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Rural Medicare Equity Act of 2009
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vs 4,048 other S bills in the 111th — cohort avg 29d
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2010 · fourth_quarter · Medicare/Medicaid
HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services;. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines on governance which were intepreted to require that each organization with a CCN have a separate governing body, medical staff, etc. in order to be accredited ; HR 5712 Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program; HR 6005 Ensuring Equality for Early EHR Adoption Act of 2010, to amend titles XVIII and XIX of the Social Security Act to provide for the temporary treatment of certain electronic health records as certified EHR technology for purposes of health information technology payment incentives under the Medicare and Medicaid Programs. Sen. Stabenow and Sen. Murkoswki, Rep. Crowley and Rep. Sessions letter to CMS asking to reevaluate the proposed IPPS regulations that will hit hospital payments in FY 2011; Rep. Pomeroy and Rep. Moran letter to CMS, regarding concerns of the proposed Medicare OPPS regulation for FY 2011 does not show continued access to full range of outpatient therapeutic services for small, rural & CAH hospitals; Discussion with CMS about implementation of the self-referral disclosure protocol; HR 5712 Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 or Physician Payment and Therapy Relief Act of 2010, to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program; HR 6005 Ensuring Equality for Early EHR Adoption Act of 2010, to amend titles XVIII and XIX of the Social Security Act to provide for the temporary treatment of certain electronic health records as certified EHR technology for purposes of health information technology payment incentives under the Medicare and Medicaid Programs.
Bills with similar content found using semantic analysis.
Sources: Congress.gov
Client expense: $5,390,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office
2010 · third_quarter · Medicare/Medicaid
HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines, as currently interpreted guidelines would require accreditation of each hospital as a standalone entity and require them to each have a separate governing body, medical staff, etc. in order to be accredited by the joint commission; Crowley- Sessions Letter to CMS urging reevaluation of the IPPS regulation that would apply a 2.9 percent cut to hospital payments in FY 2011; Letter to CMS re development of the Self-referral disclosure protocol that is authorized by the PPACA; HR 5712 Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program; HR 6005 Ensuring Equality for Early EHR Adoption Act of 2010, to amend titles XVIII and XIX of the Social Security Act to provide for the temporary treatment of certain electronic health records as certified EHR technology for purposes of health information technology payment incentives under the Medicare and Medicaid Programs. Sen. Stabenow and Sen. Murkoswki, Rep. Crowley and Rep. Sessions letter to CMS asking to reevaluate the proposed IPPS regulations that will hit hospital payments in FY 2011; Pomeroy, Moran letter to CMS, regarding concersn of the proposed Medicare OPPS regulation for FY 2011 does not show continued access to full range of outpatient therapeutic services for small, rural & CAH hospitals.
Client expense: $4,270,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office
2010 · third_quarter · Medicare/Medicaid
The following bullet points summarize the objectives of the Marshfield Clinic's Health Policy Agenda: "promoting payment fairness in Medicare physician and practice expense payments; "new formulas for aligning Medicare reimbursement with value; "value-based purchasing of health services including bonus payments for high value Medicare Advantage programs; bonus payments for efficient providers; bonus payments for primary care providers; establishment and funding of comparative effectiveness research; financing for the adoption and utilization of health information technology; repeal and reform of the Medicare sustainable growth rate mechanism for updating physician payments; improved reimbursement for the CMS Physician Group Practice (PGP) demonstration; expansion of the PGP demonstration methodology into a national accountable care organization program to extend the physician group practice demonstration; and opposition to the establishment of a public option in Health Insurance Exchanges if it were to reimburse providers at Medicare rates. Value Index Rewarding Value in the Reimbursement System Congress must introduce a value index into Medicare Parts A and B, to reward physicians and hospitals who provide safe, high quality care with excellent service to Medicare patients at a reasonable cost. The value index can be constructed for many types of payment models, including hospital DRG payments, physician fees, payment updates, and other payment formulas. We recommend that the geographic adjustment of physician work should be eliminated as recommended in legislation introduced by Senator Feingold (S 712) and Senator Grassley (S 318), and replaced with a quality/efficiency based coefficient for physician work as soon as possible. Legislation that we strongly support and would accomplish this objective, has been introduced by Iowa Rep. Bruce Braley and Wisconsin Rep. Ron Kind in the House and by Minnesota Senator Amy Klobuchar and Wisconsin Senators Feingold and Kohl in the Senate. The Medicare Payment Improvement Act (HR 2844, S 1249) seeks to reform the Medicare system to one that rewards the value of care over quantity of procedures, improving quality and lowering the total cost of care over time. The bills outcome-based approach creates the incentive for physicians and hospitals to work together to improve quality and use resources efficiently. These provisions were included in Sections 1159 and 1160 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3007 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Value Based Purchasing In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. According to a recent report by the Congressional Budget Office spending in high-spending regions could be reduced without producing worse outcomes, on average, or reductions in the quality of care. (CBO February 2008) Alternatives: Medicare must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Improve access to care in rural areas. The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. Corresponding mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. Performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. These provisions were included in Sections 1161 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3201 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act will reward Medicare Advantage plans that achieve a quality ranking of four stars or above based on a five-star rating system. The current star rating system was initiated in 2007 to allow the Centers for Medicare and Medicaid Services (CMS) and Medicare beneficiaries to assess health plans based on quality. It was not designed to be a payment system, but could be used as a means to apply bonus payments to high-performing Medicare Advantage plans. The current star rating system incorporates some of the longest-standing quality measurements (HEDIS and CAHPS) in the health care system and provides a credible, solid starting point for evaluating health plan quality. Marshfield Clinic believes that the incorporation of the quality incentive provisions into Medicare Advantage is a significant step in the evolution of Medicare payment. The current star rating system is a credible starting point, and we look forward to the opportunity to work to improve the system in ways that will sustain a strong incentive and reward for better health outcomes for Medicare beneficiaries. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. The federal government developed formulas to evaluate the cost of providing services in different practice settings and in different geographic locations. Those formulas measure resource inputs that have changed over the +40 year life of the program. To ensure affordable access to Medicare services throughout the country Medicare must take steps to refine its measures of the cost of providing services so that Medicares overwhelming financial dominance does not interfere with affordable access in markets that have changed very much since the program began. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs. Meaningful Use On December 30, 2009, the Centers for Medicare & Medicare Services (CMS) and the ONC released two regulations required by the American Recovery and Reinvestment Act that lay the foundation for meaningful use of certified electronic health record (EHR) technology. A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of meaningful use of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Marshfield Clinic is vendor of a proprietary electronic medical record, and closely follows federal developments of the HHS office of the national coordinator and the it HIT Policy and Standards Committees to assure meaningful use of electronic medical records and efficient standards for certification and interoperability of unrelated systems. Payment Equity for Physician Work Before MMA 03, Medicares payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for 04 06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. The payment floor provision expired in 06, but has been extended in federal legislation every year since then. Alternatives: The payment floor should be extended indefinitely; Geographic adjustment of work should be eliminated entirely; and replaced with a coefficient of quality and efficiency. Support Senator Feingolds bill, the Rural Medicare Equity Act, S 712. These provisions were included in Sections 1157 and 1158 and 1194 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3102 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Comparative Effectiveness/Evidence Based Medical Informatics Research Evidence-based medicine relies upon the judicious use of current best evidence in making decisions about the care of individual patients. Key to effective implementation of value-based purchasing initiatives is the systematic development of data that links the health of populations to the medical services the population receives. The application of health information technology and genomic information in population- and community-based health care delivery systems coupled with the development of wellness programs has the potential to substantially improve health and personalized health care on a national basis. These provisions were included in Sections 1401 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 6301 and 6302 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Marshfield Clinic nominated Dr. Douglas Reding for an open position on the Medicare Payment Advisory Commission, and as a candidate for appointment to the Medicaid and CHIP Payment and Access Commission (MACPAC) in 2010. Marshfield Clinic nominated Marilyn Follen for an open nurse position on the Board of Governors of the Patient-Centered Outcomes Research Institute. Marshfield Clinic also supported the nomination of Dr Jeff Thompson of the Gundersen Lutheran Health System on the same Board of Governors. On March 20, 2010, HHS Secretary Sebelius wrote a letter to the House of Representatives Quality of Care Coalition stating that HHS would commission two studies by the Institute of Medicine to 1) evaluate hospital and physician geographic payment adjustments, the validity of the adjustment factors, and the sources of data used for such adjustments; and 2) examine the geographic variation in the volume and intensity of health care services ultimately recommending ways to incorporate quality and value metrics into the Medicare reimbursement system. Secretary Sebelius also announced that she plans to convene a National Summit on Geographic Variation, cost, Access, and Value in Health Care later this year. Practice expense geographic practice cost index (GPCI) adjustment: Retroactively effective from Jan. 1, 2010, HHS is required to revise the calculation method of the practice expense (PE) portion of the GPCI. This revision results in increased PE GPCIs for certain rural areas. Implementation of this provision will likely require CMS to reprocess certain 2010 claims (Sec. 3102 of HR 3590 as modified by Sec. 1108 of HR 4872 Reconciliation). CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Marshfield Clinic supported CMS determination to extend this program, beyond its initial 3-year term, and transition these organizations into Accountable care Organizations. Section 1301 of the House bill HR 3962, the Affordable Health Care for America Act, and Section 3022 of the Senate bill HR 3590, the Patient Protections and Affordable Care Act. Marshfield Clinic Also supported efforts to eliminate the 2% threshold for payments and the 5% limitation on payments in the PGP demonstration. The Reconciliation Act of 2010, HR 4872, introduced by Rep. John Spratt included Section 1108 amending Section 3102 of the Patient Protection and Affordable Care Act, which increase the practice expense component of Medicare physician payment in localities that are below the mean of costs nationwide, effective January 1, 2010. HR 4213: The American Jobs and Closing Tax Loopholes Act introduced by rep. Charles Rangel included a 6-month ARRA FMAP extension that would provide much needed Medicaid relief for states ($305 Million for Wisconsin alone). HR 4213 also included provisions canceling the pending reductions in physician reimbursement under the SGR formula. Marshfield Clinic urged Wisconsin Senators to support the extension of federal funding.
Client expense: $90,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE
2010 · second_quarter · Medicare/Medicaid
HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines, as currently interpreted guidelines would require accreditation of each hospital as a standalone entity and require them to each have a separate governing body, medical staff, etc. in order to be accredited by the joint commission; Crowley- Sessions Letter to CMS urging reevaluation of the IPPS regulation that would apply a 2.9 percent cut to hospital payments in FY 2011.
Client expense: $4,230,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office
2010 · second_quarter · Medicare/Medicaid
The following bullet points summarize the objectives of the Marshfield Clinic's Health Policy Agenda: "promoting payment fairness in Medicare physician and practice expense payments; "new formulas for aligning Medicare reimbursement with value; "value-based purchasing of health services including bonus payments for high value Medicare Advantage programs; bonus payments for efficient providers; bonus payments for primary care providers; establishment and funding of comparative effectiveness research; financing for the adoption and utilization of health information technology; repeal and reform of the Medicare sustainable growth rate mechanism for updating physician payments; improved reimbursement for the CMS Physician Group Practice (PGP) demonstration; expansion of the PGP demonstration methodology into a national accountable care organization program to extend the physician group practice demonstration; and opposition to the establishment of a public option in Health Insurance Exchanges if it were to reimburse providers at Medicare rates. Value Index Rewarding Value in the Reimbursement System Congress must introduce a value index into Medicare Parts A and B, to reward physicians and hospitals who provide safe, high quality care with excellent service to Medicare patients at a reasonable cost. The value index can be constructed for many types of payment models, including hospital DRG payments, physician fees, payment updates, and other payment formulas. We recommend that the geographic adjustment of physician work should be eliminated as recommended in legislation introduced by Senator Feingold (S 712) and Senator Grassley (S 318), and replaced with a quality/efficiency based coefficient for physician work as soon as possible. Legislation that we strongly support and would accomplish this objective, has been introduced by Iowa Rep. Bruce Braley and Wisconsin Rep. Ron Kind in the House and by Minnesota Senator Amy Klobuchar and Wisconsin Senators Feingold and Kohl in the Senate. The Medicare Payment Improvement Act (HR 2844, S 1249) seeks to reform the Medicare system to one that rewards the value of care over quantity of procedures, improving quality and lowering the total cost of care over time. The bills outcome-based approach creates the incentive for physicians and hospitals to work together to improve quality and use resources efficiently. These provisions were included in Sections 1159 and 1160 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3007 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Value Based Purchasing In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. According to a recent report by the Congressional Budget Office spending in high-spending regions could be reduced without producing worse outcomes, on average, or reductions in the quality of care. (CBO February 2008) Alternatives: Medicare must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Improve access to care in rural areas. The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. Corresponding mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. Performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. These provisions were included in Sections 1161 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3201 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act will reward Medicare Advantage plans that achieve a quality ranking of four stars or above based on a five-star rating system. The current star rating system was initiated in 2007 to allow the Centers for Medicare and Medicaid Services (CMS) and Medicare beneficiaries to assess health plans based on quality. It was not designed to be a payment system, but could be used as a means to apply bonus payments to high-performing Medicare Advantage plans. The current star rating system incorporates some of the longest-standing quality measurements (HEDIS and CAHPS) in the health care system and provides a credible, solid starting point for evaluating health plan quality. Marshfield Clinic believes that the incorporation of the quality incentive provisions into Medicare Advantage is a significant step in the evolution of Medicare payment. The current star rating system is a credible starting point, and we look forward to the opportunity to work to improve the system in ways that will sustain a strong incentive and reward for better health outcomes for Medicare beneficiaries. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. The federal government developed formulas to evaluate the cost of providing services in different practice settings and in different geographic locations. Those formulas measure resource inputs that have changed over the +40 year life of the program. To ensure affordable access to Medicare services throughout the country Medicare must take steps to refine its measures of the cost of providing services so that Medicares overwhelming financial dominance does not interfere with affordable access in markets that have changed very much since the program began. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs. Information Technology Under current law the capital and operating expenses of installing and maintaining electronic medical records (EMRs) are assumed to be part of the overhead expense of a medical practice. Since no more than 5 10% of the physician population has installed EMRs, CMS now obsolete measurement of physician practice expenses reflect minimal average expense associated with IT. Alternatives: Congress should provide incentives for EMR adoption, and/or utilization, and Establish standards to facilitate the sharing and exchange of data. CMS must update its mechanism for evaluating the cost of medical practice. On December 30, 2009, the Centers for Medicare & Medicare Services (CMS) and the ONC released two regulations required by the American Recovery and Reinvestment Act that lay the foundation for meaningful use of certified electronic health record (EHR) technology. A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of meaningful use of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Marshfield Clinic is vendor of a proprietary electronic medical record, and closely follows federal developments of the HHS office of the national coordinator and the it HIT Policy and Standards Committees to assure meaningful use of electronic medical records and efficient standards for certification and interoperability of unrelated systems. Payment Equity for Physician Work Before MMA 03, Medicares payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for 04 06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. The payment floor provision expired in 06, but has been extended in federal legislation every year since then. Alternatives: The payment floor should be extended indefinitely; Geographic adjustment of work should be eliminated entirely; and replaced with a coefficient of quality and efficiency. Support Senator Feingolds bill, the Rural Medicare Equity Act, S 712. These provisions were included in Sections 1157 and 1158 and 1194 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3102 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Comparative Effectiveness/Evidence Based Medical Informatics Research Evidence-based medicine relies upon the judicious use of current best evidence in making decisions about the care of individual patients. Key to effective implementation of value-based purchasing initiatives is the systematic development of data that links the health of populations to the medical services the population receives. The application of health information technology and genomic information in population- and community-based health care delivery systems coupled with the development of wellness programs has the potential to substantially improve health and personalized health care on a national basis. These provisions were included in Sections 1401 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 6301 and 6302 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Marshfield Clinic nominated Dr. Douglas Reding for an open position on the Medicare Payment Advisory Commission, and as a candidate for appointment to the Medicaid and CHIP Payment and Access Commission (MACPAC) in 2010. Marshfield Clinic nominated Marilyn Follen for an open nurse position on the Board of Governors of the Patient-Centered Outcomes Research Institute. Marshfield Clinic also supported the nomination of Dr Jeff Thompson of the Gundersen Lutheran Health System on the same Board of Governors. On March 20, 2010, HHS Secretary Sebelius wrote a letter to the House of Representatives Quality of Care Coalition stating that HHS would commission two studies by the Institute of Medicine to 1) evaluate hospital and physician geographic payment adjustments, the validity of the adjustment factors, and the sources of data used for such adjustments; and 2) examine the geographic variation in the volume and intensity of health care services ultimately recommending ways to incorporate quality and value metrics into the Medicare reimbursement system. Secretary Sebelius also announced that she plans to convene a National Summit on Geographic Variation, cost, Access, and Value in Health Care later this year. Practice expense geographic practice cost index (GPCI) adjustment: Retroactively effective from Jan. 1, 2010, HHS is required to revise the calculation method of the practice expense (PE) portion of the GPCI. This revision results in increased PE GPCIs for certain rural areas. Implementation of this provision will likely require CMS to reprocess certain 2010 claims (Sec. 3102 of HR 3590 as modified by Sec. 1108 of HR 4872 Reconciliation). CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Marshfield Clinic supported CMS determination to extend this program, beyond its initial 3-year term, and transition these organizations into Accountable care Organizations. Section 1301 of the House bill HR 3962, the Affordable Health Care for America Act, and Section 3022 of the Senate bill HR 3590, the Patient Protections and Affordable Care Act. Marshfield Clinic Also supported efforts to eliminate the 2% threshold for payments and the 5% limitation on payments in the PGP demonstration. The Reconciliation Act of 2010, HR 4872, introduced by Rep. John Spratt included Section 1108 amending Section 3102 of the Patient Protection and Affordable Care Act, which increase the practice expense component of Medicare physician payment in localities that are below the mean of costs nationwide, effective January 1, 2010. HR 4213: The American Jobs and Closing Tax Loopholes Act introduced by rep. Charles Rangel included a 6-month ARRA FMAP extension that would provide much needed Medicaid relief for states ($305 Million for Wisconsin alone). HR 4213 also included provisions canceling the pending reductions in physician reimbursement under the SGR formula. Marshfield Clinic urged Wisconsin Senators to support the extension of federal funding.
