 697, Community Living Assistance Services and Supports (CLASS) Act H.R. 4204/S. 1857, Establishing a Network of Health-Advancing National Centers of Excellence for Depression (ENHANCED) Act of 2009 H.R. 667, the Heroes at Home Act H.R. 2505, the Reaching Rural Veterans Through Telehealth Act S. 1776, Medicare Physician Fairness Act of 2009 H.R. 4872, Health Care and Education Reconciliation Act of 2010 Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule; 75 Federal Register 1844 (January 13, 2010) Interim Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Docket No. CMS-2009-0040-0048; 75 Federal Register 5410 (February 2, 2010)

Client expense: $190,000 · Firm income: Not reported

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

H.R. 193, AmeriCare Health Care Act of 2009 H.R. 468/S. 245, Retooling the Health Care Workforce for an Aging America Act of 2009 H.R. 619, to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases H.R. 676, Expanded and Improved Medicare for All Act H.R. 1693/S. 671, Seniors Mental Health Access Improvement Act of 2009 (MFTs and MHCs under Medicare) H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 H.R. 194, MediKids Health Insurance Act of 2009 S. 391, Healthy Americans Act S. 1110, H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1136, Mental Illness Chronic Care Improvement Act of 2009 S. 1679, Affordable Health Choices Act H.R. 3191, Positive Aging Act of 2009 H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 3961, Physician Payment Reform Act of 2009 H.R. 4204/S. 1857, Establishing a Network of Health-Advancing National Centers of Excellence for Depression (ENHANCED) Act of 2009 S. 1776, Medicare Physician Fairness Act of 2009 H.R. 4872, Health Care and Education Reconciliation Act of 2010

Client expense: $190,000 · Firm income: Not reported

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

P.L. 108-171, Deficit Reduction Act of 2005, implementation of provisions dealing with Medicaid, TANF, other human services. Funding for Lifespan Respite Care Act, provisions that address respite care services for family caregivers of individuals with special needs. Increase Federal Medical Assistance Percentage (FMAP). Health Care Reform, including long term services and supports, and the Community Living Assistance Services and Supports (CLASS Act). S. 700 and H.R. 1708, End the Medicare Disabilities Waiting Period Act. H.R. 868, Direct Support Professional Fairness and Security Act. H.R. 2390, Guidance, Understanding, and Information for Dual-Eligibles (GUIDE) Act of 2009. H.R. 3200, America's Affordable Health Choices Act of 2009. S. 1679, Affordable Health Choices Act. Senate Finance Committee bill: America's Healthy Future Act of 2009 (no number yet). S. 1213, Patient-Centered Outcomes Research Act of 2009. Patient Protection and Affordable Care Act, P.L. 111-148. H.R. 3962, Affordable Health Care for America Act. Health Care and Education Affordability Reconciliation Act, P.L. 111-152.

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

HR 3248/ S 1283: Lifespan Respite Care Act of 2005; HR 4281: Small Business Health Fairness Act; PL 109-365: Older Americans Act Amendments of 2006; Older Americans Act Reauthorization; Healthcare reform policy; HR 2/PL 111-3: CHIP Reauthorization; HR 3267/S 1760: Healthy Start Reauthorization Act of 2007; HR 1017/S 578: Protecting Children's Health in Schools Act; HR 6111: Tax Relief and Health Care Act of 2006; Combating Autism Act; Expanding the Promise for Individuals with Autism Act; FY 2009 and FY 2010 Labor-HHS-Education Appropriations; PL 110-343: Paul Wellstone and Pete Domenici Mental Health Parity Act; HR 2502: Comparative Effectiveness Research Act of 2009; S 1213: Patient Centered Outcomes Research Act of 2009; HR 3200/S 1679: America's Affordable Health Choices Act of 2009; HR 1708/S 700: Ending the Medicare Disability Waiting Period Act of 2009; S 1630: Affordable Access to Prescription Medications Act of 2009; HR 3590: The Patient Protection and Affordable Care Act; HR 3962: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010.

