Protecting Access to Rural Therapy Services (PARTS) Act

S 1143/HR 2801 -- PARTS Act to modify physician supervision rules for therapeutic services delivered in a hospital outpatient department. Support. S 2037/HR 3991 -- Modify critical access hospital length-of-stay requirements to average annual length-of-stay. Support S 2082/HR 3698 -- Require Centers for Medicare & Medicaid Services to change two-midnights rule used to determine whether a patient is inpatient or outpatient. Support.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S 1143/HR 2801 -- PARTS Act to modify physician supervision rules for therapeutic services delivered in a hospital outpatient department. Support. S 2037/HR 3991 -- Modify critical access hospital length-of-stay requirements to average annual length-of-stay. Support S 2082/HR 3698 -- Require Centers for Medicare & Medicaid Services to change two-midnights rule used to determine whether a patient is inpatient or outpatient. Support.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Submitted comments on the Hatch Entitlement Reform in support of the several key reforms proposed for the Medicare program as alternative reductions to provider payments; Support S 351 Protecting Seniors Access to Medicare Act, a bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; Support HR 297 and S1557, Children's Hospital GME Support Reauthorization Act of 2013, the bill would reauthorize the CHGME program for an additional five years through fiscal year (FY) 2017; Support HR 1250 and S 1012 Medicare Audit Improvement Act of 2013, a bill to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Support S. 596 Fostering Independence Through Technology Act of 2014, a bill to establish pilot projects under the Medicare program to provide incentives for home health agencies to furnish remote patient monitoring services that reduce expenditures under such program; Support HR 1787 and S 842 Rural Hospital Access Act of 2013, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support HR 1920 and S 1555 DSH Reduction Relief Act of 2013, a bill to amend titles XVIII and XIX of the Social Security Act to provide for a delay in the implementation schedule of the reductions in disproportionate share hospital payments;AHA submitted a statement to the Presidents and Other Bipartisan Proposals to Reform Medicare Post-Acute Care Payments hearing to provide input on proposals to reform Medicares post-acute care payment systems; AHA submitted a statement to the Program Integrity: Oversight of Recovery Audit Contractors hearing supporting increased oversight of Recovery Audit Contractors (RACs); Support HR 2578 Rural Hospital Fairness Act of 2013, a bill to amend title XVIII of the Social Security Act to extend for one year the hold harmless provision for small rural hospitals and sole community hospitals under the Medicare prospective payment system for hospital outpatient department services related to enhanced physician supervision requirements; AHA submitted a statement to the Health Care Quality: The Path Forward hearing in support of improving transparency for the public, continuing and enhancing support of efforts to improve the safety and quality of the care delivered,and reduce unnecessary hospital expenditures; Support HR 2931 Fairness in Health Care Claims, Guidance and Investigations Act, a bill to amend the false claims provisions of title 31, United States Code, with respect to health care programs; Request additional guidance on and delay of two-midnight rule from CMS; Request issue corrected data on OPPS proposed rule and delay comment period from CMS; Discussion of ACAs patient safety evaluation system with CMS; Discussed the improvements to the National Practitioner Data Bank and new compliance efforts at HRSA; Discussions of Medicaid presumptive eligibility; Medicaid DSH; and request release of DSH audit rule with CMS; Follow up on GPO exclusion related to 340(b) entities; discussions to help shape upcoming proposed rule on 340B with HRSA; Discussed the Qualified Health Plans (QHP) 90day grace period with HHS and its implications for hospitals; Support HJ Res 59, a continuing Appropriations Resolution for 2014, which includes a provision that averts Medicare physician payment cuts as Congress continues to work on a replacement of the flawed SGR formula; Support HR 3444 Critical Access Hospital Flexibility Act of 2013, 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; Support H.R.3698 and S. 2037 Two-Midnight Rule Delay Act of 2013, to delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays; Requested CMS and ONC to extend the EHR Incentive program regulatory timelines for 2014 and allow all providers greater flexibility in Stage 2 by giving all hospitals the option to make the transition to the 2014 Edition Certified EHR and the Stage 2 requirements (or the revised Stage 1 requirements, as applicable) over the course of 2014 or 2015; Support HR 3991 and S 2037 Critical Access Hospital Relief Act of 2014, amends title XVIII (Medicare) of the Social Security Act to repeal the 96-hour physician certification requirement for inpatient critical access hospital services under which a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital; Support HR 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act, to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support H.R. 2801 and S1143 Protecting Access to Rural Therapy Services (PARTS) Act of 2013, a bill to adopt a default standard of general supervision for outpatient therapeutic services, develop a reasonable exceptions process with provider input to identify specific procedures that require direct supervision, ensure that, for CAHs, the definition of direct supervision is consistent with the CAH conditions of participation that allow a physician or NPP to present within 30 minutes of being called and prohibit enforcement of CMSs retroactive reinterpretation that the direct supervision requirements applied to services furnished since January 1, 2001; S.1932/H.R. 3890 Better Care, Lower Cost Act , AHA has not taken position on the bill, but did establish an AHA working group to analyze the legislation to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program to provide integrated care for Medicare beneficiaries with chronic conditions; requested that the increasing number of hospital compliance reviews performed by the Office of Inspector General (OIG) Office of Audit Services in which the OIG has extrapolated audit findings to estimate Medicare overpayments to the hospitals and the hospitals Medicare Administrative Contractors (MACs)have sought to recover the extrapolated overpayment amounts be halted without delay; Support HR 5481, The Flexibility in Health IT Reporting (Flex-It) Act, a bill to continue the use of a 3-month quarter EHR reporting period for health care providers to demonstrate meaningful use for 2015 under the Medicare and Medicaid EHR incentive payment programs. Senate briefing on legal barriers to providers' ability to manage risk, particularly with respect to Medicare ACO programs. Support HR 4656 and S2276, Caring for America's Heroes Act, a bill to improve access to mental health services under the TRICARE program; Funding for Ebola treatment and preparedness as part of the FY15 Omnibus Appropriations Act. Met to discuss the HHS calculator issue to ensure employers cannot offer health plans that exclude inpatient hospital care.

Client expense: $5,590,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), SENATE, Veterans Affairs, Dept of (VA)

o H.R.3833 - To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. o H.R. 2504, S. 1332 The Home Health Care Planning Improvement Act of 2013 o H.R. 2801, S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act o H.R. 2986 Protecting Access to Primary Care Act o H.R. 4385 Improving Access to Maternity Care Act of 2014 o H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act o S. 2694 Ensuring Access to Primary Care for Women & Children Act o S. 2154 Emergency Medical Services for Children Reauthorization Act of 2014 o Protecting the Public and Healthcare Workers from Ebola o 21st Century Cures Initiative o Lobbied Members of Congress regarding the demand for nurses and nurse faculty and the need for highly educated nurses to provide quality health care. Discussed with HHS agencies and lobbied Members of Congress to promote the role Advanced Practice Registered Nurses will play in a reformed healthcare delivery system. Discussed with HHS agencies and lobbied Members of Congress regarding quality initiatives and cost saving healthcare programs.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R.3833 - To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504, S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801, S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act S.2694 Ensuring Access to Primary Care for Women & Children Act S. 2658 Accelerating Biomedical Research Act S.2154 Emergency Medical Services for Children Reauthorization Act of 2014 H.R. 4385 Improving Access to Maternity Care Act of 2014 H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act Protecting the Public and Healthcare Workers from Ebola 21st Century Cures Initiative

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

H.R.3833 To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504/S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801/ S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act S.2359 - Craig Thomas Rural Hospital and Provider Equity Act of 2014 S.2694/H.R. 5723 - Ensuring Access to Primary Care for Women & Children Act Permanent Sustainable Growth Rate (SGR) efforts H.R. 5780, Protecting the Integrity of Medicare Act of 2014 (PIMA) Hospital Improvements for Payment (HIP) Act of 2014 Protecting the Public and Healthcare Workers from Ebola