Client expense: $130,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Council of Economic Advisers (CEA), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE
2010 · first_quarter · Civil Rights/Civil Liberties
Legislation: HR 1064 Youth PROMISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; HR 1215 Immigration Oversight and Fairness Act - Issues Lobbied: Immigration detention; HR 1283 the Military Readiness Enhancement Act of 2009 - Issues Lobbied: Civil Rights, LGBT Rights; HR 1304 Free Speech Protection Act of 2009 - Issues Lobbied: First Amendment, free speech; HR 1315 the Terrorist Detainees Procedures Act of 2009 - Issues Lobbied: National Security, Detention/Interrogation; HR 1507 Whistleblower Protection Enhancement Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, Protections for National Security Whistleblowers; HR 1586 FAA Air Transportation Modernization and Safety Improvement Act - Issues Lobbied: Civil Rights, First Amendment, Religious Liberty, School Vouchers; HR 1623 International Megans Law of 2009 - Issues Lobbied: Criminal Justice; HR 1800 National Security Letters Reform Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, National Security Letter Power, Patriot Act Section 215; HR 1966 `Megan Meier Cyberbullying Prevention Act' - Issues Lobbied: First Amendment, Free Speech; HR 2200 TSA authorization/body scanning machines - Issues Lobbied: Privacy/bodily integrity; HR 2289 the Juvenile Justice Accountability and Improvement Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice; HR 2517 the Domestic Partner Benefits and Obligations Act - Issues Lobbied: Civil Rights, LGBT Rights; HR 2597 Positive Behavior for Safe and Effective Schools Act - Issues Lobbied: Racial Justice, Juvenile Justice; Education; School Discipline; Positive Behavior Supports; HR 2701 Intelligence Authorization Act for Fiscal Year 2010 - Issues Lobbied: Government oversight; open government.; HR 2847 Commerce, Justice, Science and Related Agencies Appropriations Act for FY10 - Issues Lobbied: Free speech (restrictions on Legal Services Corporation), Immigration courts, LOP; HR 3017 the Employment Non-Discrimination Act (ENDA) - Issues Lobbied: Civil Rights, LGBT Rights; HR 3221 Student Aid and Fiscal Responsibility Act of 2009 - Issues Lobbied: Privacy; HR 3245 the Fairness in Cocaine Sentencing Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy; HR 3288 Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2010 omnibus spending bill for FY10 - Issues Lobbied: Free speech (restrictions on Legal Services Corporation), Ending abstinence-only programs, funding more comprehensive approaches, establishing OAH; HR 3335 Democracy Restoration Act - Issues Lobbied: Felony Voting Rights; Racial Justice; HR 3458 Internet Freedom Preservation Act of 2009 - Issues Lobbied: First Amendment, Net Neutrality; HR 3471 Real ID repeal legislation - Issues Lobbied: National ID, religious liberty; HR 3567 the Respect for Marriage Act - Issues Lobbied: Civil Rights, LGBT Rights; HR 3590 Patient Protection and Affordable Care Act - Issues Lobbied: Abortion language, opposing MTR, Title V extension; HR 3630 The Adolescent Web Awareness Requires Education Act - Issues Lobbied: First Amendment, Free Speech; HR 3721 Protecting Older Workers Against Discrimination Act - Issues Lobbied: Employment Discrimination; Restoration of ADEA in light of Gross Supreme Court Case; HR 374 the Lawful Interrogation and Detention Act - Issues Lobbied: National Security, Detention/Interrogation; HR 3764 Civil Access to Justice Act of 2009 - Issues Lobbied: Free speech (restrictions on Legal Services Corporation); HR 3845 USA PATRIOT Amendments Act of 2009 - Issues Lobbied: Privacy, constitutional rights, national security.; HR 3961 To extend expiring provisions of the USA PATRIOT Improvement and Reauthorization Act of 2005 and Intelligence Reform and Terrorism Prevention Act of 2004 until February 28, 2011 - Issues Lobbied: Privacy, constitutional rights, national security.; HR 3962 Affordable Health Care for America Act - Issues Lobbied: Opposing abortion language; due process, privacyHR 3986 the Effective Death Penalty Appeals Act - Issues Lobbied: Civil Rights, Criminal Justice, Capital Punishment; HR 4005 Judicious Use of Surveillance Tools In Counterterrorism Efforts Act of 2009 - Issues Lobbied: Privacy, constitutional rights, national security.; HR 4115 Open Access to Courts Act of 2009 - Issues Lobbied: Due Process, Right to Petition, Equal Protection; HR 4335 Prison Abuse Remedies Act (and reform of the PLRA) - Issues Lobbied: Civil Rights, Criminal Justice, Prisoners Rights; HR 4364 Anti-SLAPP bil - Issues Lobbied: right to petition, free speech; HR 4470 Strong STANDARDS Act - Issues Lobbied: Support for bill; HR 4530 the Student Non-Discrimination Act (SNDA) - Issues Lobbied: Civil Rights, LGBT Rights, Education; HR 4556 A bill to prohibit the use of Department of Justice funds for the prosecution in Article III courts of the United States of individuals involved in the September 11, 2001 terrorist attackS - Issues Lobbied: National Security, Detention/Interrogation; HR 4621 Deceptive Census bill - Issues Lobbied: civil rights; HR 476 Housing Fairness Act - Issues Lobbied: civil rights; HR 4892 Enemy Belligerent Interrogation, Detention, and Prosecution Act of 2010 - Issues Lobbied: National Security, Detention/Interrogation; HR 894 Over-Classification Reduction Act - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, decreasing over-classification; HR 984 State Secret Protection Act of 2009 - Issues Lobbied: Separation of powers, constitutional rights, open government; HR 985 Free Flow of Information Act of 2009 To maintain the free flow of information to the public by providing conditions for the federally compelled disclosure of information by certain persons connected with the news media. - Issues Lobbied: First Amendment, Free Press, Defendants Rights; HRes 383 Establishing a Select Committee to Review National Security Laws, Policies and Practices - Issues Lobbied: Intelligence oversight; S 1261 PASS ID - Issues Lobbied: National ID, religious liberty; S 147 the Lawful Interrogation and Detention Act - Issues Lobbied: National Security, Detention/Interrogation; S 1490 Personal Date Privacy and Security Act - Issues Lobbied: privacy; S 1494 Intelligence Authorization Act for Fiscal Year 2010 - Issues Lobbied: Government oversight; open government, Intelligence oversight; S 1504 A bill to provide that Federal courts shall not dismiss complaints under rule 12(b)(6) or (e) of the Federal Rules of Civil Procedure, except under the standards set forth by the Supreme Court of the United States in Conley v. Gibson, 355 U.S 41 (1957). - Issues Lobbied: Due Process, Right to Petition, Equal Protection; S 1504 Notice Pleading Restoration Act of 2009 - Issues Lobbied: Due Process, Right to Petition, Equal Protection; S 1516 Democracy Restoration Act - Issues Lobbied: Felony Voting Rights; Racial Justice; S 1549 Protect Citizens and Residents from Unlawful Detention Act - Issues Lobbied: Support for bill; S 1550 Strong STANDARDS Act - Issues Lobbied: Support for bill; S 1584 the Employment Non-Discrimination Act (ENDA) - Issues Lobbied: Civil Rights, LGBT Rights; S 1594 Secure and Safe Detention and Asylum Act - Issues Lobbied: Support for bill; S 1686 Judicious Use of Surveillance Tools In Counterterrorism Efforts Act of 2009 - Issues Lobbied: Privacy, constitutional rights, national security; S 1692 USA Patriot Act Sunset Extention Act of 2009 - Issues Lobbied: Privacy, Civil Liberties, FBI oversight, Patriot Act issues, constitutional rights, national security; S 1756 Protecting Older Workers Against Discrimination Act - Issues Lobbied: Employment Discrimination; Restoration of ADEA in light of Gross Supreme Court Case; S 1789 the Fair Sentencing Act - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy; S 182 Paycheck Fairness Act - Issues Lobbied: Womens Rights, Employment Discrimination, Legislation Updating the Equal Pay Act; S 2959 American Elections Act of 2010 - Issues Lobbied: free speech; S 2977 A bill to prohibit the use of Department of Justice funds for the prosecution in Article III courts of the United States of individuals involved in the September 11, 2001 terrorist attackS - Issues Lobbied: National Security, Detention/Interrogation; S 3065 the Military Readiness Enhancement Act of 2010 - Issues Lobbied: Civil Rights, First Amendment, LGBT Rights, Academic Freedom; S 3081 Enemy Belligerent Interrogation, Detention, and Prosecution Act of 2010 - Issues Lobbied: National Security, Detention/Interrogation; S 3113 Refugee Protection Act of 2010 - Issues Lobbied: Due Process, Immigrants Rights; S 372 Whistleblower Protection Enhancement Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, Protections for National Security Whistleblowers; S 417 State Secrets Protection Act of 2009 - Issues Lobbied: Open government; S 435 the Youth PROMISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; S 448 Free Flow of Information Act of 2009 A bill to maintain the free flow of information to the public by providing conditions for the federally compelled disclosure of information by certain persons connected with the news media - Issues Lobbied: First Amendment, Free Press, Defendants Rights; S 449 Free Speech Protection Act of 2009 A bill to protect free speech. - Issues Lobbied: First Amendment; S 678 the Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; S 712 Civil Access to Justice Act of 2009 - Issues Lobbied: Free speech (restrictions on Legal Services Corporation); S 714 the National Criminal Justice Commission Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Drug Policy; S 773 Cybersecurity - Issues Lobbied: Communications privacy, executive power; HR 2892 Homeland Security Appropriations - Issues Lobbied: Detention, 287(g) report language; Other Congressional Matters: Other Congressional Matters: Airline Security - Issues Lobbied: Privacy, 4th Amendment; Appointed counsel - Issues Lobbied: civil rights; Campaign finance issues - Issues Lobbied: Free Speech; Census issues - Issues Lobbied: Civil rights; Civil Rights Act of 2009 (no bill introduced) - Issues Lobbied: Racial Justice; Employment Discrimination; Restoring Civil Rights Protections; Comprehensive Immigration Reform - Issues Lobbied: due process, profiling; Corporal Punishment - Issues Lobbied: Racial Justice; Disability Rights; Corporal Punishment in Public Schools; Criminal Investigation, Special Prosecutor Torture Inquiry - Issues Lobbied: National Security, Torture/Detention/Interrogation; DHS Intelligence/Information Sharing - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers; DHS/TSA Oversight - Issues Lobbied: Limiting use of WBI, ending 14 country policy; Electronic Communications Privacy - Issues Lobbied: Privacy, 4th Amendment; Elementary and Secondary Education Act Reauthorization - Issues Lobbied: Racial Justice; Juvenile Justice; Education; School Discipline; End Racial Profiling Act (ERPA) Draft Legislation - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Police Practices; Fairness and Accuracy in Employment Background Checks Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Police Practices; FBI exigent ltr abuse - Issues Lobbied: open government; FBI Oversight - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government; Federal Over-criminalization - Issues Lobbied: Civil Rights, Criminal Justice; Gene Patenting Legislation (no bill introduced yet) - Issues Lobbied: First Amendment, Women's Rights; Global gag rule - Issues Lobbied: women's rights; ICE leadership - Issues Lobbied: civil rights, detention, due process; Immigration court reform - Issues Lobbied: due process; Indigent Defense Reform - Issues Lobbied: Civil Rights, Criminal Justice; Lobby restrictions - Issues Lobbied: First Amendment; Natl popular vote bill - Issues Lobbied: voting rights; Patriot Act Reform Legislation - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government; Fusion Centers - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying, fusion centers; Radical ideologies and speech rights - Issues Lobbied: Free Speech; Repro health care and EC for sexual assault victims in ICE custody - Issues Lobbied: women's rights; Torture/Detention/Interrogation Oversight - Issues Lobbied: National Security,Torture/Detention/Interrogation; U.S. Commission on Civil Rights Reauthorization - Issues Lobbied: USCCR; Racial Justice; Human Rights; Varick/Hudson Detention facilities - Issues Lobbied: civil rights, detention; Thompson prison facility - Issues Lobbied: indefinite detention, due process; Ideological exclusion - Issues Lobbied: First Amendment; Federal Agency Issues: CIS - Issues Lobbied: Terrorism-Related Inadmissibility Grounds; Commerce Department - Issues Lobbied: Electronic Communications Privacy Act reform; Department of Defense - Issues Lobbied: S 2977/HR 4556, National Security, Detention/Interrogation, National Security, Detention/Interrogation, Discrimination, Don't Ask Don't Tell,; Department of Education - Issues Lobbied: Elementary and Secondary Education Act Reauthorization, Sex-Segregated Education, civil rights data collection; Department of Health and Human Services - Issues Lobbied: Electronic medical records; Department of Health and Human Services, ORR - Issues Lobbied: reproductive health care for unaccompanied immigrant and refugee minors; Department of Homeland Security - Issues Lobbied: Preemption, watch/no fly lists, fusion centers, immigration detention, racial profiling in immigration enforcement (including 287g agreements), Mental health of detainees, Alien Criminal Response Information Management (ACRIMe) System of Records, National Security, Privacy, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers, DHS/TSA Oversight, National ID, employment verification, privacy, Use of datamining technologies by the government, use of body scanners, Racial Profiling; DHS Privacy Office - Issues Lobbied: Immigration and Enforcement Operational Records System of Records; Director of National Intelligence - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers; Department of Justice - Issues Lobbied: Fair Sentencing Act, the Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009, Fairness and Accuracy in Employment Background Checks Act (Draft Legislation), Operation Streamline, Faith-Based Programs, S 2977/HR 4556, Criminal Investigation, Special Prosecutor Torture Inquiry, National Security, Torture/Detention/Interrogation, Privacy, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers, Attorney General Guidelines, DOJ Racial Profiling Guidance , Electronic Communications Privacy Act reform; Department of Justice Office of Juvenile Justice and Delinquency Prevention - Issues Lobbied: the Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009; Department of Labor, OSHA - Issues Lobbied: Women workers; Equal Employment Opportunity Commission - Issues Lobbied: Fairness and Accuracy in Employment Background Checks Act (Draft Legislation) ; Executive Office of the President - Issues Lobbied: Fair Sentencing Act, Fairness and Accuracy in Employment Background Checks Act (Draft Legislation), Operation Streamline, Faith-Based Programs, S 2977/HR 4556, National Security, Privacy, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers, Cyber-security Review, Controlled Unclassified Information, Abortion riders for Medicaid-eligible women and Medicare beneficiaries, FEHBP, Peace Corps volunteers, Native American women, women in federal prisons, Medicaid Family Planning Extension, Civil Rights, 1st Amendment, Religious Liberty, Detention/Interrogation, Federal websites cookies policy, privacy, PCLOB vacancies, 14 country policy; FBI - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers, Attorney General Guidelines, exigent ltr abuse; Federal Communications Commission - Issues Lobbied: Net Neutrality, broadband access; Immigration and Customs Enforcement - Issues Lobbied: ICEs vision, online detainer locator, detention standards, risk assessment tool, Haiti; National Archives - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers; National Economic Counsel - Issues Lobbied: Fourth Amendment, privacy, Electronic Communications Privacy Act reform; National Security Council - Issues Lobbied: Over-Classification Reduction Act, Executive Order 12958, Improving classification policy, Controlled Unclassified Information; Office of Faith-Based and Neighborhood Partnerships - Issues Lobbied: Faith-Based Programs; Office of Management and Budget - Issues Lobbied: civil rights, data collection; Office of Personnel Management - Issues Lobbied: transgender discrimination; State Department - Issues Lobbied: Support for ratification, Restoration of Inter-agency working groups on human rights, Ideological Exclusion, 14 Country Policy; U.S. Sentencing Commission - Issues Lobbied: Fair Sentencing Act, Cultural Assimilation, Collateral Consequences, and Recency; US Interagency Council on Homelessness - Issues Lobbied: Prevent domestic violence and protect housing rights of survivors
2010 · first_quarter · Medicare/Medicaid
HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines, as currently interpreted guidelines would require accreditation of each hospital as a standalone entity and require them to each have a separate governing body, medical staff, etc. in order to be accredited by the joint commission.