Client expense: $46,308 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

H.R. 1670/S. 683, the "Community Choice Act" H.R. 1708/S.700, the "Ending the Medicare Disability Waiting Period Act of 2009" The "Benefits Rating Acceleration for Veterans Entitlement Act (BRAVE) " (Providing for expediting disability ratings for Social Security Disability Insurance

Client expense: $131,076 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

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. Medicare/Private Contracts. H.R. 164: prohibiting denial of Social Security benefits to persons who elect not to participate in Medicare. 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/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.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare/Part B Premium Hold Harmless. H.R. 3631: Provisions extending the current "hold harmless" policy to all Medicare enrollees to ensure 2010 Part B monthly premiums remain at the current rate. Comprehensive Health Care Reform. 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

H.R .1558 & S. 623: Pre-existing Condition Patient Protection Act H.R. 1708 & S. 700: Ending the Medicare Disability Waiting Perion Act of 2009 H.R .1085 & S. 442: Health Insurance Coverage Protection Act H.R. 2408 7 S. 1545: Scleroderma Research and Awareness Act H.R. 3200: America Affordable Health Care Choices Act S. 1679: Affordable Health Choices Act H.R. 3962: Affordable Health Care for America Act H.R. 3590: Patient Protection and Affordable Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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.

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

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

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

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, Social Security Administration (SSA), Veterans Affairs, Dept of (VA)

See next page and see also HCR - Health Care Issues. Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform bills ) end the institutional bias in Medicaid; 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. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with and communicated with the Medicare Ombudsman office to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance. HR 3631 Medicare Premium Fairness Act Makes premiums for Medicare Part B and the related monthly actuarial rate the same as those for 2009 for all Medicare enrollees, notwithstanding no COLAs (Cost of Living Adjustments). Urged legislation to clarify that state Medicaid plans must ensure the provision of mandated care and Services to needy individuals not simply reimburse them, if they manage to obtain such services. (HR 3200 s. 1781(e) (page 826)) Without such a clarifying provision, current trends in the courts could significantly contract the availability of health services to underserved individuals and groups.

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, Social Security Administration (SSA), Veterans Affairs, Dept of (VA)

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

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Treasury, Dept of, Veterans Affairs, Dept of (VA)

See next page and see also HCR - Health Care Issues. Medicare/Medicaid Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform) Advocated to end the institutional bias in Medicaid. The bill would 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. HR 3790 to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with CMS officials to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 a bill to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance Supported HR 3799 that would cap out of pocket prescription costs at a max of $200 per prescription and at $500 total for any group of prescriptions in Medicare Part D. For people with chronic conditions who participate in Medicare Part D the increasing costs of specialty medicines can cause hardships and make access to prescription drugs unattainable. Supported HR 3621, the Medicare Premium Fairness Act, to protect millions of seniors and people with disabilities who receive Social Security benefits from unfair increases in their 2010 Medicare Part B premiums. See also Health.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA), Treasury, Dept of, Veterans Affairs, Dept of (VA)

HR 3248/ S 1283: Lifespan Respite Care Act of 2005; HR 4281: Small Business Health Fairness Act; PL 109-365: Older Americans Act Amendments of 2006; S 845: Safety of Seniors Act of 2007; Healthcare reform policy; HR 2/PL 111-3: CHIP Reauthorization; HR 3267/S 1760: Healthy Start Reauthorization Act of 2007; HR 1017/S 578: Protecting Children's Health in Schools Act; HR 6111: Tax Relief and Health Care Act of 2006; Combating Autism Act; Expanding the Promise for Individuals with Autism Act; FY 2009 and FY 2010 Labor-HHS-Education Appropriations; PL 110-343: Paul Wellstone and Pete Domenici Mental Health Parity Act; HR 2502: Comparative Effectiveness Research Act of 2009; S 1213: Patient Centered Outcomes Research Act of 2009; HR 3200/S 1679: America's Affordable Health Choices Act of 2009; HR 1708/S 700: Ending the Medicare Disability Waiting Period Act of 2009; S 1630: Affordable Access to Prescription Medications Act of 2009; HR 3590: The Patient Protection and Affordable Care Act; HR 3962: Affordable Health Care for America Act.