Client expense: $135,715 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

HR 2801/S 1143: Protecting Access to Rural Therapy Services (PARTS) Act HR 1250/S 1012: The Medicare Audit Improvement Act of 2013 HR 4067/S 1954: Extension of Moratorium on Direct Supervision HR 3769: Extension of Moratorium on Direct Supervision HR 4015/ S 2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014 HR 3698: Two Midnight Rule Delay Act of 2013 S 2082: Two Midnight Rule Coordination and Improvement Act of 2014 H.R. 3991/ S. 2037 Critical Access Hospital Relief Act of 2014 (96 Hour Rule) H.R. 4188, the Establishing beneficiary Equity in the Hospital Readmission Program Act H.R. 4668 Protect Patient Access and Promote Hospital Efficiency Act HR 4015/ S 2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014; HR 4302: Protecting Access to Medicare Act 2014 S. 25: Repealing the Reduction in the Cost of Living Adjustment (COLA) for Retired Members of the Armed Services Bureau By Extending the Medicare Sequester. S.540 - Temporary Debt Limit Extension Act and preceding potential proposals for raising the debt limit and funding. S. 2359 Craig Thomas Rural Hospital and Provider Equity Act (R-HoPE) H.R. 3590, Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3401: Independent Payment Advisory Board; Section 3015: hospital readmissions program; Section 3124: Extension of Medicare Dependent Hospital program; Section 3137: Section 508 Reclassification; Section 9007: non-profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: Primary Care Provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: Expansion of Medicaid, CHIP; Sections 1311- 1343: CO-OPs and Exchanges; Section 3022: Accountable Care Organizations; Section 3023: Hospital Bundling Provision; Section 6401- 6402: Program Integrity Provisions; Section 6501-6503, 6505, 6508: Medicaid Program Integrity Provisions; Section 3141: Changes to the Rural Floor of the Hospital Wage Index. H.R. 4872, Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States. Other issues: Medicaid DSH Reduction rule, entire rule. Medicare and Medicaid Recovery Audit Contractor programs, including CMS' proposed changes to the rebilling policy for hospitals, CMS1455P. Medicare and Medicaid Electronic Health Record Payment Incentive Programs. Simpson/Bowles Budget proposal released in April 2013, entire proposal. Implementation of the state health insurance exchanges. 340B Drug Discount Program. Critical Access Hospitals/OIG report and potential changes to CAH designation and payment. Proposals involving site-neutral payment policies impacting payments to hospitals. Medicare Part D pre-authorization policy affecting hospices. Effects of expanded sequestration on hospital, payment issues for hospitals Two-midnight rule effects on patients and facilities 96 hour rule effects on patients and facilities

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Delay of implementation of Medicare durable medical equipment documentation requirements Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges Provisions of the 2013, 2014 and 2015 Medicare fee schedule final regulations Draft legislation to require states to recognize nurse practitioners as primary care case managers and as primary care providers in managed care plans Draft legislation to extend Medicaid incentives to adopt electronic health records to nurse-managed health clinics Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration Draft Hospital Improvement for Payment (HIP) Act H.R. 351/S. 351 - Protecting Seniors Access to Medicare Act H.R. 2504/S. 1332 - Home Health Care Planning Improvement Act H.R. 2810 - Medicare Patient Access and Quality Improvement Act H.R. 2817 - Protect Patient Access to Quality Health Professionals Act H.R. 2986 - Protecting Access to Primary Care Act H.R. 3698 - Two-Midnight Rule Delay Act H.R. 3796 - Comprehensive Care Payment Innovation Act H.R. 3833 - To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 4015/S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 4302 - Protecting Access to Medicare Act H.R. 4663 - Protect Patient Access and Promote Hospital Efficiency Act H.R. 4930 - Advancing Care for Exceptional (ACE) Kids Act H.R. 4994/S. 2553 - Improving Medicare Post-Acute Care Transformation (IMPACT) Act H.R. 5098 - Ensuring Medicaid and Medicare Access to Providers Act H.R. 5353 - Medicaid Parity Act H.R. 5364 - CHIP Extension and Improvement Act H.R. 5780 - Protecting the Integrity of Medicare Act S. 1143/H.R. 2810 - Protecting Access to Rural Therapy Services (PARTS) Act S. 1871 - SGR Repeal and Medicare Beneficiary Access Act S. 1954/H.R. 4067 - To provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2014. S. 1980 - Medicaid and CHIP Continuous Quality Act S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2122 - Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2157 - Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2359 - Craig Thomas Rural Hospital and Provider Equity Act of 2014 S. 2461 - Childrens Health Insurance Program Reauthorization Act S. 2491 - Medicare Protection Act S. 2552/H.R. 4998 - Medicare Advantage Participant Bill of Rights Act S. 2694/H.R. 5723 - Ensuring Access to Primary Care for Women & Children Act

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

S.382 Medicaid and Medicare Payment Reform Discussions, hearings, etc.; H.R.574; S.1012 and H.R.1250 Medicare Audit Improvement Act; H.R.2053 and S.183 Medicare Hospital Wage Index Floor for non-rural areas; H.R.1920 the DSH Reduction Relief Act of 2013; S.351 and H.R.351 Repeal of IPAB; H.J.Res59; S.1143 and H.R.2801 Protecting Access to Rural Therapy Services Act; H.R.4302 Protecting Access to Medicare Act of 2014; H.R.4930 Ace Kids Act;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3833 To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504/S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801/ S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act S.2359 Craig Thomas Rural Hospital and Provider Equity Act of 2014 S.2694/H.R. 5723 Ensuring Access to Primary Care for Women & Children Act Permanent Sustainable Growth Rate (SGR) efforts H.R. 5780, Protecting the Integrity of Medicare Act of 2014 (PIMA) Hospital Improvements for Payment (HIP) Act of 2014 Protecting the Public and Healthcare Workers from Ebola

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Two Midnight Rule (HR 3698 / S. 2082) Socioeconomic adjustment of the hospital readmission reduction program (H.R. 4188 / S. 2501) Medicare Audit Improvement Ace (H.R. 1250 / S. 1012) DSH Reduction Relief Act (H.R. 1920 / S. 1555)Sustainable Growth Rate Medical Liability Reform (S. 1769 / H.R. 1473, H.R. 36 / S. 961) Mental Health Policy (H.R. 3717) Rural Hospital Policies (H.R. 1787 /S. 842, H.R. 3991 / S. 2037, H.R. 3444, S. 2359, H.R. 2801 / S. 1143) Post Acute Care Policies (H.R. 4994) Graduate Medical Education (H.R. 1201 / S. 577 / H.R. 1180) Meaningful Use of Electronic Health Records (H.R. 5481) Children's Health Insurance Program Veterans Access to Care Nurse Education Policies 340B Drug Discount Program Home Health Face-To-Face Requirement FY 2015 IPPS