2010 · first_quarter · Medicare/Medicaid
Provisions of the FY 2010 Budget and Budget Resolution (S Con Res 13 and H C Res 85) regarding health care reform, funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, value based purchasing and geographic fairness in Medicare reimbursement, value based purchasing and geographic fairness in Medicare reimbursement, a freeze in Medicare reimbursement updates for physician services, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ). The following bullet points summarize the objectives of the Marshfield Clinics Health Policy Agenda: promoting payment fairness in Medicare physician and practice expense payments; new formulas for aligning Medicare reimbursement with value; value-based purchasing of health services including bonus payments for high value Medicare Advantage programs; bonus payments for efficient providers; bonus payments for primary care providers; establishment and funding of comparative effectiveness research; financing for the adoption and utilization of health information technology; repeal and reform of the Medicare sustainable growth rate mechanism for updating physician payments; improved reimbursement for the PGP demonstration; expansion of the PGP demonstration methodology into a national accountable care organization program to extend the physician group practice demonstration; and opposition to the establishment of a public option in Health Insurance Exchanges if it were to reimburse providers at Medicare rates. Value Index Rewarding Value in the Reimbursement System Congress must introduce a value index into Medicare Parts A and B, to reward physicians and hospitals who provide safe, high quality care with excellent service to Medicare patients at a reasonable cost. The value index can be constructed for many types of payment models, including hospital DRG payments, physician fees, payment updates, and other payment formulas. We recommend that the geographic adjustment of physician work should be eliminated as recommended in legislation introduced by Senator Feingold (S 712) and Senator Grassley (S 318), and replaced with a quality/efficiency based coefficient for physician work as soon as possible. Legislation that we strongly support and would accomplish this objective, has been introduced by Iowa Rep. Bruce Braley and Wisconsin Rep. Ron Kind in the House and by Minnesota Senator Amy Klobuchar and Wisconsin Senators Feingold and Kohl in the Senate. The Medicare Payment Improvement Act (HR 2844, S 1249) seeks to reform the Medicare system to one that rewards the value of care over quantity of procedures, improving quality and lowering the total cost of care over time. The bills outcome-based approach creates the incentive for physicians and hospitals to work together to improve quality and use resources efficiently. These provisions were included in Sections 1159 and 1160 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3007 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Value Based Purchasing In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. According to a recent report by the Congressional Budget Office spending in high-spending regions could be reduced without producing worse outcomes, on average, or reductions in the quality of care. (CBO February 2008) Alternatives: Medicare must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Improve access to care in rural areas. The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. Corresponding mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. Performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. These provisions were included in Sections 1161 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3201 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. The federal government developed formulas to evaluate the cost of providing services in different practice settings and in different geographic locations. Those formulas measure resource inputs that have changed over the +40 year life of the program. To ensure affordable access to Medicare services throughout the country Medicare must take steps to refine its measures of the cost of providing services so that Medicares overwhelming financial dominance does not interfere with affordable access in markets that have changed very much since the program began. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs. Information Technology Under current law the capital and operating expenses of installing and maintaining electronic medical records (EMRs) are assumed to be part of the overhead expense of a medical practice. Since no more than 5 10% of the physician population has installed EMRs, CMS now obsolete measurement of physician practice expenses reflect minimal average expense associated with IT. Alternatives: Congress should provide incentives for EMR adoption, and/or utilization, and Establish standards to facilitate the sharing and exchange of data. CMS must update its mechanism for evaluating the cost of medical practice. On December 30, 2009, the Centers for Medicare & Medicare Services (CMS) and the ONC released two regulations required by the American Recovery and Reinvestment Act that lay the foundation for meaningful use of certified electronic health record (EHR) technology. A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of meaningful use of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Marshfield Clinic is vendor of a proprietary electronic medical record, and closely follows federal developments of the HHS office of the national coordinator and the it HIT Policy and Standards Committees to assure meaningful use of electronic medical records and efficient standards for certification and interoperability of unrelated systems. Payment Equity for Physician Work Before MMA 03, Medicares payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for 04 06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. The payment floor provision expired in 06, but has been extended in federal legislation every year since then. Alternatives: The payment floor should be extended indefinitely; Geographic adjustment of work should be eliminated entirely; and replaced with a coefficient of quality and efficiency. Support Senator Feingolds bill, the Rural Medicare Equity Act, S 712. These provisions were included in Sections 1157 and 1158 and 1194 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3102 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Payment Fairness for Practice Costs The formulas by which Medicares payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: Congress should require CMS to administratively revise its measurement of cost of practice to assure the validity and fairness of payments; A payment floor could be established for practice expense. These provisions were included in Sections 1157 and 1158 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3102 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Practice Expense Payment Floor Congress must require the Centers for Medicare & Medicaid Services (CMS) to administratively revise its measurement of the cost of practice to assure the validity and fairness of payment. However, in the interim, a payment floor must be established for practice expense to stem the inequities of the current methodology as proposed by Reps. Braley and Kind in HR 2201, the Medicare Equity and Accessibility Act of 2009. Extreme variation induced by errors in the payment methodology may also be reduced without compromising the relativity of payment by establishing a geographic practice expense index that limits to the difference between relative wages and rents between fee schedule areas and the national average as proposed by Senator Grassley in S 318. These provisions were included in Sections 1157 and 1158 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3102 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Comparative Effectiveness/Evidence Based Medical Informatics Research Evidence-based medicine relies upon the judicious use of current best evidence in making decisions about the care of individual patients. Key to effective implementation of value-based purchasing initiatives is the systematic development of data that links the health of populations to the medical services the population receives. The application of health information technology and genomic information in population- and community-based health care delivery systems coupled with the development of wellness programs has the potential to substantially improve health and personalized health care on a national basis. These provisions were included in Sections 1401 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 6301 and 6302 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. The Physician Payment Sunshine Act, S. 2029, introduced by Senator Kohl with Senator Grassley in the 110th Congress to create accountability among physicians and the manufacturers of drugs and devices that physicians utilize and prescribe for their patients. This legislation would require manufacturers of pharmaceutical drugs, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, travel and other means. These provisions were included in Subtitle D of the House Bill, HR 3962, the Affordable Health Care for America Act, and in 6002 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. The Medicare Rural Health Access Improvement Act, S 2786, introduced by Senator Grassley 110th Congress to mitigate current inequities in Medicare reimbursement, improve access to health services in rural and underserved areas, and will begin to close the gap between Medicare reimbursement and the cost of providing services in predominantly rural areas. The legislation establishes a 1.0 floor for physician work and practice expense adjustments. It also revises the work and practice expense formulas to reduce payment differences and more accurately compensate physicians in rural areas for their true practice costs. The bill also extends the five percent incentive payments for primary care and specialty physicians in scarcity areas. Marshfield Clinic nominated Dr. Douglas Reding for an open position on the Medicare Payment Advisory Commission, and as a candidate for appointment to the Medicaid and CHIP Payment and Access Commission (MACPAC) in 2010. Support for Rep. Ron Kinds concept of a not yet introduced MEDICARE EFFICIENCY BILL that would amend the CHAMP Act (H.R. 3162) 304 in whole, by establishing that the 5% bonus payment would be expanded to the top 10% of efficient counties; and a corresponding 5% efficiency penalty for physicians in the bottom 10% of efficient counties. These provisions were included in Section 1123 of the House Bill, HR 3962, the Affordable Health Care for America Act. Medicare Payment Improvement Act of 2009, HR 2844. To amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule. Introduced by Rep. Ron Kind and Bruce Braley. Goal: To increase quality of health care in America and decrease cost. The Medicare Payment Improvement Act will fundamentally restructure the Medicare payment system by finally providing an incentive for physicians to provide high quality care. The bill eliminates a geographic adjuster (Work Geographic Practice Cost Index) from Medicare, and replaces it with a figure that measures Value. The value figure measures both quality of care and cost of care. Regions that provide high quality care at low cost will see their Medicare reimbursements increase. Regions that provide low quality care at high cost will see their reimbursements decrease. The current structure of Medicare is known as "fee-for-service," and incentivizes the number of services performed. The Braley bill shifts this to "value-based care," and incentivizes high quality care and low costs. This proposal will transition our current "quantity-based system" to a "quality-based system." Rep. Braley introduced HR 2201, the Medicare Equity & Accessibility Act. This bill would increase Medicare Part B reimbursement rates in Iowa, by placing a floor on the geographic adjuster (GPCI) that is part of the Part B formula. The bill would have the effect of increasing Part B reimbursements in Iowa and other rural states every time a health care provider sees a patient under Part B. Rep. Braley and others supporting the Medicare Payment Improvement Act including Reps. Kind, Inslee, and McCollum, who were representing a much broader 'Quality Coalition,' who have been pushing for a 'value index' in the Medicare Part B reimbursement equation to measure quality and efficiency of care. This provision includes the following: Quality-Based Care-- "Instruct IOM to study how to implement a 'value index' in the Medicare payment system. They will consider geographic differences, access to care, measures of quality, and the role of incentives to impact quality and efficient outcomes of care. "After a set two-year timeframe, IOM will make recommendations to the Secretary of HHS on how to specifically change the Medicare payment system to promote "high-value care," defined as the "efficient delivery of high quality, evidence-based, patient-centered care." "The Secretary will then submit a 'plan of implementation' to the Congress, to implement the recommendations of the IOM. "Congress will have a finite amount of time to pass a joint resolution of disapproval. If Congress fails to act, or if the recommendations are not expressly disapproved by both Chambers, then the recommendations of the IOM will be implemented, thereby reforming the Medicare payment system to incentivize high-value care. Addressing Geographic Disparity- "In addition, the deal resulted in substantive action to address geographic disparity in Medicare payments. IOM will do another study, completed within a year after enactment, to determine whether the data and assumptions used to determine the geographic adjusters (Geographic Practice Cost Indexes and Wage Index) are accurate, or based on flawed data. Many believe the factors that determine these indexes are based on flawed data. "Upon completion of the study (within one year), the Secretary will take immediate action to adjust the GPCIs and Wage Index to ensure they are based on accurate data. "A "Medicare Improvement Fund" is established, which will consist of $8 billion. From this fund, payments will immediately be made in 2012 and 2013, to ensure the money is there for regions who see an increase in their reimbursement due to the adjusted GPCIs and Wage Index. "In 2012 and 2013, a 'Hold Harmless' will exist to ensure that payments do not decrease in any region as a result of these more accurate measurements. The 'Hold Harmless' expires after 2013, to allow budget neutrality for all appropriate shifts that must be made due to correcting the data in the long-term. Practice expense geographic practice cost index (GPCI) adjustment: Retroactively effective from Jan. 1, 2010, HHS is required to revise the calculation method of the practice expense (PE) portion of the GPCI. This revision results in increased PE GPCIs for certain rural areas. Implementation of this provision will likely require CMS to reprocess certain 2010 claims (Sec. 3102 of HR 3590 as modified by Sec. 1108 of HR 4872 Reconciliation). CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Marshfield Clinic supported CMS determination to extend this program, beyond its initial 3-year term, and transition these organizations into Accountable care Organizations. Section 1301 of the House bill HR 3962, the Affordable Health Care for America Act, and Section 3022 of the Senate bill HR 3590, the Patient Protections and Affordable Care Act. Marshfield Clinic Also supported efforts to eliminate the 2% threshold for payments and the 5% limitation on payments in the PGP demonstration. The Reconciliation Act of 2010, HR 4872, introduced by Rep. John Spratt included Section 1108 amending Section 3102 of the Patient Protection and Affordable Care Act, which increase the practice expense component of Medicare physician payment in localities that are below the mean of costs nationwide, effective January 1, 2010.
2009 · fourth_quarter · Medicare/Medicaid
HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Senator Schumer and Senator Roberts Letter eliminating IME Cuts CMS to withdraw the Capital IME cut that was included in last years Medicare IPPS rule; Letter to President Obama from Neal/ Tiberi on Capital IME Protect America's teaching hospitals asking him to withdraw a provision in the FY 2010 IPPS rule that would cut reimbursements to teaching hospitals. Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961Medicare Physician Payment Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development.