Client expense: $55,786 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

H.R. 193, AmeriCare Health Care Act of 2009 H.R. 468/S. 245, Retooling the Health Care Workforce for an Aging America Act of 2009 H.R. 619, to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases H.R. 676, United States National Health Care Act or the Expanded and Improved Medicare for All Act H.R. 1693/S. 671, Seniors Mental Health Access Improvement Act of 2009 (MFTs and MHCs under Medicare) H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 H.R. 194, MediKids Health Insurance Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 S. 391, Healthy Americans Act S. 1110, H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1136, Mental Illness Chronic Care Improvement Act of 2009 S. 1679, Affordable Health Choices Act H.R. 3191, Positive Aging Act of 2009 H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 3961, Physician Payment Reform Act of 2009 S. 1857, H.R. 4204, Enhanced Act of 2009 S. 1776, Medicare Physician Fairness Act of 2009 Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010; Final Rule; 74 Federal Register 617380 (November 25, 2009). Proposed Rule; Medicare Program; Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs Docket No. CMS-4085-P] 74 Federal Register 54633 (October 22, 2009)

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

H.R. 20/S. 324, Melanie Blocker Stokes Mom's Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act H.R. 193, AmeriCare Health Care Act of 2009 H.R. 468/S. 245, Retooling the Health Care Workforce for an Aging America Act of 2009 H.R. 619, to repeal the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases H.R. 676, United States National Health Care Act or the Expanded and Improved Medicare for All Act H.R.1011, Community Mental Health Services Improvement Act H.R. 1708/S. 700, Ending the Medicare Disability Waiting Period Act of 2009 H.R. 15, National Health Insurance Act H.R. 194, MediKids Health Insurance Act of 2009 H.R. 211/S. 211, Calling for 2-1-1 Act of 2009 H.R. 1086, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 (medical malpractice reform) H.R. 1468, Medical Justice Act of 2009 (medical malpractice reform) S. 45, Medical Care Access Protection Act of 2009 or the MCAP Act (medical malpractice reform) H.R. 1092, No Discrimination in Health Insurance Act of 2009 H.R. 1558, Preexisting Condition Patient Protection Act of 2009 H.R. 914, Physician Workforce Enhancement Act of 2009 H.R. 1457, Geriatrics Loan Forgiveness Act of 2009 H.R. 1932, S. 999 Child Health Care Crisis Relief Act of 2009 H.R. 3200, Americas Affordable Health Choices Act of 2009 H.R. 3014 Small Business Health Information Technology Financing Act of 2009 H.R. 2537, Mental Health in Schools Act of 2009 H.R. 3090, Health Equality and Accountability Act of 2009 S. 1136, Mental Illness Chronic Care Improvement Act S. 391, Healthy Americans Act S. 1110, H.R. 2718, Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009 S. 1136, Mental Illness Chronic Care Improvement Act of 2009 S. 1679, Affordable Health Choices Act H.R. 3191, Positive Aging Act of 2009 H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act H.R. 3961, Physician Payment Reform Act of 2009 H.R. 1721/S. 697, Community Living Assistance Services and Supports (CLASS) Act H.R. 4204/S. 1857, Establishing a Network of Health-Advancing National Centers of Excellence for Depression (ENHANCED) Act of 2009 S. 1857, H.R. 4204, Enhanced Act of 2009 H.R. 667, the Heroes at Home Act H.R. 2505, the Reaching Rural Veterans Through Telehealth Act S. 1776, Medicare Physician Fairness Act of 2009

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA)

P.L. 108-171, Deficit Reduction Act of 2005, implementation of provisions dealing with Medicaid, TANF, other human services. Funding for Lifespan Respite Care Act, provisions that address respite care services for family caregivers of individuals with special needs. Increase Federal Medical Assistance Percentage (FMAP). Health Care Reform, including long term services and supports, and the Community Living Assistance Services and Supports (CLASS Act). S. 700 and H.R. 1708, End the Medicare Disabilities Waiting Period Act. H.R. 868, Direct Support Professional Fairness and Security Act. H.R. 2390, Guidance, Understanding, and Information for Dual-Eligibles (GUIDE) Act of 2009. H.R. 3200, America's Affordable Health Choices Act of 2009. S. 1679, Affordable Health Choices Act. Senate Finance Committee bill: America's Healthy Future Act of 2009 (no number yet). S. 1213, Patient-Centered Outcomes Research Act of 2009. H.R. 3590, Patient Protection and Affordable Care Act. H.R. 3962, Affordable Health Care for America Act.

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

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

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

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

H.R. 1670/S. 683, the "Community Choice Act" H.R. 1708/S. 700, the "Ending the Medicare Disability Waiting Period Act of 2009" The "Benefits Rating Acceleration for Veterans Entitlement Act (BRAVE)" (Providing for expediting disability ratings for Social Security Disability Insurance)

Client expense: $93,024 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

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. Medicare/Private Contracts. H.R. 164: prohibiting denial of Social Security benefits to persons who elect not to participate in Medicare. 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/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.