Client expense: $46,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Submitted comments on the Hatch Entitlement Reform in support of the several key reforms proposed for the Medicare program as alternative reductions to provider payments; Support S 351 Protecting Seniors Access to Medicare Act, a bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; Support HR 297 and S1557, Children's Hospital GME Support Reauthorization Act of 2013, the bill would reauthorize the CHGME program for an additional five years through fiscal year (FY) 2017; Support HR 1250 and S 1012 Medicare Audit Improvement Act of 2013, a bill to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Support S. 596 Fostering Independence Through Technology Act of 2014, a bill to establish pilot projects under the Medicare program to provide incentives for home health agencies to furnish remote patient monitoring services that reduce expenditures under such program; Support HR 1787 and S 842 Rural Hospital Access Act of 2013, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support HR 1920 and S 1555 DSH Reduction Relief Act of 2013, a bill to amend titles XVIII and XIX of the Social Security Act to provide for a delay in the implementation schedule of the reductions in disproportionate share hospital payments;AHA submitted a statement to the Presidents and Other Bipartisan Proposals to Reform Medicare Post-Acute Care Payments hearing to provide input on proposals to reform Medicares post-acute care payment systems; AHA submitted a statement to the Program Integrity: Oversight of Recovery Audit Contractors hearing supporting increased oversight of Recovery Audit Contractors (RACs); Support HR 2578 Rural Hospital Fairness Act of 2013, a bill to amend title XVIII of the Social Security Act to extend for one year the hold harmless provision for small rural hospitals and sole community hospitals under the Medicare prospective payment system for hospital outpatient department services related to enhanced physician supervision requirements; AHA submitted a statement to the Health Care Quality: The Path Forward hearing in support of improving transparency for the public, continuing and enhancing support of efforts to improve the safety and quality of the care delivered,and reduce unnecessary hospital expenditures; Support HR 2931 Fairness in Health Care Claims, Guidance and Investigations Act, a bill to amend the false claims provisions of title 31, United States Code, with respect to health care programs; Request additional guidance on and delay of two-midnight rule from CMS; Request issue corrected data on OPPS proposed rule and delay comment period from CMS; Discussion of ACAs patient safety evaluation system with CMS; Discussed the improvements to the National Practitioner Data Bank and new compliance efforts at HRSA; Discussions of Medicaid presumptive eligibility; Medicaid DSH; and request release of DSH audit rule with CMS; Follow up on GPO exclusion related to 340(b) entities; discussions to help shape upcoming proposed rule on 340B with HRSA; Discussed the Qualified Health Plans (QHP) 90day grace period with HHS and its implications for hospitals; Support HJ Res 59, a continuing Appropriations Resolution for 2014, which includes a provision that averts Medicare physician payment cuts as Congress continues to work on a replacement of the flawed SGR formula; Support HR 3444 Critical Access Hospital Flexibility Act of 2013, 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; Support H.R.3698 and S. 2037 Two-Midnight Rule Delay Act of 2013, to delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays; Requested CMS and ONC to extend the EHR Incentive program regulatory timelines for 2014 and allow all providers greater flexibility in Stage 2 by giving all hospitals the option to make the transition to the 2014 Edition Certified EHR and the Stage 2 requirements (or the revised Stage 1 requirements, as applicable) over the course of 2014 or 2015; Support HR 3991 and S 2037 Critical Access Hospital Relief Act of 2014, amends title XVIII (Medicare) of the Social Security Act to repeal the 96-hour physician certification requirement for inpatient critical access hospital services under which a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital; Support HR 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act, to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support H.R. 2801 and S 1143 Protecting Access to Rural Therapy Services (PARTS) Act of 2013, a bill to adopt a default standard of general supervision for outpatient therapeutic services, develop a reasonable exceptions process with provider input to identify specific procedures that require direct supervision, ensure that, for CAHs, the definition of direct supervision is consistent with the CAH conditions of participation that allow a physician or NPP to present within 30 minutes of being called and prohibit enforcement of CMSs retroactive reinterpretation that the direct supervision requirements applied to services furnished since January 1, 2001; S.1932/H.R. 3890 Better Care, Lower Cost Act , AHA has not taken position on the bill, but did establish an AHA working group to analyze the legislation to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program to provide integrated care for Medicare beneficiaries with chronic conditions; requested that the increasing number of hospital compliance reviews performed by the Office of Inspector General (OIG) Office of Audit Services in which the OIG has extrapolated audit findings to estimate Medicare overpayments to the hospitals and the hospitals Medicare Administrative Contractors (MACs)have sought to recover the extrapolated overpayment amounts be halted without delay; Support HR 5481, The Flexibility in Health IT Reporting (Flex-It) Act, a bill to continue the use of a 3-month quarter EHR reporting period for health care providers to demonstrate meaningful use for 2015 under the Medicare and Medicaid EHR incentive payment programs.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), SENATE

Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Delay of implementation of Medicare durable medical equipment documentation requirements Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges Provisions of the 2013 and 2014 Medicare fee schedule final regulations Draft legislation to require states to recognize nurse practitioners as primary care case managers and as primary care providers in managed care plans Draft legislation to extend Medicaid incentives to adopt electronic health records to nurse-managed health clinics Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration H.R. 351/S. 351 - Protecting Seniors Access to Medicare Act H.R. 2504/S. 1332 - Home Health Care Planning Improvement Act H.R. 2810 - Medicare Patient Access and Quality Improvement Act H.R. 2817 - Protect Patient Access to Quality Health Professionals Act H.R. 2986 - Protecting Access to Primary Care Act H.R. 3698 - Two-Midnight Rule Delay Act H.R. 3796 - Comprehensive Care Payment Innovation Act H.R. 3833 - To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 4015/S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 4302 - Protecting Access to Medicare Act H.R. 4663 - Protect Patient Access and Promote Hospital Efficiency Act H.R. 4930 - Advancing Care for Exceptional (ACE) Kids Act H.R. 4994/S. 2553 - Improving Medicare Post-Acute Care Transformation (IMPACT) Act H.R. 5098 - Ensuring Medicaid and Medicare Access to Providers Act H.R. 5353 - Medicaid Parity Act H.R. 5364 - CHIP Extension and Improvement Act S. 1143/H.R. 2810 - Protecting Access to Rural Therapy Services (PARTS) Act S. 1871 - SGR Repeal and Medicare Beneficiary Access Act S. 1954/H.R. 4067 - To provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2014. S. 1980 - Medicaid and CHIP Continuous Quality Act S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2122 - Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2157 - Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2359 - Craig Thomas Rural Hospital and Provider Equity Act of 2014 S. 2461 - Childrens Health Insurance Program Reauthorization Act S. 2491 - Medicare Protection Act S. 2552/H.R. 4998 - Medicare Advantage Participant Bill of Rights Act S. 2694 - Ensuring Access to Primary Care for Women & Children Act

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R. 4302 Public Law No.: 113-93: Protecting Access to Medicare Act of 2014 H.R.3833 To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504/S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801/ S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act S.2359 - Craig Thomas Rural Hospital and Provider Equity Act of 2014 Protecting the Integrity of Medicare Act of 2014 (PIMA) S.2694 - Ensuring Access to Primary Care for Women & Children Act Permanent Sustainable Growth Rate (SGR) efforts

Client expense: $122,011 · Firm income: Not reported

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

Provisions related to Registered Nurse Safe Staffing. H.R. 1821/S. 2353 Provisions related to Advance Practice Registered Nurses and Home Health Certification H.R. 2504/S. 1332 Provisions related to Safe Patient Handling and Mobility H.R. 2480 DME - Face-to-Face Physician Signature H.R. 3833, Ways & Means PIMAComments related to the Evaluation of the Graduate Nurse Education Demonstration Program (78 Fed. Reg. 20321). Provisions related to the repeal of the Sustainable Growth Rate formula and reform of Medicare payment. Support for S. 1143 - Protecting Access to Rural Therapy Service (PARTS) Act. Support for H.R. 2180 SGR fix and Medicare Reform. Oppose a 14 percent cut in Medicare Home Health over 4 years and decreased access to care. Support for provisions to provide incentive payments to APRNs. Support for H.R. 2986 - Protecting Access to Primary Care Act. Support for the development of a calculator to help consumers understand the total costs of health insurance options. Support for HHS to make all rate filings public. Support for provider non-discrimination section of ACA. Ensuring Access to Primary Care for Women & Children Act (S. 2694).