2009 · fourth_quarter · Civil Rights/Civil Liberties
Legislation: HR 1064 Youth PROMISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; HR 1139 COPS Improvements Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice; HR 1215 Immigration Oversight and Fairness Act - Issues Lobbied: Support for Immigration reform; HR 1283 Military Readiness Enhancement Act of 2009 - Issues Lobbied: Civil Rights, LGBT Rights; HR 1304 Free Speech Protection Act of 2009 - Issues Lobbied: First Amendment, Free Press, Defendants Rights; HR 1315 Terrorist Detainees Procedures Act of 2009 - Issues Lobbied: National Security, Torture/Detention/Interrogation; HR 1412 Justice Integrity Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice; HR 1507 Whistleblower Protection Enhancement Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, Protections for National Security Whistleblowers; HR 157 Fairness Doctrine Amendment - Issues Lobbied: First Amendment, Free Press; HR 1726 Lap top searches at the border - Issues Lobbied: Fourth Amendment, racial discrimination; HR 1788 A bill to amend the False Claims Act - Issues Lobbied: First Amendment, Legal Representation; HR 1800 National Security Letters Reform Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, National Security Letter Power, Patriot Act Section 215; HR 1966 Megan Meier Cyberbullying Prevention Act - Issues Lobbied: First Amendment, Free Speech; HR 2200 - Issues Lobbied: TSA authorization/body scanning machines, Privacy/bodily integrity; HR 2289 Juvenile Justice Accountability and Improvement Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice; HR 2517 Domestic Partner Benefits and Obligations Act - Issues Lobbied: Civil Rights, LGBT Rights; HR 2597 Positive Behavior for Safe and Effective Schools Act - Issues Lobbied: Racial Justice, Juvenile Justice, Positive Behavior Supports; HR 2647 National Defense Authorization Act Conference Report - Issues Lobbied: National Security, Detention, Military Commissions, Civil Rights, LGBT Rights, Death Penalty, 1st Amendment, Free Speech and Association, Religious Liberty; HR 2701 Intelligence Authorization Act for Fiscal Year 2010 - Issues Lobbied: Intelligence oversight, openness and congressional oversight; HR 2847 Commerce, Justice, Science, and Related Agencies Appropriations Act for Fiscal Year 2010 - Issues Lobbied: National Security, Torture/Detention/Interrogation, Free speech, restrictions on Legal Services Corporation, , Voting Rights, Against the Vitter Census Amendment; HR 3017 Employment Non-Discrimination Act (ENDA) - Issues Lobbied: Civil Rights, LGBT Rights; HR 3081 FY2011 State and Foreign Operations Appropriations Bill - Issues Lobbied: Support UNFPA funding and advocate for permanent rescission of the Global Gag Rule; HR 3082 Military Construction, Veterans Affairs, and Related Agencies Appropriations Act for Fiscal Year 2010 - Issues Lobbied: National Security, Torture/Detention/Interrogation; HR 3170 FY 2010 Financial Services and General Government Appropriations Act - Issues Lobbied: Civil Rights, 1st Amendment, Religious Liberty, Opposition to the DC abortion rider and FEHBP abortion rider, Criminal Justice, Drug Policy, Medical Marijuana; HR 3221 the Student Aid and Fiscal Responsibility Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy, HEA Penalty, Privacy; HR 3245 Fairness in Cocaine Sentencing Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy; HR 3288 FY 2010 Consolidated Omnibus Appropriations Act - Issues Lobbied: Civil Rights, HIV/AIDS, LGBT Rights, Free speech, restrictions on Legal Services Corporation, End funding for abstinence-only programs and fund more comprehensive sex ed programs, Support UNFPA funding and advocate for permanent rescission of the Global G; HR 3293 FY2010 Labor, Health, and Human Services Appropriations Bill - Issues Lobbied: End funding for abstinence-only programs and fund more comprehensive sex ed programs; HR 3295 RISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy, HEA Penalty; HR 3326 FY 2010 Department of Defense Appropriations Act - Issues Lobbied: National Security, Torture/Detention/Interrogation, Franken Senate Amendment No. 2588, Mandatory Pre-dispute Arbitration; Title VII; Sexual Assault; HR 3335 Democracy Restoration Act - Issues Lobbied: Felony Voting Rights; HR 3458 Net Neutrality Legislation - Issues Lobbied: First Amendment; HR 3471 Real ID - Issues Lobbied: repeal legislation, National ID, religious liberty; HR 3531 Humane Enforcement and Legal Protections for Separated Children Act - Issues Lobbied: Support for bill and trying to get Senate counterpart; HR 3567 the Respect for Marriage Act - Issues Lobbied: Civil Rights, LGBT Rights; HR 3590 Patient Protection and Affordable Care Act - Issues Lobbied: Oppose Nelson-Hatch amendment and anti-choice language in the managers amendment; support womens health amendment; oppose Title V extension and support Personal Responsibility Education program; HR 3630 Adolescent Web Awareness Requires Education Act - Issues Lobbied: First Amendment, Free Speech; HR 3721 Protecting Older Workers Against Discrimination Act - Issues Lobbied: Employment Discrimination; Restoration of ADEA in light of Gross Supreme Court Case; HR 374 Lawful Interrogation and Detention Act - Issues Lobbied: National Security, Torture/Detention/Interrogation; HR 3764 Civil Access to Justice Act of 2009 - Issues Lobbied: Free speech, restrictions on Legal Services Corporation; HR 3845 USA PATRIOT Act Sunset Extension Act of 2009 - Issues Lobbied: national security, privacy and constitutional rights; HR 3962 Affordable Health Care for America Act - Issues Lobbied: Oppose Stupak-Pitts anti-choice amendment; support Healthy Teen Initiative to Prevent Teen Pregnancy; HR 3986 Effective Death Penalty Appeals Act - Issues Lobbied: Civil Rights, Criminal Justice, Capital Punishment; HR 4005 JUSTICE Act - Issues Lobbied: national security, privacy and constitutional rights; HR 4321 Immigration Reform - Issues Lobbied: Due process, judicial review of legalization decisions, e-verify, indefinite detention, prolonged detention, community-based alternatives to detention, mandatory detention, restoration of judicial review, federal preemption of state and local immigration; HR 4335 Prison Abuse Remedies Act - Issues Lobbied: Civil Rights, Criminal Justice, Prisoners Rights; HR 4386 Compassionate Care for Servicewomen Act - Issues Lobbied: support for emergency contraception; HR 5577 Chemical Facility Anti-Terrorism Act of 2009 - Issues Lobbied: Open government, access to information, over-classification; HR 894 Over-Classification Reduction Act - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, decreasing over-classification; HR 984 State Secret Protection Act - Issues Lobbied: national security, privacy and constitutional rights; HR 985 Free Flow of Information Act of 2009 - Issues Lobbied: First Amendment, Free Press; HRes 383 Establishing a Select Committee to Review National Security Laws, Policies and Practices - Issues Lobbied: Intelligence oversight; S 1390 the National Defense Authorization Act - Issues Lobbied: National Security, Detention, Military Commissions, Civil Rights, LGBT Rights, Death Penalty, 1st Amendment, Free Speech and Association; S 147 Lawful Interrogation and Detention Act - Issues Lobbied: National Security, Torture/Detention/Interrogation; S 1494 Intelligence Authorization Act for Fiscal Year 2010 - Issues Lobbied: Intelligence oversight; S 1516 Democracy Restoration Act - Issues Lobbied: Felony Voting Rights; S 1549 Protect Citizens and Residents from Unlawful Detention Act - Issues Lobbied: detention; S 1550 Strong Standards Act - Issues Lobbied: detention conditions; S 1584 Employment Non-Discrimination Act (ENDA) - Issues Lobbied: Civil Rights, LGBT Rights; S 160 Fairness Doctrine Amendment - Issues Lobbied: First Amendment, Free Press; S 167 COPS Improvements Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice; S 1692 USA PATRIOT Act Sunset Extension Act of 2009 - Issues Lobbied: national security, privacy and constitutional rights; S 1756 Protecting Older Workers Against Discrimination Act - Issues Lobbied: Employment Discrimination; Restoration of ADEA in light of Gross Supreme Court Case; S 1789 Fair Sentencing Act - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy; S 1796 Americas Healthy Futures Act - Issues Lobbied: Due process, privacy; S 182 Paycheck Fairness Act - Issues Lobbied: Womens Rights, Employment Discrimination, Legislation Updating the Equal Pay Act; S 2904 Compassionate Care for Servicewomen Act - Issues Lobbied: support for emergency contraception; S 372 Whistleblower Protection Enhancement Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, Protections for National Security Whistleblowers; S 417 State Secrets Protection Act of 2009 - Issues Lobbied: National Security, access to information; S 428 A bill to allow travel between the United States and Cuba - Issues Lobbied: First Amendment, Right to Travel; S 435 Youth PROMISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; S 449 Free Flow of Information Act of 2009 - Issues Lobbied: First Amendment, Free Press; S 458 A bill to amend the False Claims Act - Issues Lobbied: First Amendment, Legal Representation; S 495 Justice Integrity Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice; S 612 FOIA Memorandum/OPEN FOIA Act of 2009 - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, Freedom of Information Act Reform; S 678 Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; S 712 Civil Access to Justice Act of 2009 - Issues Lobbied: Free speech, restrictions on Legal Services Corporation; S 714 National Criminal Justice Commission Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Drug Policy; S 773 Cybersecurity Act of 2009 - Issues Lobbied: Cybersecurity, Communications privacy, executive power; S. 1686 JUSTICE Act - Issues Lobbied: national security, privacy and constitutional rights; S.448 Free Flow of Information Act of 2009 - Issues Lobbied: First Amendment, Free Press, Defendants Rights; S1261 PASS ID - Issues Lobbied: National ID, religious liberty; S1490 Personal Date Privacy and Security Act - Issues Lobbied: Privacy; Other Congessional Matters: ACORN Funding - Issues Lobbied: First Amendment; Against the establishment of a Commission to Investigate Violent Extremism in the US - Issues Lobbied: First Amendment; Animal Enterprise Terrorism Act - Issues Lobbied: First Amendment; Asylum legislative proposal - Issues Lobbied: Immigration; Biometric ID - Issues Lobbied: Oppose mandatory biometric ID; Border deaths (ACLU-San Diego Report) - Issues Lobbied: Human Rights, Immigration; CEDAW - Issues Lobbied: Human Rights; Civil Rights Act of 2009 - Issues Lobbied: Racial Justice; Employment Discrimination; Restoring Civil Rights Protections; Comprehensive Immigration Reform - Issues Lobbied: Due process, judicial review of legalization decisions, e-verify, indefinite detention, prolonged detention, community-based alternatives to detention, mandatory detention, restoration of judicial review, federal preemption of state and local immigration; Corporal Punishment - Issues Lobbied: Civil Rights; Deaths in detention - Issues Lobbied: civil liberties, due process; DHS Intelligence/Information Sharing - Issues Lobbied: national security; Electronic Communications Privacy Act reform - Issues Lobbied: Fourth Amendment, privacy; End Racial Profiling Act (ERPA) Draft Legislation - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Police Practices; Fairness and Accuracy in Employment Background Checks Act (Draft Legislation) - Issues Lobbied: Privacy; FBI Oversight - Issues Lobbied: civil liberties; Gene Patenting Legislation (no bill introduced yet) - Issues Lobbied: Civil Liberties, First Amendment; Human Rights in the 111th Congress - Issues Lobbied: YS treaty implementation and mental illness in US jails and prisons; Human Rights Treaty Implementation Hearing - Issues Lobbied: Human Rights; Indigent Defense Reform - Issues Lobbied: Civil Rights, Criminal Justice; Interior enforcement in CIR - Issues Lobbied: Civil Liberties, Immigration; Iqbal/Twombley decision Notice Pleadings Standards - Issues Lobbied: Due Process, Right to Petition, Equal Protection; Patent Reform (no bill introduced yet) - Issues Lobbied: First Amendment; Privacy and domestic spying concerns with Fusion Centers - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying, fusion centers; Library of Congress Oversight Issues Lobbied: First Amendment, federal employees' rights; Terrorism Studies and Prevention Act - Issues Lobbied: First Amendment; The Convention on the Rights of the Child Treaty - Issues Lobbied: Human Rights; National Security Issues - Issues Lobbied: Torture/Detention/Interrogation Oversight; Use of datamining technologies by the government - Issues Lobbied: Privacy; Federal Agency Issues: Commission on Civil Rights - Issues Lobbied: Reauthorization; Department of Defense - Issues Lobbied: Posse comitatus , Discrimination; Department of Education - Issues Lobbied: Support rescission of the 2006 Single-Sex Education Regulations, Human Rights, First Amendment; Department of Education, Office of Civil Rights - Issues Lobbied: Comments on Civil Rights Data Collection; Department of Health and Human Services - Issues Lobbied: Electronic medical records, Privacy, Prostitution Pledge - Oppose new proposed regulations, Supporting reproductive health care for unaccompanied minors; Department of Health and Human Services, Office of Inspector General - Issues Lobbied: Detainee transfers; Department of Homeland Security - Issues Lobbied: Preemption, indefinite detention, prolonged detention, Criminalization of unlawful presence, Detainee transfers, National ID, religious liberty, employment, lap top searches at the border, 4th Amendment, Racial Discrimination, Use of datamining technologies by the government, Government Watch Lists, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers, Controlled Unclassified Information, Ideological Exclusion, Restrictions on Travel; Department of Justice - Issues Lobbied: Criminalization of unlawful presence, Indigent Defense Reform, Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009, Fairness and Accuracy in Employment Background Checks Act (Draft Legislation), Crack Cocaine Sentencing Reform, Criminal Investigation, Special Prosecutor Torture Inquiry, National Security, Torture/Detention/Interrogation, Executive Order Ensuring Lawful Interrogations, Closure of Guantanamo Detention Facilities, Executive Order - Review of Detention Policy Options, National Security, Torture/Detention/Interrogations, Whistleblower Protection Enhancement Act of 2009, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers, Attorney General Guidelines; Department of Justice, Office of Civil Rights - Issues Lobbied: State and local police enforcement of immigration; Department of Justice, Office of Juvenile Justice and Delinquency Prevention - Issues Lobbied: Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009; Director of National Intelligence - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers, Privacy and domestic spying concerns with Fusion Centers; Equal Employment Opportunity Commission - Issues Lobbied: Proposed Rulemaking RIN 3046-AA85: Regulations to Implement the Equal Employment Provisions of the Americans With Disabilities Act as Amended; Executive Office of the President - Issues Lobbied: Immigration Reform, Opposing Secure Communities, promoting alternatives to detention and enforceable detention standards, Fairness and Accuracy in Employment Background Checks Act (Draft Legislation), Crack Cocaine Sentencing Reform, JUSTICE Act, USA PATRIOT Act Sunset Extension Act of 2009, Faith-Based Programs, Executive Branch Protections Against LGBT Discrimination, Whistleblower Protection Enhancement Act of 2009, National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers, Cyber-security Review, Executive Order 12958, Controlled Unclassified Information, Federal websites cookies policy; FBI - Issues Lobbied: FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers, Attorney General Guidelines; Federal Communications Commission - Issues Lobbied: Child Safe Viewing Act; National Archives - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers; National Archives, Information Security Oversight Office - Issues Lobbied: Controlled Unclassified Information; National Economic Counsel - Issues Lobbied: Fourth Amendment, privacy; National Security Council - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, decreasing over-classification, Executive Order 12958; Office of Faith-Based and Neighborhood Partnerships - Issues Lobbied: Faith-Based Programs; Office of Management and Budget - Issues Lobbied: Executive Order 12886, Title X Funding in FY11 Budget Request, Lobbying Restrictions; Office of Management and Budget, Office of Information and Regulatory Affairs - Issues Lobbied: Restrictions on Travel; Office of Personnel Management - Issues Lobbied: Federal Long Term Care Insurance Program (74 Fed. Reg. 46937) RIN Number 3206-AL92, Civil Rights, LGBT Rights, Executive Branch Protections Against LGBT Discrimination; Office of Personnel Management, Center for Pay and Leave Administration - Issues Lobbied: Absence and Leave' Sick Leave program (74 Fed. Reg. 46934) RIN Number 3206-AL93, Civil Rights, LGBT Rights; State Department - Issues Lobbied: Trafficking, Restoration of Inter-agency working groups on human rights, Ideological Exclusion; Immigration and Customs Enforcement - Issues Lobbied: Immigration Reform, Opposing Secure Communities; promoting alternatives to detention and enforceable detention standards
2009 · fourth_quarter · Medicare/Medicaid