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

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

H.R. 1558 & S. 623: Pre-existing Condition Patient Protection Act H.R. 1708 & S. 700: Ending the Medicare Disability Waiting Period Act of 2009 H.R. 1085 & S. 442: Health Insurance Coverage Protection Act H.R. 2408 & S. 1545: Scleroderma Research and Awareness Act H.R. 3200, America's Affordable Health Care Choices Act S. 1679, Affordable Health Choices Act HR 3962, Affordable Health Care for America Act HR 3590, Patient Protection and Affordable Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1030 & S 2803: Tom Lantos Pulmonary Hypertension Research and Education Act HR 1558 & S 623: Pre-existing Condition Patient Protection Act Pulmonary Hypertension Research Prog. at NIH HR 1085 & S 442: Health Insurance Coverage Protection Act Health Ins. Reform Legislation HR 1708 & S 700: Ending the Medicare Disability Waiting Period Act of 2009 H.R. 2866, Improving Access to Clinical Trials Act S. 1674, Improving Access to Clinical Trials Act H.R. 3200, America's Affordable Health Care Choices Act S. 1679, Affordable Health Choices Act H.R. 3962, Affordable Health Care for America Act H.R. 3590, Patient Protection and Affordable Care Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), SENATE

HR 1558 & S 623: Pre-existing Condition Patient Protection Act HR 2866, Improving Access to Clinical Trials Act HR 1708 & S 700: Ending the Medicare Disability Waiting Period Act S 1674, Improving Access to Clinical Trials Act HR 1085 & S 442: Health Insurance Coverage Protection Act HR 3200, America's Affordable Health Care Choices Act Marfan Syndrome Research and Education Programs at NIH S 1679, Affordable Health Choices Act HR 3962, Affordable Health Care for America Act HR 3590, Patient Protection and Affordable Care Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3200: America's Affordable Health Care Choices Act S 1679: Affordable Health Choices Act HR 3590: Patient Protection and Affordable Care Act HR 3962: Affordable Health Care for America Act HR 1558 & S 623: Pre-existing Condition Patient Protection Act HR 1708 & S 700: Ending the Medicare Disability Waiting Period Act of 2009 Inflammatory Bowel Disease Research Programs at NIH and CDC HR 1085 & S 442: Health Insurance Coverage Protection Act HR 2275 & S 981: Inflammatory Bowel Disease Research and Awareness Act

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

Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE

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.

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

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

See next page and see also HCR - Health Care Issues. Community Choice Act (HR 1670 and S 683) (changed to Community First Choice Option in health reform bills ) end the institutional bias in Medicaid; 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. Medicare In the Home restriction (HR 3184 and S 1186) - reintroduction of legislation to reverse the CMS rule that Medicare will pay for wheelchairs only as needed in the home rather than as needed for the individual to go to medical appointments, go to the pharmacy and grocery store, attend worship services, accompany children to school and other activities, vote and otherwise be independent and participate in the community. HR 2390, the Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act to provide one-on-one counseling to people with cognitive impairments navigate and protect their rights with regard to the confusing Part D Prescription Drug Benefit Program authorized under the Medicare Modernization Act (MMA) of 2003. S 700/HR 1708 to end the waiting period for Medicare for people who qualify for Title II Social Security disability benefits and people with life-threatening conditions. DME Competitive Bidding - Met with and communicated with the Medicare Ombudsman office to discuss implementation of the DMEPOS competitive bidding program to make the transition as easy as possible for members who are Medicare beneficiaries. S 1630 to amend Medicare to improve prescription drug coverage under Medicare part D and to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to improve prescription drug coverage under private health insurance. HR 3631 Medicare Premium Fairness Act Makes premiums for Medicare Part B and the related monthly actuarial rate the same as those for 2009 for all Medicare enrollees, notwithstanding no COLAs (Cost of Living Adjustments). Urged legislation to clarify that state Medicaid plans must ensure the provision of mandated care and Services to needy individuals not simply reimburse them, if they manage to obtain such services. (HR 3200 s. 1781(e) (page 826)) Without such a clarifying provision, current trends in the courts could significantly contract the availability of health services to underserved individuals and groups, just as

Client expense: $70,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, Social Security Administration (SSA), Veterans Affairs, Dept of (VA)