Client expense: $405,196 · Firm income: Not reported

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

H.R. 1201- Training Tomorrow's Doctors Today; Graduate Medical Education provisions S. 577, H.R. 1180- Resident Physician Shortage Reducation Act Hospital Evaluation and Management site-neutrality payment proposal H.R. 1920- DSH Reducation Relief Act of 2013H.R. 1787, S. 842- Rural Hospital Access Act of 2013; Critical Access Hospitals S. 1143, H.R. 2801- Protecting Access to Rural Therapy Services Act- provisions re "direct supervision" at Critical Access Hospitals S. 1871- SGR Repeal and Medicare Beneficiary Access Improvement Act; Medicare Sustainable Growth Rate provisions and "general supervision" provisions for rural and Critical Access Hospitals H.R. 2810- Medicare Patient Access and Quality Improvement Act; Sustainable Growth Rate Provisions H.R. 3077-Telehealth Enhancement Act of 2013 H.R. 3991- Critical Access Hospital Relief Act of 2014; provisions on 96-hour physician certification requirement H.R. 4302- Protecting Access to Medicare Act of 2014 CMS-1606-P Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal Year Beginning October 1, 2014 H.R. 5558- ACO Improvement Act H.R. 4851- FLEX-IT Act; provsions related to "Meaningful Use"

Client expense: Not reported · Firm income: $34,400

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

H.R. 1201- Training Tomorrow's Doctors Today; Graduate Medical Education provisions S. 577, H.R. 1180- Resident Physician Shortage Reducation Act Hospital Evaluation and Management site-neutrality payment proposal H.R. 1920- DSH Reducation Relief Act of 2013H.R. 1787, S. 842- Rural Hospital Access Act of 2013; Critical Access Hospitals S. 1143, H.R. 2801- Protecting Access to Rural Therapy Services Act- provisions re "direct supervision" at Critical Access Hospitals S. 1871- SGR Repeal and Medicare Beneficiary Access Improvement Act; Medicare Sustainable Growth Rate provisions and "general supervision" provisions for rural and Critical Access Hospitals H.R. 2810- Medicare Patient Access and Quality Improvement Act; Sustainable Growth Rate Provisions H.R. 3077-Telehealth Enhancement Act of 2013 H.R. 3991- Critical Access Hospital Relief Act of 2014; provisions on 96-hour physician certification requirement H.R. 4302- Protecting Access to Medicare Act of 2014 CMS-1606-P Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal Year Beginning October 1, 2014 H.R. 5558- ACO Improvement Act H.R. 4851- FLEX-IT Act; provsions related to "Meaningful Use"

Client expense: $100,018 · Firm income: Not reported

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

H.R.3833 - To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504, S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801, S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act H.R. 4385 Improving Access to Maternity Care Act of 2014 H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act S. 2694 Ensuring Access to Primary Care for Women & Children Act S. 2154 Emergency Medical Services for Children Reauthorization Act of 2014 Lobbied Members of Congress regarding the demand for nurses and nurse faculty and the need for highly educated nurses to provide quality health care. Discussed with HHS agencies and lobbied Members of Congress to promote the role Advanced Practice Registered Nurses will play in a reformed healthcare delivery system. Discussed with HHS agencies and lobbied Members of Congress regarding quality initiatives and cost saving healthcare programs.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R.3833 To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504/S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801/ S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act S.2359 - Craig Thomas Rural Hospital and Provider Equity Act of 2014 Protecting the Integrity of Medicare Act of 2014 (PIMA) S.2694 - Ensuring Access to Primary Care for Women & Children Act Permanent Sustainable Growth Rate (SGR) efforts

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

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

HR 2801/S 1143: Protecting Access to Rural Therapy Services (PARTS) Act HR 1250/S 1012: The Medicare Audit Improvement Act of 2013 HR 4067/S 1954: Extension of Moratorium on Direct Supervision HR 3769: Extension of Moratorium on Direct Supervision HR 4015/ S 2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014 HR 3698: Two Midnight Rule Delay Act of 2013 S 2082: Two Midnight Rule Coordination and Improvement Act of 2014 H.R. 3991/ S. 2037 Critical Access Hospital Relief Act of 2014 (96 Hour Rule) H.R. 4188, the Establishing beneficiary Equity in the Hospital Readmission Program Act H.R. 4668 Protect Patient Access and Promote Hospital Efficiency Act HR 4015/ S 2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014; HR 4302: Protecting Access to Medicare Act 2014 S. 25: Repealing the Reduction in the Cost of Living Adjustment (COLA) for Retired Members of the Armed Services Bureau By Extending the Medicare Sequester. S.540 - Temporary Debt Limit Extension Act and preceding potential proposals for raising the debt limit and funding. S. 2359 Craig Thomas Rural Hospital and Provider Equity Act (R-HoPE) H.R. 3590, Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3401: Independent Payment Advisory Board; Section 3015: hospital readmissions program; Section 3124: Extension of Medicare Dependent Hospital program; Section 3137: Section 508 Reclassification; Section 9007: non-profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: Primary Care Provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: Expansion of Medicaid, CHIP; Sections 1311- 1343: CO-OPs and Exchanges; Section 3022: Accountable Care Organizations; Section 3023: Hospital Bundling Provision; Section 6401- 6402: Program Integrity Provisions; Section 6501-6503, 6505, 6508: Medicaid Program Integrity Provisions; Section 3141: Changes to the Rural Floor of the Hospital Wage Index. H.R. 4872, Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States. Other issues: Medicaid DSH Reduction rule, entire rule. Medicare and Medicaid Recovery Audit Contractor programs, including CMS' proposed changes to the rebilling policy for hospitals, CMS1455P. Medicare and Medicaid Electronic Health Record Payment Incentive Programs. Simpson/Bowles Budget proposal released in April 2013, entire proposal. Implementation of the state health insurance exchanges. 340B Drug Discount Program. Critical Access Hospitals/OIG report and potential changes to CAH designation and payment. Proposals involving site-neutral payment policies impacting payments to hospitals. Medicare Part D pre-authorization policy affecting hospices. Effects of expanded sequestration on hospital, payment issues for hospitals Two-midnight rule effects on patients and facilities 96 hour rule effects on patients and facilities Medicare Part D Prior Authorization Delay

Client expense: $60,102 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3833 - To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504, S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801, S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act S.2694 Ensuring Access to Primary Care for Women & Children Act S. 2658 Accelerating Biomedical Research Act S.2154 Emergency Medical Services for Children Reauthorization Act of 2014 H.R. 4385 Improving Access to Maternity Care Act of 2014 H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Two Midnight Rule (HR 3698 / S. 2082) Socioeconomic adjustment of the hospital readmission reduction program (H.R. 4188 / S. 2501) Medicare Audit Improvement Ace (H.R. 1250 / S. 1012) DSH Reduction Relief Act (H.R. 1920 / S. 1555)Sustainable Growth Rate (H.R. 4302) Medical Liability Reform (S. 1769 / H.R. 1473, H.R. 36 / S. 961) Mental Health Policy (H.R. 3717) Rural Hospital Policies (H.R. 1787 /S. 842, H.R. 3991 / S. 2037, H.R. 3444, S. 2359, H.R. 2801 / S. 1143) Post Acute Care Policies (H.R. 4994) Graduate Medical Education (H.R. 1201 / S. 577 / H.R. 1180) Meaningful Use of Electronic Health Records (H.R. 5481) Nurse Education Policies 340B Discount Drug Program Home Health Face-to-Face Requirement FY 2015 IPPS