Provisions of the FY 2010 Budget and Budget Resolution (S Con Res 13 and H C Res 85) regarding health care reform, funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, value based purchasing and geographic fairness in Medicare reimbursement, a freeze in Medicare reimbursement updates for physician services, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ). The following bullet points summarize the objectives of the Marshfield Clinics Health Policy Agenda: promoting payment fairness in Medicare physician and practice expense payments; new formulas for aligning Medicare reimbursement with value; value-based purchasing of health services including bonus payments for high value Medicare Advantage programs; bonus payments for efficient providers; bonus payments for primary care providers; establishment and funding of comparative effectiveness research; financing for the adoption and utilization of health information technology; repeal and reform of the Medicare sustainable growth rate mechanism for updating physician payments; improved reimbursement for the PGP demonstration; expansion of the PGP demonstration methodology into a national accountable care organization program to extend the physician group practice demonstration; and opposition to the establishment of a public option in Health Insurance Exchanges if it were to reimburse providers at Medicare rates. Value Index Rewarding Value in the Reimbursement System Congress must introduce a value index into Medicare Parts A and B, to reward physicians and hospitals who provide safe, high quality care with excellent service to Medicare patients at a reasonable cost. The value index can be constructed for many types of payment models, including hospital DRG payments, physician fees, payment updates, and other payment formulas. We recommend that the geographic adjustment of physician work should be eliminated as recommended in legislation introduced by Senator Feingold (S 712) and Senator Grassley (S 318), and replaced with a quality/efficiency based coefficient for physician work as soon as possible. Legislation that we strongly support and would accomplish this objective, has been introduced by Iowa Rep. Bruce Braley and Wisconsin Rep. Ron Kind in the House and by Minnesota Senator Amy Klobuchar and Wisconsin Senators Feingold and Kohl in the Senate. The Medicare Payment Improvement Act (HR 2844, S 1249) seeks to reform the Medicare system to one that rewards the value of care over quantity of procedures, improving quality and lowering the total cost of care over time. The bills outcome-based approach creates the incentive for physicians and hospitals to work together to improve quality and use resources efficiently. These provisions were included in Sections 1159 and 1160 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3007 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Value Based Purchasing In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. According to a recent report by the Congressional Budget Office spending in high-spending regions could be reduced without producing worse outcomes, on average, or reductions in the quality of care. (CBO February 2008) Alternatives: Medicare must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Improve access to care in rural areas. The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. Corresponding mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. Performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. These provisions were included in Sections 1161 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3201 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. The federal government developed formulas to evaluate the cost of providing services in different practice settings and in different geographic locations. Those formulas measure resource inputs that have changed over the +40 year life of the program. To ensure affordable access to Medicare services throughout the country Medicare must take steps to refine its measures of the cost of providing services so that Medicares overwhelming financial dominance does not interfere with affordable access in markets that have changed very much since the program began. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs. Information Technology Under current law the capital and operating expenses of installing and maintaining electronic medical records (EMRs) are assumed to be part of the overhead expense of a medical practice. Since no more than 5 10% of the physician population has installed EMRs, CMS now obsolete measurement of physician practice expenses reflect minimal average expense associated with IT. Alternatives: Congress should provide incentives for EMR adoption, and/or utilization, and Establish standards to facilitate the sharing and exchange of data. CMS must update its mechanism for evaluating the cost of medical practice. On December 30, 2009, the Centers for Medicare & Medicare Services (CMS) and the ONC released two regulations required by the American Recovery and Reinvestment Act that lay the foundation for meaningful use of certified electronic health record (EHR) technology. A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of meaningful use of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Marshfield Clinic is vendor of a proprietary electronic medical record, and closely follows federal developments of the HHS office of the national coordinator and the it HIT Policy and Standards Committees to assure meaningful use of electronic medical records and efficient standards for certification and interoperability of unrelated systems. Payment Equity for Physician Work Before MMA 03, Medicares payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for 04 06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. The payment floor provision expired in 06, but has been extended in federal legislation every year since then. Alternatives: The payment floor should be extended indefinitely; Geographic adjustment of work should be eliminated entirely; and replaced with a coefficient of quality and efficiency. Support Senator Feingolds bill, the Rural Medicare Equity Act, S 712. These provisions were included in Sections 1157 and 1158 and 1194 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3102 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Payment Fairness for Practice Costs The formulas by which Medicares payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: Congress should require CMS to administratively revise its measurement of cost of practice to assure the validity and fairness of payments; A payment floor could be established for practice expense. These provisions were included in Sections 1157 and 1158 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3102 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Practice Expense Payment Floor Congress must require the Centers for Medicare & Medicaid Services (CMS) to administratively revise its measurement of the cost of practice to assure the validity and fairness of payment. However, in the interim, a payment floor must be established for practice expense to stem the inequities of the current methodology as proposed by Reps. Braley and Kind in HR 2201, the Medicare Equity and Accessibility Act of 2009. Extreme variation induced by errors in the payment methodology may also be reduced without compromising the relativity of payment by establishing a geographic practice expense index that limits to the difference between relative wages and rents between fee schedule areas and the national average as proposed by Senator Grassley in S 318. These provisions were included in Sections 1157 and 1158 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 3102 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. Comparative Effectiveness/Evidence Based Medical Informatics Research Evidence-based medicine relies upon the judicious use of current best evidence in making decisions about the care of individual patients. Key to effective implementation of value-based purchasing initiatives is the systematic development of data that links the health of populations to the medical services the population receives. The application of health information technology and genomic information in population- and community-based health care delivery systems coupled with the development of wellness programs has the potential to substantially improve health and personalized health care on a national basis. These provisions were included in Sections 1401 of the House Bill, HR 3962, the Affordable Health Care for America Act, and in section 6301 and 6302 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. The Physician Payment Sunshine Act, S. 2029, introduced by Senator Kohl with Senator Grassley in the 110th Congress to create accountability among physicians and the manufacturers of drugs and devices that physicians utilize and prescribe for their patients. This legislation would require manufacturers of pharmaceutical drugs, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, travel and other means. These provisions were included in Subtitle D of the House Bill, HR 3962, the Affordable Health Care for America Act, and in 6002 of the Senate Bill HR 3590, the Patient Protection and Affordable Care Act. The Medicare Rural Health Access Improvement Act, S 2786, introduced by Senator Grassley 110th Congress to mitigate current inequities in Medicare reimbursement, improve access to health services in rural and underserved areas, and will begin to close the gap between Medicare reimbursement and the cost of providing services in predominantly rural areas. The legislation establishes a 1.0 floor for physician work and practice expense adjustments. It also revises the work and practice expense formulas to reduce payment differences and more accurately compensate physicians in rural areas for their true practice costs. The bill also extends the five percent incentive payments for primary care and specialty physicians in scarcity areas. Marshfield Clinic nominated Dr. Douglas Reding for an open position on the Medicare Payment Advisory Commission, and as a candidate for appointment to the Medicaid and CHIP Payment and Access Commission (MACPAC) in 2010. Support for Rep. Ron Kinds concept of a not yet introduced MEDICARE EFFICIENCY BILL that would amend the CHAMP Act (H.R. 3162) 304 in whole, by establishing that the 5% bonus payment would be expanded to the top 10% of efficient counties; and a corresponding 5% efficiency penalty for physicians in the bottom 10% of efficient counties. These provisions were included in Section 1123 of the House Bill, HR 3962, the Affordable Health Care for America Act. Medicare Payment Improvement Act of 2009, HR 2844. To amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule. Introduced by Rep. Ron Kind and Bruce Braley. Goal: To increase quality of health care in America and decrease cost. The Medicare Payment Improvement Act will fundamentally restructure the Medicare payment system by finally providing an incentive for physicians to provide high quality care. The bill eliminates a geographic adjuster (Work Geographic Practice Cost Index) from Medicare, and replaces it with a figure that measures Value. The value figure measures both quality of care and cost of care. Regions that provide high quality care at low cost will see their Medicare reimbursements increase. Regions that provide low quality care at high cost will see their reimbursements decrease. The current structure of Medicare is known as fee-for-service, and incentivizes the number of services performed. The Braley bill shifts this to value-based care, and incentivizes high quality care and low costs. This proposal will transition our current quantity-based system to a quality-based system. Rep. Braley introduced HR 2201, the Medicare Equity & Accessibility Act. This bill would increase Medicare Part B reimbursement rates in Iowa, by placing a floor on the geographic adjuster (GPCI) that is part of the Part B formula. The bill would have the effect of increasing Part B reimbursements in Iowa and other rural states every time a health care provider sees a patient under Part B. Rep. Braley and others supporting the Medicare Payment Improvement Act including Reps. Kind, Inslee, and McCollum, who were representing a much broader Quality Coalition, who have been pushing for a value index in the Medicare Part B reimbursement equation to measure quality and efficiency of care. This provision includes the following: Quality-Based Care-- Instruct IOM to study how to implement a value index in the Medicare payment system. They will consider geographic differences, access to care, measures of quality, and the role of incentives to impact quality and efficient outcomes of care. After a set two-year timeframe, IOM will make recommendations to the Secretary of HHS on how to specifically change the Medicare payment system to promote high-value care, defined as the efficient delivery of high quality, evidence-based, patient-centered care. The Secretary will then submit a plan of implementation to the Congress, to implement the recommendations of the IOM. Congress will have a finite amount of time to pass a joint resolution of disapproval. If Congress fails to act, or if the recommendations are not expressly disapproved by both Chambers, then the recommendations of the IOM will be implemented, thereby reforming the Medicare payment system to incentivize high-value care. Addressing Geographic Disparity In addition, the deal resulted in substantive action to address geographic disparity in Medicare payments. IOM will do another study, completed within a year after enactment, to determine whether the data and assumptions used to determine the geographic adjusters (Geographic Practice Cost Indexes and Wage Index) are accurate, or based on flawed data. Many believe the factors that determine these indexes are based on flawed data. Upon completion of the study (within one year), the Secretary will take immediate action to adjust the GPCIs and Wage Index to ensure they are based on accurate data. A Medicare Improvement Fund is established, which will consist of $8 billion. From this fund, payments will immediately be made in 2012 and 2013, to ensure the money is there for regions who see an increase in their reimbursement due to the adjusted GPCIs and Wage Index. In 2012 and 2013, a Hold Harmless will exist to ensure that payments do not decrease in any region as a result of these more accurate measurements. The Hold Harmless expires after 2013, to allow budget neutrality for all appropriate shifts that must be made due to correcting the data in the long-term. CMS Physician Group Practice Demonstration Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Marshfield Clinic supported CMS determination to extend this program, beyond its initial 3-year term, and transition these organizations into Accountable care Organizations. Section 1301 of the House bill HR 3962, the Affordable Health Care for America Act, and Section 3022 of the Senate bill HR 3590, the Patient Protections and Affordable Care Act. Marshfield Clinic Also supported efforts to eliminate the 2% threshold for payments and the 5% limitation on payments in the PGP demonstration.
2009 · third_quarter · Medicare/Medicaid
HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the State Children's Health Insurance Program for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a Centers for Medicare & Medicaid Services Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Senator Schumer and Senator Roberts Letter eliminating IME Cuts CMS to withdraw the Capital IME cut that was included in last years Medicare IPPS rule; Letter to President Obama from Neal/ Tiberi on Capital IME PROTECT AMERICAS TEACHING HOSPITALS, asking him to withdraw a provision in the FY 2010 IPPS rule that would cut reimbursements to teaching hospitals. Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral.
2009 · third_quarter · Civil Rights/Civil Liberties
Legislation: HR 1 American Recovery and Reinvestment Act of 2009 - Issues Lobbied: Lobbying Restrictions, Ethics Executive Order; HR 157 Fairness Doctrine Amendment - Issues Lobbied: First Amendment, Free Press; HR 374 Lawful Interrogation and Detention Act - Issues Lobbied: National Security, Torture/Detention/Interrogation; HR 894 Over-Classification Reduction Act - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, over-classification; HR 984 To provide safe, fair, and responsible procedures and standards for resolving claims of state secret privilege. - Issues Lobbied: National security and civil liberties, due process; HR 985 Free Speech Protection Act of 2009 - Issues Lobbied: First Amendment, Free Press, Defendants Rights; HR 1064 Youth PROMISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; HR 1139 COPS Improvements Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice; HR 1215 Immigration Oversight & Fairness Act - Issues Lobbied: Immigration, due process, detention conditions; HR 1283 Military Readiness Enhancement Act of 2009 - Issues Lobbied: Civil Rights, LGBT Rights; HR1304 Free Speech Protection Act of 2009 - Issues Lobbied: First Amendment, Free Press, Defendants Rights; HR 1315 Terrorist Detainees Procedures Act of 2009 - Issues Lobbied: National Security, Torture/Detention/Interrogation; HR 1412 Justice Integrity Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice; HR 1467 To extend certain provisions of the USA PATRIOT Act and the Intelligence Reform and Terrorism Prevention Act of 2004 for 10 years. - Issues Lobbied: National security and civil liberties, surveillance; HR 1507 Whistleblower Protection Enhancement Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, Protections for National Security Whistleblowers; HR 1604 Universal Right to Vote by Mail Act of 2009 - Issues Lobbied: Absentee Voting Rights; HR 1788 A bill to amend the False Claims Act - Issues Lobbied: First Amendment, Legal Representation; HR 1800 National Security Letters Reform Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, National Security Letter Power, Patriot Act Section 215; HR 1966 Megan Meier Cyberbullying Prevention Act - Issues Lobbied: First Amendment, Free Speech; HR 2289 Juvenile Justice Accountability and Improvement Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice; HR 2517 Domestic Partner Benefits and Obligations Act - Issues Lobbied: Civil Rights, LGBT Rights; HR 2597 Positive Behavior for Safe and Effective Schools Act - Issues Lobbied: Racial Justice, No Child Left Behind, Juvenile Justice, Positive Behavior Supports; HR 2647 National Defense Authorization Act Conference Report - Issues Lobbied: National Security, Detention, Military Commissions, Civil Rights, LGBT Rights, Death Penalty, Free Speech and Association, Religious Liberty; HR 2701 Intelligence Authorization Act for Fiscal Year 2010 - Issues Lobbied: Intelligence oversight; HR 2847 Commerce, Justice, Science and Related Agencies Appropriations Act for FY10 - Issues Lobbied: Free speech,restrictions on Legal Services Corporations; HR 2892 Department of Homeland Security Appropriations Act for FY 2010 Conference Report - Issues Lobbied: National Security, Torture/Detention/Interrogation; HR 3017 Employment Non-Discrimination Act (ENDA) - Issues Lobbied: Civil Rights, LGBT Rights; HR 3081 State-Foreign Ops Appropriations - Issues Lobbied: Global Gag Rule; HR 3170 FY 2010 Financial Services and General Government Appropriations Act - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy, Medical Marijuana, 1st Amendment, Religious Liberty, Federal Employees Health Benefits, DC abortion funding bans; HR 3200 Americas Affordable Health Choices Act - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice, Abortion restrictions, abstinence-only programs, comprehensive sex ed, gender rating, womens health amendment; HR 3221 Student Aid and Fiscal Responsibility Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy, HEA Penalty; HR 3245 Fairness in Cocaine Sentencing Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy; HR 3293 Labor-Health and Human Services-Education Appropriations - Issues Lobbied: Abstinence-only, comprehensive sex ed, Title X/PPFA funding; HR 3295 RISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy, HEA Penalty; HR 3312 Reducing the Need for Abortion and Supporting Parents Act - Issues Lobbied: Reproductive Rights; HR 3335 Democracy Restoration Act - Issues Lobbied: Felon Voting Rights; HR 3531 HELP Separated Children Act - Issues Lobbied: Immigration; HR 3567 Respect for Marriage Act - Issues Lobbied: Civil Rights, LGBT Rights; HR 3630 Adolescent Web Awareness Requires Education Act - Issues Lobbied: First Amendment, Free Speech; HR 3721 Gross Legislation - Issues Lobbied: Employment Discrimination; Restoration of ADEA in light of Gross Supreme Court Case; HR 3764 Civil Access to Justice Act of 2009 - Issues Lobbied: Free speech, restrictions on Legal Services Corporations; HR 5577 Chemical Facility Anti-Terrorism Act of 2009 - Issues Lobbied: Open government, access to information, over-classification; HRes 383 Establishing a Select Committee to Review National Security Laws, Policies and Practices - Issues Lobbied: Intelligence oversight; S 147 Lawful Interrogation and Detention Act - Issues Lobbied: National Security, Torture/Detention/Interrogation; S 160 Fairness Doctrine Amendment - Issues Lobbied: First Amendment, Free Press; S 167 COPS Improvements Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice; S 182 Paycheck Fairness Act - Issues Lobbied: Womens Rights, Employment Discrimination, Legislation Updating the Equal Pay Act; S 372 Whistleblower Protection Enhancement Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, Protections for National Security Whistleblowers; S 417 State Secrets Protection Act of 2009 - Issues Lobbied: National security and civil liberties; S 428 A bill to allow travel between the United States and Cuba. - Issues Lobbied: First Amendment, Right to Travel; S 435 Youth PROMISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; S 448 Free Speech Protection Act of 2009 - Issues Lobbied: First Amendment, Free Press, Defendants Rights; S 449 Free Speech Protection Act of 2009 - Issues Lobbied: First Amendment, Free Press, Defendants Rights; S 458 A bill to amend the False Claims Act - Issues Lobbied: First Amendment, Legal Representation; S 495 Justice Integrity Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice; S 612 FOIA Memorandum/OPEN FOIA Act of 2009 - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, Freedom of Information Act Reform; S 678 Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; S 712 Civil Access to Justice Act of 2009 - Issues Lobbied: Free speech, restrictions on Legal Services Corporations; S 714 National Criminal Justice Commission Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Drug Policy; S.1220 Patient Access to Critical Lab Tests Act Issues Lobbied: Civil Liberties, First Amendment; S 1390 National Defense Authorization Act - Issues Lobbied: Civil Rights, Criminal Justice, Death Penalty, Mandatory Minimums, National Security, Detention, Military Commissions, LGBT Rights, 1st Amendment, Free Speech and Association; S 1494 Intelligence Authorization Act for Fiscal Year 2010 - Issues Lobbied: Intelligence oversight; S 1516 Democracy Restoration Act - Issues Lobbied: Felon Voting Rights; S 1549 Protect Citizens from Unlawful Detention Act - Issues Lobbied: Detention conditions; S 1550 Strong STANDARDS Act - Issues Lobbied: Detention conditions; S 1584 Employment Non-Discrimination Act (ENDA) - Issues Lobbied: Civil Rights, LGBT Rights; S 1594 Secure and Safe Detention and Asylum Act - Issues Lobbied: Detention conditions; S 1679 Health care reform - Issues Lobbied: Abortion restrictions, abstinence-only programs, comprehensive sex ed, gender rating, womens health amendment, immigration status, LGBT discrimination; S 