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.382, Medicaid and Medicare Payment Reform Discussions, hearings, etc.; H.R.574; S.1012 and H.R.1250 - Medicare Audit Improvement Act; H.R.2053 and S.183 dealing with Medicare Hospital Wage Index Floor for non-rural areas; H.R.1920 the DSH Reduction Relief Act of 2013; S.351 and H.R.351 Repeal of IPAB; H.J.Res.59; S.1143 and H.R.2801 Protecting Access to Rural Therapy Services Act; H.R.4302 Protecting Access to Medicare Act of 2014; H.R.4930 - Ace Kids Act of 2014;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1012 / H.R. 1250: Medicare Audit Improvement Act S. 183 / H.R. 2053: Hospital Payment Fairness Act H.R. 2329: Administrative Relief and Accurate Medicare Payments Act H.R. 3698: Two Midnight Rule Delay Act S. 2082: Two-Midnight Rule Coordination and Improvement Act S. 1143 / H.R. 2801: Protecting Access to Rural Therapy Services Act H.R. 3769: Delays enforcement of physician supervision requirements for CAHs S. 2037 / H.R. 3991: Critical Access Hospital Relief Act S. 2187: Rural Community Hospital Demonstration Extension Act S. 2359: Craig Thomas Rural Hospital and Provider Equity Act H.R. 5227: Making the Education of Nurses Dependable for Schools Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4302 Public Law No.: 113-93: Protecting Access to Medicare Act of 2014 H.R.3833 To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504/S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801/ S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act S.2359 - Craig Thomas Rural Hospital and Provider Equity Act of 2014

Client expense: $118,293 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA), White House Office

Submitted comments on the Hatch Entitlement Reform in support of the several key reforms proposed for the Medicare program as alternative reductions to provider payments; Support S 351 Protecting Seniors Access to Medicare Act, a bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; Support HR 297 and S1557, Children's Hospital GME Support Reauthorization Act of 2013, the bill would reauthorize the CHGME program foran additional five years through fiscal year (FY) 2017; Support HR 1250 and S 1012 Medicare Audit Improvement Act of 2013, a bill to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Support S. 596 Fostering Independence Through Technology Act of 2014, a bill to establish pilot projects under the Medicare program to provide incentives for home health agencies to furnish remote patient monitoring services that reduce expenditures under such program; Support HR 1787 and S 842 Rural Hospital Access Act of 2013, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support HR 1920 and S 1555 DSH Reduction Relief Act of 2013, a bill to amend titles XVIII and XIX of the Social Security Act to provide for a delay in the implementation schedule of the reductions in disproportionate share hospital payments; AHA submitted a statement to the Presidents and Other Bipartisan Proposals to Reform Medicare Post-Acute Care Payments hearing to provide input on proposals to reform Medicares post-acute care payment systems; AHA submitted a statement to the Program Integrity: Oversight of Recovery Audit Contractors hearing supporting increased oversight of Recovery Audit Contractors (RACs); Support HR 2578 Rural Hospital Fairness Act of 2013, a bill to amend title XVIII of the Social Security Act to extend for one year the hold harmless provision for small rural hospitals and sole community hospitals under the Medicare prospective payment system for hospital outpatient department services related to enhanced physician supervision requirements; AHA submitted a statement to the Health Care Quality: The Path Forward hearing in support of improving transparency for the public, continuing and enhancing support of efforts to improve the safety and quality of the care delivered, and reduce unnecessary hospital expenditures; Support HR 2931 Fairness in Health Care Claims, Guidance and Investigations Act, a bill to amend the false claims provisions of title 31, United States Code, with respect to health care programs; Request additional guidance on and delay of two-midnight rule from CMS; Request issue corrected data on OPPS proposed rule and delay comment period from CMS; Discussion of ACAs patient safety evaluation system with CMS; Discussed the improvements to the National Practitioner Data Bank and new compliance efforts at HRSA; Discussions of Medicaid presumptive eligibility; Medicaid DSH; and request release of DSH audit rule with CMS; Follow up on GPO exclusion related to 340(b) entities; discussions to help shape upcoming proposed rule on 340B with HRSA; Discussed the Qualified Health Plans (QHP) 90day grace period with HHS and its implications for hospitals; Support HJ Res 59, a continuing Appropriations Resolution for 2014, which includes a provision that averts Medicare physician payment cuts as Congress continues to work on a replacement of the flawed SGR formula; Support HR 3444 Critical Access Hospital Flexibility Act of 2013, 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; Support H.R.3698 and S. 2037 Two-Midnight Rule Delay Act of 2013, to delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays; Requested CMS and ONC to extend the EHR Incentive program regulatory timelines for 2014 and allow all providers greater flexibility in Stage 2 by giving all hospitals the option to make the transition to the 2014 Edition Certified EHR and the Stage 2 requirements (or the revised Stage 1 requirements, as applicable) over the course of 2014 or 2015; Support HR 3991 and S 2037 Critical Access Hospital Relief Act of 2014, amends title XVIII (Medicare) of the Social Security Act to repeal the 96-hour physician certification requirement for inpatient critical access hospital services under which a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital; Support HR 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act, to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support H.R. 2801 and S 1143 Protecting Access to Rural Therapy Services (PARTS) Act of 2013, a bill to adopt a default standard of general supervision for outpatient therapeutic services, develop a reasonable exceptions process with provider input to identify specific procedures that require direct supervision, ensure that, for CAHs, the definition of direct supervision is consistent with the CAH conditions of participation that allow a physician or NPP to present within 30 minutes of being called and prohibit enforcement of CMSs retroactive reinterpretation that the direct supervision requirements applied to services furnished since January 1, 2001; S. 1932/H.R. 3890 Better Care, Lower Cost Act , AHA has not taken position on the bill, but did establish an AHA working group to analyze the legislation to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program to provide integrated care for Medicare beneficiaries with chronic conditions; requested that the increasing number of hospital compliance reviews performed by the Office of Inspector General (OIG) Office of Audit Services in which the OIG has extrapolated audit findings to estimate Medicare overpayments to the hospitals and the hospitals Medicare Administrative Contractors (MACs) have sought to recover the extrapolated overpayment amounts be halted without delay.

Client expense: $4,370,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), SENATE

H.R. 1201- Training Tomorrow's Doctors Today; Graduate Medical Education provisions S. 577, H.R. 1180- Resident Physician Shortage Reducation Act Hospital Evaluation and Management site-neutrality payment proposal H.R. 1920- DSH Reducation Relief Act of 2013H.R. 1787, S. 842- Rural Hospital Access Act of 2013; Critical Access Hospitals S. 1143, H.R. 2801- Protecting Access to Rural Therapy Services Act- provisions re "direct supervision" at Critical Access Hospitals S. 1871- SGR Repeal and Medicare Beneficiary Access Improvement Act; Medicare Sustainable Growth Rate provisions and "general supervision" provisions for rural and Critical Access Hospitals H.R. 2810- Medicare Patient Access and Quality Improvement Act; Sustainable Growth Rate Provisions H.R. 3077-Telehealth Enhancement Act of 2013 H.R. 3991- Critical Access Hospital Relief Act of 2014; provisions on 96-hour physician certification requirement H.R. 4302- Protecting Access to Medicare Act of 2014 CMS-1606-P Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal Year Beginning October 1, 2014

Client expense: Not reported · Firm income: $5,850

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

H.R. 1201- Training Tomorrow's Doctors Today; Graduate Medical Education provisions S. 577, H.R. 1180- Resident Physician Shortage Reducation Act Hospital Evaluation and Management site-neutrality payment proposal H.R. 1920- DSH Reducation Relief Act of 2013H.R. 1787, S. 842- Rural Hospital Access Act of 2013; Critical Access Hospitals S. 1143, H.R. 2801- Protecting Access to Rural Therapy Services Act- provisions re "direct supervision" at Critical Access Hospitals S. 1871- SGR Repeal and Medicare Beneficiary Access Improvement Act; Medicare Sustainable Growth Rate provisions and "general supervision" provisions for rural and Critical Access Hospitals H.R. 2810- Medicare Patient Access and Quality Improvement Act; Sustainable Growth Rate Provisions H.R. 3077-Telehealth Enhancement Act of 2013 H.R. 3991- Critical Access Hospital Relief Act of 2014; provisions on 96-hour physician certification requirement H.R. 4302- Protecting Access to Medicare Act of 2014 CMS-1606-P Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal Year Beginning October 1, 2014

Client expense: Not reported · Firm income: $34,400

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

Inpatient and outpatient hospital payments Impact of the Sequester on Medicare/Medicaid payments Issues and Legislation related to the Medicare Sustainable Growth Rate H.R.3698, Two-Midnight Rule Delay Act of 2013S.2082, Two-Midnight Rule Coordination and Improvement Act of 2014 H.R.1250, Medicare Audit Improvement Act of 2013 S.1012, Medicare Audit Improvement Act of 2013 H.R.2801, Protecting Access to Rural Therapy Services (PARTS) Act S.1143, Protecting Access to Rural Therapy Services (PARTS) Act Issues Related to 340B Program Changes Issues Related to ICD-10 - No More Delay Issues Related to Reductions/Payment Cuts Re: Site-Neutral Payments & Graduate Medical Education Telehealth Issues & Legislation, Including: H.R. 3077, TELE-MED Act of 2013 H.R. 3306, Telehealth Enhancement Act of 2013 H.R. 3750, Telehealth Modernization Act of 2013

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

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

H.R.3833 - To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504, S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801, S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act H.R. 4385 Improving Access to Maternity Care Act of 2014 H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act Lobbied Members of Congress regarding the demand for nurses and nurse faculty and the need for highly educated nurses to provide quality health care. Discussed with HHS agencies and lobbied Members of Congress to promote the role Advanced Practice Registered Nurses will play in a reformed healthcare delivery system. Discussed with HHS agencies and lobbied Members of Congress regarding quality initiatives and cost saving healthcare programs.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE, Veterans Affairs, Dept of (VA), White House Office

Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Delay of implementation of Medicare durable medical equipment documentation requirements Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges Provisions of the 2013 and 2014 Medicare fee schedule final regulations Draft legislation to require states to recognize nurse practitioners as primary care case managers and as primary care providers in managed care plans Draft legislation to extend Medicaid incentives to adopt electronic health records to nurse-managed health clinics Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration H.R. 351/S. 351 - Protecting Seniors Access to Medicare Act H.R. 2504/S. 1332 - Home Health Care Planning Improvement Act H.R. 2810 - Medicare Patient Access and Quality Improvement Act H.R. 2817 - Protect Patient Access to Quality Health Professionals Act H.R. 2986 - Protecting Access to Primary Care Act H.R. 3698 - Two-Midnight Rule Delay Act H.R. 3796 - Comprehensive Care Payment Innovation Act H.R. 3833 - To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 4015/S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act H.R. 4302 - Protecting Access to Medicare Act H.R. 4930 - Advancing Care for Exceptional (ACE) Kids Act H.R. 4994/S. 2553 - Improving Medicare Post-Acute Care Transformation (IMPACT) Act S. 1143/H.R. 2810 - Protecting Access to Rural Therapy Services (PARTS) Act S. 1871 - SGR Repeal and Medicare Beneficiary Access Act S. 1954/H.R. 4067 - To provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2014. S. 1980 - Medicaid and CHIP Continuous Quality Act S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2122 - Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2157 - Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2359 - Craig Thomas Rural Hospital and Provider Equity Act of 2014 S. 2552/H.R. 4998 - Medicare Advantage Participant Bill of Rights Act

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

S.382; Medicaid and Medicare Payment Reform - Discussions, hearings, etc.: H.R. 574; S.1012 and H.R. 1250 - Medicare Audit Improvement Act; H.R.2053 and S.183 dealing with Medicare Hospital Wage Index Floor for non-rural areas; H.R. 1920 the DSH Reduction Relief Act of 2013; S.351 and H.R.351 Repeal of IPAB; H.J.Res. 59; S.1143 and H.R. 2801 Protecting Access to Rural Therapy Services Act; Protecting Access to Medicare Act of 2014 - H.R.4302;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1012 / H.R. 1250: Medicare Audit Improvement Act of 2013 S. 183 / H.R. 2053: Hospital Payment Fairness Act of 2013 H.R. 2329: Administrative Relief and Accurate Medicare Payments Act of 2013 H.R. 3698: Two Midnight Rule Delay ActS. 2082: Two-Midnight Rule Coordination and Improvement Act of 2014 S. 1143 / H.R. 2801: Protecting Access to Rural Therapy Services Act H.R. 3769: Delays enforcement of physician supervision requirements for CAHs S. 2037 / H.R. 3991: Critical Access Hospital Relief Act of 2014 S. 2187: Rural Community Hospital Demonstration Extension Act of 2014 S. 2359: Craig Thomas Rural Hospital and Provider Equity Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1201- Training Tomorrow's Doctors Today; Graduate Medical Education provisions S. 577, H.R. 1180- Resident Physician Shortage Reducation Act Hospital Evaluation and Management site-neutrality payment proposal H.R. 1920- DSH Reducation Relief Act of 2013H.R. 1787, S. 842- Rural Hospital Access Act of 2013; Critical Access Hospitals S. 1143, H.R. 2801- Protecting Access to Rural Therapy Services Act- provisions re "direct supervision" at Critical Access Hospitals S. 1871- SGR Repeal and Medicare Beneficiary Access Improvement Act; Medicare Sustainable Growth Rate provisions and "general supervision" provisions for rural and Critical Access Hospitals H.R. 2810- Medicare Patient Access and Quality Improvement Act; Sustainable Growth Rate Provisions H.R. 3077-Telehealth Enhancement Act of 2013 H.R. 3991- Critical Access Hospital Relief Act of 2014; provisions on 96-hour physician certification requirement H.R. 4302- Protecting Access to Medicare Act of 2014 CMS-1606-P Inpatient Psychiatric Facilities Prospective Payment System-Update for Fiscal Year Beginning October 1, 2014

Client expense: $67,247 · Firm income: Not reported

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

Two Midnight Rule (H.R. 3698 / S. 2082) Socioeconomic adjustment of the hospital readmission reduction program (H.R. 4188 / S. 2501) Medicare Audit Improvement Act (H.R. 1250 / S. 1012) DSH Reduction Relief Act (H.R. 1920 / S. 1555)Sustainable Growth Rate (H.R. 4302) Medical Liability Reform (S. 1769 / H.R. 1473, H.R. 36 / S.961) Mental Health Policy (H.R. 3717) Rural Hospital Policies (H.R. 1787 / S.842, H.R. 3991 / S. 2037, H.R. 3444, S. 2359, H.R. 2801 / S.1143) J-1 Visas Post Acute Care Policies Graduate Medical Education (H.R. 1201 / S.577 / H.R. 1180) Children's Hospitals Graduate Medical Education (S. 1557 / H.R. 297) Meaningful Use of Electronic Health Records Regulations 340B Drug Pricing Program Home Health Face-to-Face Equipment FY 2015 IPPS

Client expense: $64,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4302 Public Law No.: 113-93: Protecting Access to Medicare Act of 2014 H.R.3833 To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504/S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801/ S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act H.R. 4663 Protect Patient Access and Promote Hospital Efficiency Act S.2359 - Craig Thomas Rural Hospital and Provider Equity Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Provisions related to Registered Nurse Safe Staffing. Provisions related to Advance Practice Registered Nurses and Home Health Certification Provisions related to Safe Patient Handling and Mobility DME - Face-to-Face Physician SignatureComments related to the Evaluation of the Graduate Nurse Education Demonstration Program (78 Fed. Reg. 20321). Provisions related to the repeal of the Sustainable Growth Rate formula and reform of Medicare payment. Support for S. 1143 - Protecting Access to Rural Therapy Service (PARTS) Act. Support for H.R. 2180 SGR fix and Medicare Reform. Oppose a 14 percent cut in Medicare Home Health over 4 years and decreased access to care. Support for provisions to provide incentive payments to APRNs. Support for H.R. 2986 - Protecting Access to Primary Care Act. Support for the development of a calculator to help consumers understand the total costs of health insurance options. Support for HHS to make all rate filings public. Support for provider non-discrimination section of ACA.