1686 JUSTICE ACT - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, Patriot Act issues; S 1692 USA Patriot Act Sunset Extention Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, Patriot Act issues; S 1756 Gross Legislation - Issues Lobbied: Employment Discrimination; Restoration of ADEA; Other Congressional Matters: Biometric ID - Issues Lobbied: Oppose mandatory biometric ID; Civil Rights Act of 2009 draft legislation- Issues Lobbied: Racial Justice; Employment Discrimination; Restoring Civil Rights Protections; Comprehensive Immigration Reform - Issues Lobbied: privacy/border security, Biometric ID, E-verify, immigration court reform, 287(g); Corporal Punishment - Issues Lobbied: Corporal Punishment in Public Schools; NCLB Reauthorization; End Racial Profiling Act (ERPA) Draft Legislation - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Police Practices; E-Verify - Issues Lobbied: employment verification, immigration status; Health Care Reform - Issues Lobbied: Verification requirements; Immigration detention reform - Issues Lobbied: Civil Liberties, due process; Indigent Defense Reform - Issues Lobbied: Civil Rights, Criminal Justice, due process; Iqbal/Twombley decision/ Notice Pleadings Standards - Issues Lobbied: Due Process, Right to Petition, Equal Protection; Medicaid family planning expansion - Issues Lobbied: Reproductive Rights; Patent Reform - Issues Lobbied: Civil Liberties, First Amendment; Prison Abuse Remedies Act draft legislation(and reform of the PLRA) - Issues Lobbied: Civil Rights, Criminal Justice, Prisoners Rights; Fusion Centers - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying; Convention on the Rights of the Child Treaty - Issues Lobbied: Human Rights; TVPRA of 2008 draft bill - Issues Lobbied: Human Rights; Federal Agency Issues: Centers for Disease Control - Issues Lobbied: Lift the HIV Travel Ban; Department of Defense - Issues Lobbied: Posse comitatus , Discrimination; Director of National Intelligence - Issues Lobbied: DHS Intelligence/Information Sharing, National Security, Privacy, Civil Liberties, FBI oversight, DHS oversight, law enforcement oversight, open government, domestic spying , fusion centers; Department of Justice - Issues Lobbied: Civil Rights, Criminal Justice, Privacy, National Security, Torture/Detention/Interrogations, Indigent Defense Reform, Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009, Crack Cocaine Sentencing Reform, Executive Order Ensuring Lawful Interrogations, Executive Order Review of Detention Policy Options, Executive Order Closure of Guantanamo Detention Facilities, Executive Order Ensuring Lawful Interrogations, Executive Order Closure of Guantanamo Detention Facilities, Executive Order Review of Detention Policy Options, DHS Intelligence/Information Sharing, FBI Oversight, domestic spying concerns with Fusion Centers, FOIA Memorandum/OPEN FOIA Act of 2009, Attorney General Guidelines, Faith-Based Programs, Special Prosecutor Torture Inquiry; Federal Bureau of Investigation - Issues Lobbied: National Security, Privacy, Civil Liberties, open government, DHS Intelligence/Information Sharing, FBI oversight, DHS oversight, law enforcement oversight, domestic spying concerns with Fusion Centers, Attorney General Guidelines; Federal Communication Commission - Issues Lobbied: Child Safe Viewing Act; Homeland Security - Issues Lobbied: Ideological Exclusion, Restrictions on Travel, Racial profiling concerns, opposing 287(g), HELP Separated Children Act, DHS Intelligence/Information Sharing, Privacy and domestic spying concerns with Fusion Centers; Immigration and Customs Enforcement - Issues Lobbied: 287(g) agreements, local enforcement of immigration laws, detention conditions, due process; Department of Health and Human Services - Issues Lobbied: OCR Enforcement, Positive Behavior Supports, Corporal Punishment, NCLB Reauthorization; Office of Safe Schools Enforcement - Issues Lobbied: OCR Enforcement, Positive Behavior Supports, Corporal Punishment, NCLB Reauthorization; Office of Management and Budget - Issues Lobbied: Restrictions on Travel, Lobbying Restrictions, Open government, regulatory review, Executive Order 12886; Office of Personnel Management - Issues Lobbied: Executive Branch Protections Against LGBT Discrimination; State Department - Issues Lobbied: Restoration of Inter-agency working groups on human rights, Ideological Exclusion, TVPRA of 2008; U.S. Commission on Civil Rights - Issues Lobbied: USCCR Reauthorization; Department of Education - Issues Lobbied: OCR Enforcement, Positive Behavior Supports, Corporal Punishment, NCLB Reauthorization; Executive Office of the President - Issues Lobbied: Federal websites cookies policy , Privacy, Crack Cocaine Sentencing Reform, Comprehensive Immigration Reform, Executive Branch Protections Against LGBT Discrimination, Cyber-security Review, Faith-Based Programs, Crack Cocaine Sentencing Reform Civil Rights, 1st Amendment, Religious Liberty, Office of Science and Technology and Scientific Integrity; National Security Council - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, over-classification
2009 · third_quarter · Medicare/Medicaid
Provisions of the FY 2010 Budget and Budget Resolution (S Con Res 13 and H C Res 85) regarding health care reform, funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, value based purchasing and geographic fairness in Medicare reimbursement, a freeze in Medicare reimbursement updates for physician services, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ). Value Index Rewarding Value in the Reimbursement System Congress must introduce a value index into Medicare Parts A and B, to reward physicians and hospitals who provide safe, high quality care with excellent service to Medicare patients at a reasonable cost. The value index can be constructed for many types of payment models, including hospital DRG payments, physician fees, payment updates, and other payment formulas. We recommend that the geographic adjustment of physician work should be eliminated as recommended in legislation introduced by Senator Feingold (S 712) and Senator Grassley (S 318), and replaced with a quality/efficiency based coefficient for physician work as soon as possible. Legislation that we strongly support and would accomplish this objective, has been introduced by Iowa Rep. Bruce Braley and Wisconsin Rep. Ron Kind in the House and by Minnesota Senator Amy Klobuchar and Wisconsin Senators Feingold and Kohl in the Senate. The Medicare Payment Improvement Act (HR 2844, S 1249) seeks to reform the Medicare system to one that rewards the value of care over quantity of procedures, improving quality and lowering the total cost of care over time. The bills outcome-based approach creates the incentive for physicians and hospitals to work together to improve quality and use resources efficiently. Value Based Purchasing In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. According to a recent report by the Congressional Budget Office spending in high-spending regions could be reduced without producing worse outcomes, on average, or reductions in the quality of care. (CBO February 2008) Alternatives: Medicare must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Improve access to care in rural areas. The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. Corresponding mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. Performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Medicare Advantage Program Marshfield Clinic has concerns about payment projections and policy changes outlined by the Centers for Medicare and Medicaid Services in its Advance Notice of Methodological Changes for Calendar Year 2010 for Medicare Advantage Capitation Rate and Part C and Part D Payment Policies, dated February 20, 2009. Our first concern is that the national per capita growth rate projected in CMSs Advance Notice deviates significantly from the growth rate health plans are experiencing. CMSs projection is based in large part on an unrealistic assumption that Medicare fee-for-service payments for physician services will be cut by 21% this year. However, since 2003, previously scheduled fee reductions have been overridden by Congress. Secondly, an across-the-board 3.74% reduction for risk score coding patterns for all health plans appears quite large. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. The federal government developed formulas to evaluate the cost of providing services in different practice settings and in different geographic locations. Those formulas measure resource inputs that have changed over the +40 year life of the program. To ensure affordable access to Medicare services throughout the country Medicare must take steps to refine its measures of the cost of providing services so that Medicares overwhelming financial dominance does not interfere with affordable access in markets that have changed very much since the program began. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs. Information Technology Under current law the capital and operating expenses of installing and maintaining electronic medical records (EMRs) are assumed to be part of the overhead expense of a medical practice. Since no more than 5 10% of the physician population has installed EMRs, CMS now obsolete measurement of physician practice expenses reflect minimal average expense associated with IT. Alternatives: Congress should provide incentives for EMR adoption, and/or utilization, and Establish standards to facilitate the sharing and exchange of data. CMS must update its mechanism for evaluating the cost of medical practice. Payment Equity for Physician Work Before MMA 03, Medicares payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for 04 06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. The payment floor provision expired in 06, but has been extended in federal legislation every year since then. Alternatives: The payment floor should be extended indefinitely; Geographic adjustment of work should be eliminated entirely; and replaced with a coefficient of quality and efficiency. Support Senator Feingolds bill, the Rural Medicare Equity Act, S 712. Payment Fairness for Practice Costs The formulas by which Medicares payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: Congress should require CMS to administratively revise its measurement of cost of practice to assure the validity and fairness of payments; A payment floor could be established for practice expense. Practice Expense Payment Floor Congress must require the Centers for Medicare & Medicaid Services (CMS) to administratively revise its measurement of the cost of practice to assure the validity and fairness of payment. However, in the interim, a payment floor must be established for practice expense to stem the inequities of the current methodology as proposed by Reps. Braley and Kind in HR 2201, the Medicare Equity and Accessibility Act of 2009. Extreme variation induced by errors in the payment methodology may also be reduced without compromising the relativity of payment by establishing a geographic practice expense index that limits to the difference between relative wages and rents between fee schedule areas and the national average as proposed by Senator Grassley in S 318. Comparative Effectiveness/Evidence Based Medical Informatics Research Evidence-based medicine relies upon the judicious use of current best evidence in making decisions about the care of individual patients. Key to effective implementation of value-based purchasing initiatives is the systematic development of data that links the health of populations to the medical services the population receives. The application of health information technology and genomic information in population- and community-based health care delivery systems coupled with the development of wellness programs has the potential to substantially improve health and personalized health care on a national basis. The Physician Payment Sunshine Act, S. 2029, introduced by Senator Kohl with Senator Grassley in the 110th Congress to create accountability among physicians and the manufacturers of drugs and devices that physicians utilize and prescribe for their patients. This legislation would require manufacturers of pharmaceutical drugs, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, travel and other means. The Medicare Rural Health Access Improvement Act, S 2786, introduced by Senator Grassley 110th Congress to mitigate current inequities in Medicare reimbursement, improve access to health services in rural and underserved areas, and will begin to close the gap between Medicare reimbursement and the cost of providing services in predominantly rural areas. The legislation establishes a 1.0 floor for physician work and practice expense adjustments. It also revises the work and practice expense formulas to reduce payment differences and more accurately compensate physicians in rural areas for their true practice costs. The bill also extends the five percent incentive payments for primary care and specialty physicians in scarcity areas. Marshfield Clinic nominated Dr. Douglas Reding for an open position on the Medicare Payment Advisory Commission, and sought the endorsement of the Wisconsin delegation, and other Senators and Representatives that serve on the Committees with jurisdiction over the Medicare program. Support for Rep. Ron Kinds concept of a not yet introduced MEDICARE EFFICIENCY BILL that would amend the CHAMP Act (H.R. 3162) 304 in whole, by establishing that the 5% bonus payment would be expanded to the top 10% of efficient counties; and a corresponding 5% efficiency penalty for physicians in the bottom 10% of efficient counties. Medicare Payment Improvement Act of 2009 H.R.2844 : To amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule. Introduced by Rep. Ron Kind and Bruce Braley. Goal: To increase quality of health care in America and decrease cost. The Medicare Payment Improvement Act will fundamentally restructure the Medicare payment system by finally providing an incentive for physicians to provide high quality care. The bill eliminates a geographic adjuster (Work Geographic Practice Cost Index) from Medicare, and replaces it with a figure that measures Value. The value figure measures both quality of care and cost of care. Regions that provide high quality care at low cost will see their Medicare reimbursements increase. Regions that provide low quality care at high cost will see their reimbursements decrease. The current structure of Medicare is known as fee-for-service, and incentivizes the number of services performed. The Braley bill shifts this to value-based care, and incentivizes high quality care and low costs. This proposal will transition our current quantity-based system to a quality-based system. Rep. Braley introduced HR 2201, the Medicare Equity & Accessibility Act. This bill would increase Medicare Part B reimbursement rates in Iowa, by placing a floor on the geographic adjuster (GPCI) that is part of the Part B formula. The bill would have the effect of increasing Part B reimbursements in Iowa and other rural states every time a health care provider sees a patient under Part B. Rep. Braley and others supporting the Medicare Payment Improvement Act including Reps. Kind, Inslee, and McCollum, who were representing a much broader Quality Coalition, who have been pushing for a value index in the Medicare Part B reimbursement equation to measure quality and efficiency of care. This provision includes the following: Quality-Based Care-- Instruct IOM to study how to implement a value index in the Medicare payment system. They will consider geographic differences, access to care, measures of quality, and the role of incentives to impact quality and efficient outcomes of care. After a set two-year timeframe, IOM will make recommendations to the Secretary of HHS on how to specifically change the Medicare payment system to promote high-value care, defined as the efficient delivery of high quality, evidence-based, patient-centered care. The Secretary will then submit a plan of implementation to the Congress, to implement the recommendations of the IOM. Congress will have a finite amount of time to pass a joint resolution of disapproval. If Congress fails to act, or if the recommendations are not expressly disapproved by both Chambers, then the recommendations of the IOM will be implemented, thereby reforming the Medicare payment system to incentivize high-value care. Addressing Geographic Disparity In addition, the deal resulted in substantive action to address geographic disparity in Medicare payments. IOM will do another study, completed within a year after enactment, to determine whether the data and assumptions used to determine the geographic adjusters (Geographic Practice Cost Indexes and Wage Index) are accurate, or based on flawed data. Many believe the factors that determine these indexes are based on flawed data. Upon completion of the study (within one year), the Secretary will take immediate action to adjust the GPCIs and Wage Index to ensure they are based on accurate data. A Medicare Improvement Fund is established, which will consist of $8 billion. From this fund, payments will immediately be made in 2012 and 2013, to ensure the money is there for regions who see an increase in their reimbursement due to the adjusted GPCIs and Wage Index. In 2012 and 2013, a Hold Harmless will exist to ensure that payments do not decrease in any region as a result of these more accurate measurements. The Hold Harmless expires after 2013, to allow budget neutrality for all appropriate shifts that must be made due to correcting the data in the long-term. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Marshfield Clinic supported CMS determination to extend this program, beyond its initial 3-year term. Also supports efforts to eliminate the 2% threshold for payments and the 5% limitation on payments.
2009 · second_quarter · Civil Rights/Civil Liberties