Client expense: $405,196 · Firm income: Not reported

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

HR 2801/S 1143: Protecting Access to Rural Therapy Services (PARTS) Act HR 1250/S 1012: The Medicare Audit Improvement Act of 2013 HR 4067/S 1954: Extension of Moratorium on Direct Supervision HR 3769: Extension of Moratorium on Direct Supervision HR 4015/ S 2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014 HR 3698: Two Midnight Rule Delay Act of 2013 S 2082: Two Midnight Rule Coordination and Improvement Act of 2014 H.R. 3991/ S. 2037 Critical Access Hospital Relief Act of 2014 (96 Hour Rule) H.R. 4188, the Establishing beneficiary Equity in the Hospital Readmission Program Act H.R. 4668 Protect Patient Access and Promote Hospital Efficiency Act HR 4015/ S 2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014; HR 4302: Protecting Access to Medicare Act 2014 S. 25: Repealing the Reduction in the Cost of Living Adjustment (COLA) for Retired Members of the Armed Services Bureau By Extending the Medicare Sequester. S.540 - Temporary Debt Limit Extension Act and preceding potential proposals for raising the debt limit and funding. S. 2359 Craig Thomas Rural Hospital and Provider Equity Act (R-HoPE) H.R. 3590, Patient Protection and Affordable Care Act, provisions relating to hospitals, hospice and physicians including: Section 3001: hospital value-based purchasing; Section 3125: low-volume hospital payment; Section 3401: productivity adjustments; Section 3121: outpatient hold harmless for hospitals; Sections 7101-7103: 340B Program; Section 3401: Independent Payment Advisory Board; Section 3015: hospital readmissions program; Section 3124: Extension of Medicare Dependent Hospital program; Section 3137: Section 508 Reclassification; Section 9007: non-profit hospital provision; Section 3105: ambulance services; Section 3008 and Section 2702: payment adjustment for hospital acquired conditions; Section 3133: Medicare DSH; Section 2551: Disproportionate Share Hospitals; Section 5501: Primary Care Provisions; Section 5503: Graduate Medical Education; Sections 2001-2081: Expansion of Medicaid, CHIP; Sections 1311-1343: CO-OPs and Exchanges; Section 3022: Accountable Care Organizations; Section 3023: Hospital Bundling Provision; Section 6401-6402: Program Integrity Provisions; Section 6501-6503, 6505, 6508: Medicaid Program Integrity Provisions; Section 3141: Changes to the Rural Floor of the Hospital Wage Index. H.R. 4872, Health Care & Education Affordability Reconciliation Act of 2010: provisions relating to hospitals and physicians, including: Section 2302: 340B program; Section 1104 and Section 1203: Medicare and Medicaid DSH Payments; Sections 1108 and 1109 involving geographic disparities in Medicare payment; Section 1105: Market basket updates; Section 1201: Federal funding for States. Other issues: Medicaid DSH Reduction rule, entire rule. Medicare and Medicaid Recovery Audit Contractor programs, including CMS' proposed changes to the rebilling policy for hospitals, CMS1455P. Medicare and Medicaid Electronic Health Record Payment Incentive Programs. Simpson/Bowles Budget proposal released in April 2013, entire proposal. Implementation of the state health insurance exchanges. 340B Drug Discount Program. Critical Access Hospitals/OIG report and potential changes to CAH designation and payment. Proposals involving site-neutral payment policies impacting payments to hospitals. Medicare Part D pre-authorization policy affecting hospices. Effects of expanded sequestration on hospital, payment issues for hospitals Two-midnight rule effects on patients and facilities 96 hour rule effects on patients and facilities

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3833 - To amend title XVIII of the Social Security Act to modify the Medicare durable medical equipment face-to-face encounter documentation requirement. H.R. 2504, S. 1332 The Home Health Care Planning Improvement Act of 2013 H.R. 2801, S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2986 Protecting Access to Primary Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Legislation and policies relating to: Provisions of the Patient Protection & Affordable Care Act (ACA) (P.L. 111-148) Section 2706 of the ACA regarding provider non-discrimination Health care coverage and payment options in tax reform discussionsPolicies affecting nurse practitioner education and workforce Definition of essential health benefits Health information technology and electronic health records Mental health services and violence prevention Draft legislation on reauthorization of the National Quality Forum H.R. 1427 Truth in Healthcare Marketing Act H.R. 1947/H.R. 2642 Federal Agriculture Reform and Risk Management (FARRM) Act H.R.2575 Save American Workers Act H.R. 2663/S. 1422 To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings H.R. 3102 Nutrition Reform and Work Opportunity Act H.R. 3306 Telehealth Enhancement Act H.R. 3304/S. 1197 National Defense Authorization Act (Section 1725) H.R. 3717 Helping Families in Mental Health Crisis Act S. 689 Mental Health Awareness and Improvement Act S. 264/H.R. 1263 Excellence in Mental Health Act S. 744/H.R. 15 Border Security, Economic Opportunity, and Immigration Modernization Act S. 954 Agriculture Reform, Food, and Jobs Act S. 1152 Building a Health Care Workforce for the Future Act S.1562 Older Americans Act Reauthorization Act S. 1871, SGR Repeal and Beneficiary Access Act of 2013 S. 2110, Medicare SGR Repeal and Beneficiary Access Act of 2014 H.R. 4015/S. 2000 The Sustainable Growth Rate Repeal and Medicare Modernization Act H.R. 4302/Public Law No.: 113-93: Protecting Access to Medicare Act of 2014 H.R. 3833 H.R. 2504/S. 1332 Home Health Care Planning Improvement Act H.R. 2986 Protecting Access to Primary Care Act S. 1143/H.R. 2810 Protecting Access to Rural Therapy Services (PARTS) Act

Client expense: $117,584 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

S.382; Medicaid and Medicare Payment Reform - discussions, hearings, etc.; H.R.574; S1012 and H.R.1250 - Medicare Audit Improvement Act; H.R.2053 and S.183 dealing with Medicare Hospital Wage Index Floor for non-rural areas; H.R.1920 the DSH Reduction Relief Act of 2013; S.351 and H.R.351 Repeal of IPAB; H.J.Res.59; S.1143 and H.R.2801 Protecting Access to Rural Therapy Services Act; Protecting Access to Medicare Act of 2014 - H.R.4302

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Submitted comments on the Hatch Entitlement Reform in support of the several key reforms proposed for the Medicare program as alternative reductions to provider payments; Support S 351 Protecting Seniors Access to Medicare Act, a bill to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board; Support HR 297 and S1557, Children's Hospital GME Support Reauthorization Act of 2013, the bill would reauthorize the CHGME program foran additional five years through fiscal year (FY) 2017; Support HR 1250 and S 1012 Medicare Audit Improvement Act of 2013, a bill to amend title XVIII of the Social Security Act to improve operations of recovery auditors under the Medicare integrity program, to increase transparency and accuracy in audits conducted by contractors; Support S. 596 Fostering Independence Through Technology Act of 2014, a bill to establish pilot projects under the Medicare program to provide incentives for home health agencies to furnish remote patient monitoring services that reduce expenditures under such program; Requested the Health Resource and Service Admin (HRSA) to delay the compliance date by at least six months to allow sufficient time for affected hospitals to make the necessary modifications to their existing inventory management practices as required by the new GPO guidance and recommend that HRSA continue to work with affected 340B hospitals to provide guidance and education on the GPO compliance issues.; Discussion of the Medicaid ACA implementation --DSH, expansion, eligibility at CMS; Discussion of the implementation of the American Taxpayer Relief Act (ATRA) specifically, the outpatient therapy provision and extension of the MDH program and enhanced low-volume adjustment at CMS; Urged CMS to to extend the timeline for meaningful use in 2014 and provide greater flexibility in Stage 2; Support HR 1787 and S 842 Rural Hospital Access Act of 2013, a bill to amend title XVIII of the Social Security Act to provide for an extension of the Medicare-dependent hospital (MDH) program and the increased payments under the Medicare low-volume hospital program; Support HR 1920 and S 1555 DSH Reduction Relief Act of 2013, a bill to amend titles XVIII and XIX of the Social Security Act to provide for a delay in the implementation schedule of the reductions in disproportionate share hospital payments; AHA submitted a statement to the Presidents and Other Bipartisan Proposals to Reform Medicare Post-Acute Care Payments hearing to provide input on proposals to reform Medicares post-acute care payment systems; AHA submitted a statement to the Program Integrity: Oversight of Recovery Audit Contractors hearing supporting increased oversight of Recovery Audit Contractors (RACs); Support HR 2578 Rural Hospital Fairness Act of 2013, a bill to amend title XVIII of the Social Security Act to extend for one year the hold harmless provision for small rural hospitals and sole community hospitals under the Medicare prospective payment system for hospital outpatient department services related to enhanced physician supervision requirements; AHA submitted a statement to the Health Care Quality: The Path Forward hearing in support of improving transparency for the public, continuing and enhancing support of efforts to improve the safety and quality of the care delivered, and reduce unnecessary hospital expenditures; Support HR 2931 Fairness in Health Care Claims, Guidance and Investigations Act, a bill to amend the false claims provisions of title 31, United States Code, with respect to health care programs; Request additional guidance on and delay of two-midnight rule from CMS; Request issue corrected data on OPPS proposed rule and delay comment period from CMS; Discussion of ACAs patient safety evaluation system with CMS; Discussed the improvements to the National Practitioner Data Bank and new compliance efforts at HRSA; Discussions of Medicaid presumptive eligibility; Medicaid DSH; and request release of DSH audit rule with CMS; Follow up on GPO exclusion related to 340(b) entities; discussions to help shape upcoming proposed rule on 340B with HRSA; Discussed the Qualified Health Plans (QHP) 90day grace period with HHS and its implications for hospitals; Support HJ Res 59, a continuing Appropriations Resolution for 2014, which includes a provision that averts Medicare physician payment cuts as Congress continues to work on a replacement of the flawed SGR formula; Support HR 3444 Critical Access Hospital Flexibility Act of 2013, 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; Support H.R.3698 and S. 2037 Two-Midnight Rule Delay Act of 2013, to delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays; Requested CMS and ONC to extend the EHR Incentive program regulatory timelines for 2014 and allow all providers greater flexibility in Stage 2 by giving all hospitals the option to make the transition to the 2014 Edition Certified EHR and the Stage 2 requirements (or the revised Stage 1 requirements, as applicable) over the course of 2014 or 2015; Requested CMS to expedite its ICD-10 testing plans to ensure that testing begins no later than January 2014, be made available to all hospitals and include extensive end-to-end testing by Medicare contractors and state Medicaid agencies of both the electronic transaction and the adjudication of the claim; Support HR 3991 and S 2037 Critical Access Hospital Relief Act of 2014, amends title XVIII (Medicare) of the Social Security Act to repeal the 96-hour physician certification requirement for inpatient critical access hospital services under which a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital; Support HR 4188 Establishing Beneficiary Equity in the Hospital Readmission Program Act, to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support H.R. 2801 and S 1143 Protecting Access to Rural Therapy Services (PARTS) Act of 2013, a bill to adopt a default standard of general supervision for outpatient therapeutic services, develop a reasonable exceptions process with provider input to identify specific procedures that require direct supervision, ensure that, for CAHs, the definition of direct supervision is consistent with the CAH conditions of participation that allow a physician or NPP to present within 30 minutes of being called and prohibit enforcement of CMSs retroactive reinterpretation that the direct supervision requirements applied to servicesfurnished since January 1, 2001; S. 1932/H.R. 3890 Better Care, Lower Cost Act , AHA has not taken position on the bill, but did establish an AHA working group to analyze the legislation to amend title XVIII of the Social Security Act to establish a Medicare Better Care Program to provide integrated care for Medicare beneficiaries with chronic conditions.

Client expense: $4,060,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), SENATE

H.R. 1201- Training Tomorrow's Doctors Today; Graduate Medical Education provisions S. 577, H.R. 1180- Resident Physician Shortage Reducation Act Hospital Evaluation and Management site-neutrality payment proposal H.R. 1920- DSH Reducation Relief Act of 2013H.R. 1787, S. 842- Rural Hospital Access Act of 2013; Critical Access Hospitals H.R. 1250, S. 1012- Medicare Audit Improvement Act, RAC Audits Medicare coverage policy for treatment with intravenous immunoglobulin (IVIG) for patients pending kidney transplant S. 1143, H.R. 2801- Protecting Access to Rural Therapy Services Act- provisions re "direct supervision" at Critical Access Hospitals S. 1871- SGR Repeal and Medicare Beneficiary Access Improvement Act; Medicare Sustainable Growth Rate provisions and "general supervision" provisions for rural and Critical Access Hospitals H.R. 2810- Medicare Patient Access and Quality Improvement Act; Sustainable Growth Rate Provisions H.R. 3077-Telehealth Enhancement Act of 2013 H.R. 3698- Two Midnight Rule Delay Act of 2013 H.R. 2019- Gabriella Miller Kids First Research Act H.R. 3991- Critical Access Hospital Relief Act of 2014; provisions on 96-hour physician certification requirement H.R. 4302- Protecting Access to Medicare Act of 2014

Client expense: Not reported · Firm income: $5,850

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

H.R. 1201- Training Tomorrow's Doctors Today; Graduate Medical Education provisions S. 577, H.R. 1180- Resident Physician Shortage Reducation Act Hospital Evaluation and Management site-neutrality payment proposal H.R. 1920- DSH Reducation Relief Act of 2013H.R. 1787, S. 842- Rural Hospital Access Act of 2013; Critical Access Hospitals H.R. 1250, S. 1012- Medicare Audit Improvement Act, RAC Audits Medicare coverage policy for treatment with intravenous immunoglobulin (IVIG) for patients pending kidney transplant S. 1143, H.R. 2801- Protecting Access to Rural Therapy Services Act- provisions re "direct supervision" at Critical Access Hospitals S. 1871- SGR Repeal and Medicare Beneficiary Access Improvement Act; Medicare Sustainable Growth Rate provisions and "general supervision" provisions for rural and Critical Access Hospitals H.R. 2810- Medicare Patient Access and Quality Improvement Act; Sustainable Growth Rate Provisions H.R. 3077-Telehealth Enhancement Act of 2013 H.R. 3698- Two Midnight Rule Delay Act of 2013 H.R. 2019- Gabriella Miller Kids First Research Act H.R. 3991- Critical Access Hospital Relief Act of 2014; provisions on 96-hour physician certification requirement H.R. 4302- Protecting Access to Medicare Act of 2014

Client expense: Not reported · Firm income: $34,400

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