Legislation: HR 1064 Youth PROMISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; HR 1139 COPS Improvements Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice; HR 1215 Immigration Oversight & Fairness Act - Issues Lobbied: Immigration detention standards; HR 1256 A bill to protect the public health by providing the Food and Drug Administration with certain authority to regulate tobacco products. - Issues Lobbied: First Amendment, Free Speech; HR 1283 Military Readiness Enhancement Act of 2009 - Issues Lobbied: LGBT Rights; HR 1304 Free Speech Protection Act of 2009 - Issues Lobbied: First Amendment; HR 1315 Terrorist Detainees Procedures Act of 2009 - Issues Lobbied: Torture/Detention/Interrogation; HR 1409 The Employee Free Choice Act - Issues Lobbied: First Amendment, Employee Rights; HR 1412 Justice Integrity Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice; HR 1429 Stop AIDS in Prison Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Prisoners Rights, HIV/AIDS, Privacy; HR 157 Fairness Doctrine Amendment - Issues Lobbied: First Amendment, Free Press; HR 1604 Universal Right to Vote by Mail Act of 2009 - Issues Lobbied: Absentee Voting Rights; HR 1788 A bill to amend the False Claims Act - Issues Lobbied: First Amendment, Legal Representation; HR 1800 National Security Letters Reform Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, National Security Letter Power, Patriot Act Section 215; HR 1913 Local Law Enforcement Hate Crimes Prevention Act of 2009 - Issues Lobbied: LGBT Rights, 1st Amendment, Free Speech, Free Association; HR 1966 Megan Meier Cyberbullying Prevention Act - Issues Lobbied: First Amendment, Free Speech; HR 2028 New Employee Verification Act - Issues Lobbied: Privacy; HR 2289 Juvenile Justice Accountability and Improvement Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice; HR 2346 2009 Supplemental Appropriations Act - Issues Lobbied: Torture/Detention/Interrogation; HR 2460 Healthy Families Act - Issues Lobbied: paid sick leave; HR 2597 Positive Behavior for Safe and Effective Schools Act - Issues Lobbied: Racial Justice, Education Reform, Juvenile Justice, Positive Behavior Supports; HR 2647 FY 2010 National Defense Authorization Act - Issues Lobbied: Torture/Detention/Interrogation; HR 265 Drug Sentencing Reform and Cocaine Kingpin Trafficking Act - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy; HR 2701 Intelligence Reauthorization Act - Issues Lobbied: National security, constitutional rights, open government; HR 2847 Commerce, Justice, Science and Related Agencies Appropriations Act for FY10 - Issues Lobbied: Free speech, restrictions on Legal Services Corporations; HR 2894 The Voter Confidence and Increased Accessibility Act of 2009 - Issues Lobbied: Voting Rights, Electronic Voting, Disability Access; HR 3017 Employment Non-Discrimination Act - Issues Lobbied: LGBT Rights; HR 3170 FY 2010 Financial Services and General Government Appropriations Act - Issues Lobbied: Criminal Justice, Drug Policy, Medical Marijuana, Religious Liberty, Civil Rights; HR 374 Lawful Interrogation and Detention Act - Issues Lobbied: Torture/Detention/Interrogation; HR 383 Establishing a select committee to review national security laws, policies, and practices. - Issues Lobbied: National security, privacy, constitutional rights, balance of powers; HR 4109 Prison Abuse Remedies Act of 2007 (and reform of the PLRA) - Issues Lobbied: Civil Rights, Criminal Justice; HR 5577 Chemical Facility Anti-Terrorism Act of 2009 - Issues Lobbied: Open government, access to information, over-classification; HR 894 Over-Classification Reduction Act - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, decreasing over-classification; HR 984 State Secrets Protection Act - Issues Lobbied: National security, access to justice; HR 985 Free Flow of Information Act of 2009 - Issues Lobbied: First Amendment, Free Press, Defendants Rights; HR 1507 Whistleblower Protection Enhancement Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, Protections for National Security Whistleblowers; S 1152 Healthy Families Act - Issues Lobbied: paid sick leave; S 1390 FY 2010 National Defense Authorization Act - Issues Lobbied: LGBT Rights, 1st Amendment, Free Speech, Free Association, Detention; S 147 awful Interrogation and Detention Act - Issues Lobbied: Torture/Detention/Interrogation; S 160 Fairness Doctrine Amendment - Issues Lobbied: First Amendment, Free Press; S 167 COPS Improvements Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Juvenile Justice; S 182 Paycheck Fairness Act - Issues Lobbied: Womens Rights, Employment Discrimination, Legislation Updating the Equal Pay Act; S 324 Melanie Blocker Stokes MOTHERS Act - Issues Lobbied: Reproductive Health; S 372 Whistleblower Protection Enhancement Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, Protections for National Security Whistleblowers; S 417 State Secrets Protection Act - Issues Lobbied: National security, access to justice; S 424 Uniting American Families Act - Issues Lobbied: Immigrants Rights, LGBT rights; S 428 A bill to allow travel between the United States and Cuba. - Issues Lobbied: First Amendment, Right to Travel; S 435 Youth PROMISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; S 448 Free Flow of Information Act of 2009 - Issues Lobbied: First Amendment, Free Press, Defendants Rights; S 449 Free Speech Protection Act of 2009 A bill to protect free speech. - Issues Lobbied: First Amendment; S 458 A bill to amend the False Claims Act - Issues Lobbied: First Amendment, Legal Representation; S 495 Justice Integrity Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice; S 560 The Employee Free Choice Act - Issues Lobbied: First Amendment, Employee Rights; S 612 FOIA Memorandum/OPEN FOIA Act of 2009 - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, Freedom of Information Act Reform; S 678 Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; S 712 Civil Access to Justice Act of 2009 - Issues Lobbied: Free speech, restrictions on Legal Services Corporations; S 714 National Criminal Justice Commission Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Drug Policy; S 909 Matthew Shepard Hate Crimes Prevention Act - Issues Lobbied: LGBT Rights, 1st Amendment, Free Speech, Free Association; S 982 A bill to protect the public health by providing the Food and Drug Administration with certain authority to regulate tobacco products. - Issues Lobbied: First Amendment, Free Speech; Other Congressional Matters: Abstinence-only-until marriage programs and sex ed - Issues Lobbied: End funding for the programs, Reproductive Rights; Attorney General Guidelines - Issues Lobbied: FBI investigative authorities, civil rights; Census Funding - Issues Lobbied: Census Funding, FY10 Budget; Civil Rights Act of 2009 - Issues Lobbied: Racial Justice; Employment Discrimination; Restoring Civil Rights Protections; Committee on the Elimination of Discrimination against Women - Issues Lobbied: Womens Rights; Comprehensive Immigration Reform - Issues Lobbied: due process, employment verification; Corporal Punishment - Issues Lobbied: Corporal Punishment in Public Schools; NCLB Reauthorization; DC abortion ban and FEHBP abortion ban - Issues Lobbied: Reproductive Rights; Democracy Restoration Act - Issues Lobbied: Felony Voting Rights; DHS Intelligence/Information Sharing - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers; End Racial Profiling Draft Legislation - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Police Practices; English Only Legislation - Issues Lobbied: Immigrants Rights; E-Verify - Issues Lobbied: Immigrants Rights, Workers Rights; Family and Medical Leave Restoration Act - Issues Lobbied: Reproductive Rights; FBI Oversight - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government; Gene Patenting Legislation - Issues Lobbied: First Amendment; Gross Decision - Issues Lobbied: Employment Discrimination; Restoration of ADEA in light of Gross Supreme Court Case; Indigent Defense Reform - Issues Lobbied: Civil Rights, Criminal Justice; Intelligence Oversight and Accountability - Issues Lobbied: Abuse of authority; Oversight Hearings for Attorney General - Issues Lobbied: ACLU Civil Rights Issues; Patent Reform - Issues Lobbied: First Amendment; Patriot Act Reform - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, surveillance issues; Preventing Unintended Pregnancies, Reducing the Need for Abortion and Supporting Parents Act - Issues Lobbied: Reproductive Rights; Privacy and domestic spying concerns with Fusion Centers - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying, fusion centers; Prolonged and indefinite detention - Issues Lobbied: due process; Sandoval Legislation - Issues Lobbied: Racial Justice; Restoration of Title VI in light Sandoval Supreme Court Case; State and Foreign Ops appropriations - Issues Lobbied: Permanent rescission of the Global Gag Rule; The Convention on the Rights of the Child Treaty - Issues Lobbied: Human Rights; Universal Voter Registration - Issues Lobbied: Voting Rights; Violence Against Women Act - Issues Lobbied: Housing for victims of domestic violence; Voting Rights - Issues Lobbied: Voting Rights, NAMUNDO and Bartlett Supreme Court Case; Net Neutrality Issues Lobbied: Privacy, First Amendment; Real ID/Pass ID Issues Lobbied: Privacy; Electronic Employment Verification Issues Lobbied: Large scale databases, National ID; Federal Agency Issues: Department of Education - Issues Lobbied: Allocation of stimulus funds, CERD Compliance, OCR Enforcement, Positive Behavior Supports, Corporal Punishment, NCLB Reauthorization; Census Bureau - Issues Lobbied: Limited English Proficiency; Center for Disease Control - Issues Lobbied: HPV Vaccine for immigrants; Citizenship and Immigration Services - Issues Lobbied: SSA No-Match; Department of Defense - Issues Lobbied: Discrimination; Department of Homeland Security - Issues Lobbied: National Security, Oppose 287(g), Napolitano review, Secure Communities, Raids,Ideological Exclusion, Restrictions on Travel, Real ID/Pass ID, Medical Records; Department of Justice - Issues Lobbied: Limited English Proficiency, Ideological exclusion, Criminal Investigation/Special Prosecutor Torture Inquiry, Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009, Crack Cocaine Sentencing Reform, privacy, National Security, Privacy, Open Government, Freedom of Information Act Reform; Director of National Intelligence - Issues Lobbied: National Security, Privacy, Civil Liberties, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers; Executive Office of the President - Issues Lobbied: Lobbying Restrictions, Ethics Executive Order, Restrictions on Travel, Reproductive Rights, End funding of Abstinence Only Programs, DC abortion ban, FEHBP abortion ban, Executive Order Ensuring Law Interrogations, Executive Order Closure of Guantanamo Detention Facilities, Executive Order Review of Detention Policy Options, Executive Order Amendments to Executive Order 13199 and Establishment of the Presidents Advisory Council for Faith-Based and Neighborhood Partnerships, Torture, Detention, Interrogation, Religious Liberty, Civil Rights, Crack Cocaine Sentencing Reform, Cyber-security Review; Federal Bureau of Investigations - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers; Federal Communication Commission - Issues Lobbied: Child Safe Viewing Act; Food and Drug Administration - Issues Lobbied: Plan B, EC over the counter status; Health and Human Services - Issues Lobbied: Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law (73 Fed. Reg. 78,072) , Rescind healthcare denial regulation, American Health Choices Act, Limited English Proficiency, Ideological exclusion; Immigration and Customs Enforcement - Issues Lobbied: Immigration Detention Conditions, Oppose 287(g); National Security Council - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, decreasing over-classification, interagency working group on human rights; Office of Information and Regulatory Affairs - Issues Lobbied: Restrictions on Travel; Office of Justice Programs - Issues Lobbied: Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009; Office of Juvenile Justice and Delinquency Prevention - Issues Lobbied: Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009; Office of Management and Budget - Issues Lobbied: Lobbying Restrictions, Reproductive Rights, End funding of Abstinence Only Programs, DC abortion ban, FEHBP abortion ban, Executive Order 12886; Office of Science and Technology Policy - Issues Lobbied: Scientific Integrity; State Department - Issues Lobbied: Restoration of Inter-agency working groups on human rights, Ideological Exclusion, TVPRA of 2008 (PL 110-457); U.S. Commission on Civil Rights - Issues Lobbied: USCCR Reauthorization; U.S. Equal Employment Opportunity Commission - Issues Lobbied: Employment Discrimination; EEOC Enforcement; Office of Personnel Management Issues Lobbied: employment criminal background checks
2009 · second_quarter · Medicare/Medicaid
HR 27Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the State Children's Health Insurance Program for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465,a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a Centers for Medicare & Medicaid Services Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Senator Schumer and Senator Roberts Letter eliminating IME Cuts CMS to withdraw the Capital IME cut that was included in last years Medicare IPPS rule; Letter to President Obama from Neal/ Tiberi on Capital IME PROTECT AMERICAS TEACHING HOSPITALS, asking him to withdraw a provision in the FY 2010 IPPS rule that would cut reimbursements to teaching hospitals. Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS).Working on legislation to amend the Medicare Recovery Audit Contractor Program. S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare Program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letter to CMS, Physician Supervision for Outpatient Service, Resend policy changes requiring PSO therapeutic Service in and on hospital campus. Withdraw it to minimize legal risk; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009A bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals, and for other purposes HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the Medicare Payment Advisory Commission on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy.
S. 712 - Lobbied against changing the definition of "navigable water" to "waters of the United States" in the Clean Water Act.
Client expense: $283,791 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
S. 712 - Lobbied against changing the definition of "navigable water" to "waters of the United States" in the Clean Water Act.
Client expense: $283,791 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2009 · second_quarter · Medicare/Medicaid
Provisions of the FY 2010 Budget and Budget Resolution (S Con Res 13 and H C Res 85) regarding health care reform, funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, value based purchasing and geographic fairness in Medicare reimbursement, a freeze in Medicare reimbursement updates for physician services, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ). Value Index Rewarding Value in the Reimbursement System Congress must introduce a value index into Medicare Parts A and B, to reward physicians and hospitals who provide safe, high quality care with excellent service to Medicare patients at a reasonable cost. The value index can be constructed for many types of payment models, including hospital DRG payments, physician fees, payment updates, and other payment formulas. We recommend that the geographic adjustment of physician work should be eliminated as recommended in legislation introduced by Senator Feingold (S 712) and Senator Grassley (S 318), and replaced with a quality/efficiency based coefficient for physician work as soon as possible. Legislation that we strongly support and would accomplish this objective, has been introduced by Iowa Rep. Bruce Braley and Wisconsin Rep. Ron Kind in the House and by Minnesota Senator Amy Klobuchar and Wisconsin Senators Feingold and Kohl in the Senate. The Medicare Payment Improvement Act (HR 2844, S 1249) seeks to reform the Medicare system to one that rewards the value of care over quantity of procedures, improving quality and lowering the total cost of care over time. The bills outcome-based approach creates the incentive for physicians and hospitals to work together to improve quality and use resources efficiently. Value Based Purchasing In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. According to a recent report by the Congressional Budget Office spending in high-spending regions could be reduced without producing worse outcomes, on average, or reductions in the quality of care. (CBO February 2008) Alternatives: Medicare must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Improve access to care in rural areas. The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. Corresponding mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. Performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Medicare Advantage Program Marshfield Clinic has concerns about payment projections and policy changes outlined by the Centers for Medicare and Medicaid Services in its Advance Notice of Methodological Changes for Calendar Year 2010 for Medicare Advantage Capitation Rate and Part C and Part D Payment Policies, dated February 20, 2009. Our first concern is that the national per capita growth rate projected in CMSs Advance Notice deviates significantly from the growth rate health plans are experiencing. CMSs projection is based in large part on an unrealistic assumption that Medicare fee-for-service payments for physician services will be cut by 21% this year. However, since 2003, previously scheduled fee reductions have been overridden by Congress. Secondly, an across-the-board 3.74% reduction for risk score coding patterns for all health plans appears quite large. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. The federal government developed formulas to evaluate the cost of providing services in different practice settings and in different geographic locations. Those formulas measure resource inputs that have changed over the +40 year life of the program. To ensure affordable access to Medicare services throughout the country Medicare must take steps to refine its measures of the cost of providing services so that Medicares overwhelming financial dominance does not interfere with affordable access in markets that have changed very much since the program began. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs. Information Technology Under current law the capital and operating expenses of installing and maintaining electronic medical records (EMRs) are assumed to be part of the overhead expense of a medical practice. Since no more than 5 10% of the physician population has installed EMRs, CMS now obsolete measurement of physician practice expenses reflect minimal average expense associated with IT. Alternatives: Congress should provide incentives for EMR adoption, and/or utilization, and Establish standards to facilitate the sharing and exchange of data. CMS must update its mechanism for evaluating the cost of medical practice. Payment Equity for Physician Work Before MMA 03, Medicares payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for 04 06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. The payment floor provision expired in 06, but has been extended in federal legislation every year since then. Alternatives: The payment floor should be extended indefinitely; Geographic adjustment of work should be eliminated entirely; and replaced with a coefficient of quality and efficiency. Support Senator Feingolds bill, the Rural Medicare Equity Act, S 712. Payment Fairness for Practice Costs The formulas by which Medicares payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: Congress should require CMS to administratively revise its measurement of cost of practice to assure the validity and fairness of payments; A payment floor could be established for practice expense. Practice Expense Payment Floor Congress must require the Centers for Medicare & Medicaid Services (CMS) to administratively revise its measurement of the cost of practice to assure the validity and fairness of payment. However, in the interim, a payment floor must be established for practice expense to stem the inequities of the current methodology as proposed by Reps. Braley and Kind in HR 2201, the Medicare Equity and Accessibility Act of 2009. Extreme variation induced by errors in the payment methodology may also be reduced without compromising the relativity of payment by establishing a geographic practice expense index that limits to the difference between relative wages and rents between fee schedule areas and the national average as proposed by Senator Grassley in S 318. Comparative Effectiveness/Evidence Based Medical Informatics Research Evidence-based medicine relies upon the judicious use of current best evidence in making decisions about the care of individual patients. Key to effective implementation of value-based purchasing initiatives is the systematic development of data that links the health of populations to the medical services the population receives. The application of health information technology and genomic information in population- and community-based health care delivery systems coupled with the development of wellness programs has the potential to substantially improve health and personalized health care on a national basis. The Physician Payment Sunshine Act, S. 2029, introduced by Senator Kohl with Senator Grassley in the 110th Congress to create accountability among physicians and the manufacturers of drugs and devices that physicians utilize and prescribe for their patients. This legislation would require manufacturers of pharmaceutical drugs, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, travel and other means. The Medicare Rural Health Access Improvement Act, S 2786, introduced by Senator Grassley 110th Congress to mitigate current inequities in Medicare reimbursement, improve access to health services in rural and underserved areas, and will begin to close the gap between Medicare reimbursement and the cost of providing services in predominantly rural areas. The legislation establishes a 1.0 floor for physician work and practice expense adjustments. It also revises the work and practice expense formulas to reduce payment differences and more accurately compensate physicians in rural areas for their true practice costs. The bill also extends the five percent incentive payments for primary care and specialty physicians in scarcity areas. Marshfield Clinic nominated Dr. Douglas Reding for an open position on the Medicare Payment Advisory Commission, and sought the endorsement of the Wisconsin delegation, and other Senators and Representatives that serve on the Committees with jurisdiction over the Medicare program. Support for Rep. Ron Kinds concept of a not yet introduced MEDICARE EFFICIENCY BILL that would amend the CHAMP Act (H.R. 3162) 304 in whole, by establishing that the 5% bonus payment would be expanded to the top 10% of efficient counties; and a corresponding 5% efficiency penalty for physicians in the bottom 10% of efficient counties. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Marshfield Clinic supported CMS determination to extend this program, beyond its initial 3-year term. Also supports efforts to eliminate the 2% threshold for payments and the 5% limitation on payments.
2009 · first_quarter · Civil Rights/Civil Liberties
Legislation: HR 1 the American Recovery and Reinvestment Act of 2009 - Issues Lobbied: Civil Rights, Drug Policy, Criminal Justice, Privacy, E-Medical Records, E-Verify, Net Neutrality, Religious Liberty, Medicaid Family Planning Waiver, Title V Ab-Only; H.Con.Res. 85 Budget Resolution - Issues Lobbied: Opposing Bunning amendment to extend Title V ab-only and Coburn amendment to prevent rescission of the Health Care Denial Reg; HR 1029 Alien Smuggling and Terrorism Prevention Act of 2009 - Issues Lobbied: Harboring/alien smuggling criminalization; push for exemption of humanitarian assistance organizations; HR 1064 the Youth PROMISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; HR 11 Lilly Ledbetter Fair Pay Act of 2009 - Issues Lobbied: Civil Rights, Civil Liberties, Womens Rights, Employment Discrimination, legislation responding to the Ledbetter v. Goodyear decision; HR 1105 Omnibus Appropriations Act of 2009 - Issues Lobbied: Religious Liberty, Vouchers, Ending abstinence-only funding; opposing anti-choice amendments; HR 12 Paycheck Fairness Act - Issues Lobbied: Civil Rights, Civil Liberties, Womens Rights, Employment Discrimination, legislation enhancing the Equal Pay Act; HR 1215 Immigration Oversight and Fairness Act of 2009 - Issues Lobbied: Humane immigration detention standards; HR 1283 Military Readiness Enhancement Act of 2009 - Issues Lobbied: LGBT Rights; HR 1304 Free Speech Protection Act of 2009 - Issues Lobbied: First Amendment; HR 1315 Terrorist Detainees Procedures Act of 2009 - Issues Lobbied: Torture/Detention/Interrogation; HR 1409 Employee Free Choice Act of 2009 - Issues Lobbied: Labor, Employee rights; HR 1412 the Justice Integrity Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice; HR 1429 the Stop AIDS in Prison Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Prisoners Rights, HIV/AIDS, Privacy; HR 146 the Omnibus Public Land Management Act of 2009 - Issues Lobbied: Criminal Justice; HR 1507 Whistleblower Protection Enhancement Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, Protections for National Security Whistleblowers; HR 1604 Universal Right to Vote by Mail Act of 2009 - Issues Lobbied: Civil Rights, Civil Liberties, Voting Rights, absentee voting; HR 1617 Privacy Officer Act of 2009 - Issues Lobbied: Privacy; HR 1651 Access to Justice Act - Issues Lobbied: Opposing Moran bill aimed at fixing Compean; HR 1788 False Claims Act Correction Act of 2009 - Issues Lobbied: First Amendment, Legal Representation; HR 1800 National Security Letters Reform Act of 2009 - Issues Lobbied: protections for recipients of NSLs and limiting gag provision; HR 1913 Local Law Enforcement Hate Crimes Prevention Act of 2009 - Issues Lobbied: LGBT Rights, 1st Amendment, Free Speech, Free Association; HR 2 Children's Health Insurance Program Reauthorization Act of 2009 - Issues Lobbied: Hatch amendment to reinstate 5-year bar; HR 265 the Drug Sentencing Reform and Cocaine Kingpin Trafficking Act - Issues Lobbied: Civil Rights, Criminal Justice, Drug Policy; HR 374 Lawful Interrogation and Detention Act - Issues Lobbied: Torture/Detention/Interrogation; HR 2857 GIVE Act - Issues Lobbied: Opposing anti-choice amendments; HR 5577 Chemical Facility Anti-Terrorism Act of 2009 - Issues Lobbied: Open government, access to information, over-classification; HR 7322 Commerce, Justice, Science and Related Agencies Appropriations Act for FY09 - Issues Lobbied: Free speech, legal representation; HR 894 Over-Classification Reduction Act - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, decreasing over-classification; HR 984 State Secret Protection Act of 2009 - Issues Lobbied: Support bill/limits on governments ability to assert state secrets to end lawsuits without court oversight; HR 985 Free Flow of Information Act of 2009 - Issues Lobbied: First Amendment, free press, defendant's rights; S 128 Paycheck Fairness Act - Issues Lobbied: Civil Rights, Civil Liberties, Womens Rights, Employment Discrimination, legislation enhancing the Equal Pay Act; S 147 Lawful Interrogation and Detention Act - Issues Lobbied: Torture/Detention/Interrogation; S 160 District of Columbia House Voting Rights Act of 2009 - Issues Lobbied: Religious Liberty, Vouchers; S 181 Lilly Ledbetter Fair Pay Act of 2009 - Issues Lobbied: Civil Rights, Civil Liberties, Womens Rights, Employment Discrimination, legislation responding to the Ledbetter v. Goodyear decision; S 3182 Commerce, Justice, Science and Related Agencies Appropriations Act for FY09 - Issues Lobbied: Free speech, legal representation; S 372 Whistleblower Protection Enhancement Act of 2009 - Issues Lobbied: National Security, Privacy, Civil Liberties, Protections for National Security Whistleblowers; S 417 State Secret Protection Act of 2009 - Issues Lobbied: Support bill/limits on governments ability to assert state secrets to end lawsuits without court oversight; S 428 Freedom to Travel to Cuba Act - Issues Lobbied: First Amendment, right to travel; S 435 the Youth PROMISE Act - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; S 448 Free Flow of Information Act of 2009 - Issues Lobbied: First Amendment, free press, defendant's rights; S 449 Free Speech Protection Act of 2009 - Issues Lobbied: First Amendment; S 458 False Claims Act Clarification Act of 2009 - Issues Lobbied: First Amendment, Legal Representation; S 495 the Justice Integrity Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice; S 560 Employee Free Choice Act of 2009 - Issues Lobbied: Labor, employee rights; S 612 FOIA Memorandum/OPEN FOIA Act of 2009 - Issues Lobbied: National Security, Civil Liberties, Privacy, Open Government, Freedom of Information Act Reform; S 678 the Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice; S 712 Civil Access to Justice Act of 2009 - Issues Lobbied: Free speech, legal representation; S 714 the National Criminal Justice Commission Act of 2009 - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Drug Policy; S.CON.RES.13 Senate Budget Resolution - Issues Lobbied: Immigration, Civil Rights, Civil Liberties, Employment Discrimination, EEOC funding, Opposing Bunning amendment to extend Title V ab-only and Coburn amendment to prevent rescission of the Health Care Denial Regulations Other Congressional Matters: Commerce, Justice, Science and Related Agencies Appropriations Act for FY10 - Issues Lobbied: Free speech, legal representation; Comprehensive Immigration Reform - Issues Lobbied: Immigration, due process rights, employment verification; Asylum bill - Issues Lobbied: Immigration detention; Democracy Restoration Act - Issues Lobbied: Civil Rights, Civil Liberties, Voting Rights, Felon Voting Rights; Draft Omnibus Privacy Legislation - Issues Lobbied: Privacy, consumer privacy rights; Immigration Court Reform bill - Issues Lobbied: Immigration Court Reform and federal jurisdiction, due process; Electronic Voting Legislation - Issues Lobbied: Civil Rights, Civil Liberties, Voting Rights, electronic voting, disability access; End Racial Profiling Draft Legislation - Issues Lobbied: Civil Rights, Criminal Justice, Racial Justice, Police Practices, racial profiling; FY 2010 Concurrent Budget Resolution - Issues Lobbied: Religious Liberty, Vouchers, Ending abstinence-only funding; funding comprehensive sex ed; Global Gag Rule - Issues Lobbied: rescission, supporting codifying rescission; Department of Health and Human Services Health Care Denial Regulation - Issues Lobbied: Encouraging support for rescission of regulation; Homeland Security Appropriations - Issues Lobbied: Report language re 287(g) and similar local immigration enforcement programs; House Homeland Security Subcommittee on Intelligence, Information Sharing and Terrorism Risk Assessment hearings on fusion centers and homeland security intelligence - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying , fusion centers; Intelligence Oversight and Accountability - Issues Lobbied: Abuse of authority; Unlawful Detention bill - Issues Lobbied: Unlawful detention and immigration due process; Net Neutrality Draft Legislation - Issues Lobbied: Privacy, 1st Amendment, free speech, equal access rights; Patriot Act Reform - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, Patriot Act issues, surveillance; Positive Behavior for Effective Schools Act - Issues Lobbied: Civil Rights, Civil Liberties, Racial Justice, No Child Left Behind, Juvenile Justice, Positive Behavior Support; Privacy and domestic spying concerns with Fusion Centers - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying, fusion centers; Real ID Draft Legislation - Issues Lobbied: Privacy; Senate Judiciary Committee Confirmation Hearing for Eric Holder - Issues Lobbied: Civil Rights, Civil Liberties, Submitted Qs to SJC staff for Holder Confirmation on ACLU issues; Senate Judiciary Committee Hearing on FBI Oversight - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government; Torture Oversight - Issues Lobbied: Torture/Detention/Interrogation; Universal Voter Registration - Issues Lobbied: Civil Rights, Civil Liberties, Voting Rights, Voter Registration; Voting Rights Hearings in House Judiciary Constitution Civil Right and Civil Liberties Subcommittee , House Administration Elections Subcommittee and Senate Rules Committee - Issues Lobbied: Civil Rights, Civil Liberties, Voting Rights, Election Administration in the 2008 election. Federal Agency Issues: Executive Office of the President - Issues Lobbied: American Recovery and Reinvestment Act of 2009, Civil Rights, Criminal Justice, Drug Policy, Lobbyist Restrictions, HIV/AIDS, Prisoner Rights, LGBT Rights Rights, Executive Order Ensuring Law Interrogations , Executive Order Closure of Guantanamo Detention Facilities, Executive Order Review of Detention Policy Options, Executive Order Amendments to Executive Order 13199 and Establishment of the Presidents Advisory Council for Faith-Based and Neighborhood Partnerships, Global Gag Rule; Federal Communication Commission - Issues Lobbied: Media ownership, net neutrality, ownership diversity; Department of Education - Issues Lobbied: funding for CERD compliance; Department of Justice - Issues Lobbied: Special Prosecutor Torture Inquiry, Civil Rights, Criminal Justice, Racial Justice, Juvenile Justice, Opposing Moran bill aimed at fixing Compean, Torture/Detention/Interrogation, Attorney General Guidelines; Department of Homeland Security - Issues Lobbied: Local and police enforcement of immigration laws, Racial Profiling, National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying, fusion centers; US Commission on Civil Rights - Issues Lobbied: US Commission on Civil Rights Reauthorization, Civil Rights, Civil Liberties, USCCR Reauthorization; Director of National Intelligence - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying, fusion centers; Federal Bureau of Investigation - Issues Lobbied: National Security, Privacy, Civil Liberties, FBI oversight, law enforcement oversight, open government, DHS oversight, domestic spying, fusion centers, Attorney General Guidelines; Office of Management and Budget - Issues Lobbied: Executive Order 12886, FY2010 budget and appropriations, Open government, regulatory review, Ending abstinence-only funding,comprehensive sex ed; Department of Health and Human Services - Issues Lobbied: rescission of HHS Health Care Denial Regulation, and the misuse of funding to promote abstinence-only in the Healthy Marriage and Responsible Fatherhood initiative; State Department - Issues Lobbied: rescission of the Trafficking Victims Protection Reauthorization Act; Department of Housing and Urban Development - Issues Lobbied: Violence Against Women Act
S. 712 - Lobbied against changing the definition of "navigable water" to "waters of the United States" in the Clean Water Act.
Client expense: $290,022 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2009 · first_quarter · Medicare/Medicaid
HR 27Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 53 Nursing School Clinics Act of 2009, a bill to amend title XIX of the Social Security Act to provide for coverage of services provided by nursing school clinics under State Medicaid programs; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; S 63 Medicaid Advanced Practice Nurses and Physician Assistants Access Act of 2009, a bill to amend title XIX of the Social Security Act to improve access to advanced practice nurses and physicians' assistants under the Medicaid Program; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the State Children's Health Insurance Program for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465,a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; S 301Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; HR 1094 Medicare Home Health Flexibility Act of 2009, a bill to ensure that home health agencies can assign the most appropriate skilled service to make the initial assessment visit for home health services for Medicare beneficiaries requiring rehabilitation therapy under a home health plan of care, based upon physician referral; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1118 Health Care Choices for Senior Act, a bill to amend the Social Security Act to improve choices available to Medicare eligible seniors by permitting them to elect (instead of regular Medicare benefits) to receive a voucher for a health savings acount, for premiums for a high deductible health insurance plan, or both and by suspending Medicare late enrollment penalties between ages 65 and 70; HR 1125 Long-Term Care Quality Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the quality of care in skilled nursing facilities under the Medicare Program through requiring the reporting of expenditures for nursing; HR 1137 Athletic Trainers' Equal Access to Medicare Act of 2009, a bill to amend title XVIII of the Social Security Act to provide improved access to physical medicine and rehabilitation services under part B of the Medicare Program, and for other purposes; S 457 Fostering Independence Through Technology Act of 2009, a bill to establish pilot projects under the Medicare program to provide incentives for home health agencies to utilize home monitoring and communications technologies; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a Centers for Medicare & Medicaid Services Working Group, and for other purposes; HR 1643 and S 648 Medicare Access to Community Health Centers (MATCH) Act of 2009, a bill to amend title XVIII of the Social Security Act to establish a prospective payment system instead of the reasonable cost-based reimbursement method for Medicare-covered services provided by Federally qualified health centers and to expand the scope of such covered services to account for expansions in the scope of services provided by Federally qualified health centers since the inclusion of such services for coverage under the Medicare Program; S 677 Reforming an Entitlement through Premium Adjustments based on Income Resources (REPAIR) Act of 2009, a bill to amend title XVIII of the Social Security Act to require wealthy beneficiaries to pay a greater share of their premiums under the Medicare prescription drug program; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Senator Schumer and Senator Roberts Letter eliminating IME Cuts CMS to withdraw the Capital IME cut that was included in last years Medicare IPPS rule; Letter to President Obama from Neal/ Tiberi on Capitol IME PROTECT AMERICAS TEACHING HOSPITALS, asking him to withdraw a provision in the FY 2010 IPPS rule that would cut reimbursements to teaching hospitals. Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS).Working on legislation to amend the Medicare Recovery Audit Contractor Program.
2009 · first_quarter · Medicare/Medicaid
Provisions of the FY 2010 Budget and Budget Resolution (S Con Res 13 and H C Res 85) regarding health care reform, funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, value based purchasing and geographic fairness in Medicare reimbursement, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ). General Issue Area Code MMM (Medicare and Medicaid) Provisions of the FY 2010 Budget and Budget Resolution (S Con Res 13 and H C Res 85) regarding health care reform, funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, value based purchasing and geographic fairness in Medicare reimbursement, a freeze in Medicare reimbursement updates for physician services, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ). Value Based Purchasing In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. According to a recent report by the Congressional Budget Office spending in high-spending regions could be reduced without producing worse outcomes, on average, or reductions in the quality of care. (CBO February 2008) Alternatives: Medicare must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Improve access to care in rural areas. The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. Corresponding mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. Performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Medicare Advantage Program Marshfield Clinic has concerns about payment projections and policy changes outlined by the Centers for Medicare and Medicaid Services in its Advance Notice of Methodological Changes for Calendar Year 2010 for Medicare Advantage Capitation Rate and Part C and Part D Payment Policies, dated February 20, 2009. Our first concern is that the national per capita growth rate projected in CMSs Advance Notice deviates significantly from the growth rate health plans are experiencing. CMSs projection is based in large part on an unrealistic assumption that Medicare fee-for-service payments for physician services will be cut by 21% this year. However, since 2003, previously scheduled fee reductions have been overridden by Congress. Secondly, an across-the-board 3.74% reduction for risk score coding patterns for all health plans appears quite large. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. The federal government developed formulas to evaluate the cost of providing services in different practice settings and in different geographic locations. Those formulas measure resource inputs that have changed over the +40 year life of the program. To ensure affordable access to Medicare services throughout the country Medicare must take steps to refine its measures of the cost of providing services so that Medicares overwhelming financial dominance does not interfere with affordable access in markets that have changed very much since the program began. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs. Information Technology Under current law the capital and operating expenses of installing and maintaining electronic medical records (EMRs) are assumed to be part of the overhead expense of a medical practice. Since no more than 5 10% of the physician population has installed EMRs, CMS now obsolete measurement of physician practice expenses reflect minimal average expense associated with IT. Alternatives: Congress should provide incentives for EMR adoption, and/or utilization, and Establish standards to facilitate the sharing and exchange of data. CMS must update its mechanism for evaluating the cost of medical practice. Payment Equity for Physician Work Before MMA 03, Medicares payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for 04 06 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. The payment floor provision expired in 06, but has been extended in federal legislation every year since then. Alternatives: The payment floor should be extended indefinitely; Geographic adjustment of work should be eliminated entirely; and replaced with a coefficient of quality and efficiency. Support Senator Feingolds bill, the Rural Medicare Equity Act, S 712. Payment Fairness for Practice Costs The formulas by which Medicares payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: Congress should require CMS to administratively revise its measurement of cost of practice to assure the validity and fairness of payments; A payment floor could be established for practice expense; or Comparative Effectiveness/Evidence Based Medical Informatics Research Evidence-based medicine relies upon the judicious use of current best evidence in making decisions about the care of individual patients. Key to effective implementation of value-based purchasing initiatives is the systematic development of data that links the health of populations to the medical services the population receives. The application of health information technology and genomic information in population- and community-based health care delivery systems coupled with the development of wellness programs has the potential to substantially improve health and personalized health care on a national basis. The Physician Payment Sunshine Act, S. 2029, introduced by Senator Kohl with Senator Grassley in the 110th Congress to create accountability among physicians and the manufacturers of drugs and devices that physicians utilize and prescribe for their patients. This legislation would require manufacturers of pharmaceutical drugs, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, travel and other means. The Medicare Rural Health Access Improvement Act, S 2786, introduced by Senator Grassley 110th Congress to mitigate current inequities in Medicare reimbursement, improve access to health services in rural and underserved areas, and will begin to close the gap between Medicare reimbursement and the cost of providing services in predominantly rural areas. The legislation establishes a 1.0 floor for physician work and practice expense adjustments. It also revises the work and practice expense formulas to reduce payment differences and more accurately compensate physicians in rural areas for their true practice costs. The bill also extends the five percent incentive payments for primary care and specialty physicians in scarcity areas. Marshfield Clinic nominated Dr. Douglas Reding for an open position on the Medicare Payment Advisory Commission, and sought the endorsement of the Wisconsin delegation, and other Senators and Representatives that serve on the Committees with jurisdiction over the Medicare program. Support for Rep. Ron Kinds concept of a not yet introduced MEDICARE EFFICIENCY BILL that would amend the CHAMP Act (H.R. 3162) 304 in whole, by establishing that the 5% bonus payment would be expanded to the top 10% of efficient counties; and a corresponding 5% efficiency penalty for physicians in the bottom 10% of efficient counties. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Marshfield Clinic supported CMS determination to extend this program, beyond its initial 3-year term. Also supports efforts to eliminate the 2% threshold for payments and the 5% limitation on payments.
Client expense: $334,182 · Firm income: Not reported
Government targets: Commerce, Dept of (DOC), Defense, Dept of (DOD), Education, Dept of, Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Archives & Records Administration (NARA), Natl Economic Council (NEC), Natl Security Council (NSC), Occupational Safety & Health Administration (OSHA), Office of Faith-Based & Community Initiatives, Office of Juvenile Justice & Delinquency Prevention, Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, State, Dept of (DOS), U.S. Immigration & Customs Enforcement (ICE)
Client expense: $3,730,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: $150,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $5,400,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: $406,539 · Firm income: Not reported
Government targets: Defense, Dept of (DOD), Director of National Intelligence (ODNI), Education, Dept of, Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Archives & Records Administration (NARA), Natl Economic Council (NEC), Natl Security Council (NSC), Office of Faith-Based & Community Initiatives, Office of Juvenile Justice & Delinquency Prevention, Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, State, Dept of (DOS), U.S. Commission on Civil Rights, U.S. Immigration & Customs Enforcement (ICE)
Client expense: $140,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE
Client expense: $3,830,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: $482,697 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Defense, Dept of (DOD), Director of National Intelligence (ODNI), Education, Dept of, Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Security Council (NSC), Office of Faith-Based & Community Initiatives, Office of Justice Program, Office of Juvenile Justice & Delinquency Prevention, Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, State, Dept of (DOS), U.S. Commission on Civil Rights, U.S. Immigration & Customs Enforcement (ICE), White House Office
Client expense: $90,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Economic Council (NEC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: $394,576 · Firm income: Not reported
Government targets: Bureau of Citizenship & Immigration Services (BCIS), Bureau of the Census, Centers For Disease Control & Prevention (CDC), Defense, Dept of (DOD), Director of National Intelligence (ODNI), Education, Dept of, Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Communications Commission (FCC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Natl Security Council (NSC), Office of Justice Program, Office of Juvenile Justice & Delinquency Prevention, Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), U.S. Commission on Civil Rights, U.S. Immigration & Customs Enforcement (ICE)
Client expense: $3,490,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: $90,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE
Client expense: $438,418 · Firm income: Not reported
Government targets: Director of National Intelligence (ODNI), Education, Dept of, Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), U.S. Commission on Civil Rights
Client expense: $3,580,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: $90,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE