Craig Thomas Rural Hospital and Provider Equity Act of 2014

Opposing Medicare and Medicaid Payment reductions, including those to Graduate Medical Education (H.R. 3292, the Medicare IME Pool Act of 2015), bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) payments, CAH payments, IPPS coding offset, rural hospital payments, hospital outpatient department (HOPD) clinics, and sequestration. Support for changes to site-neutral payment provision of Bipartisan Budget Act of 2015 (P.L. 114-74) Protecting 340B Drug Pricing Program in regulatory and legislative proposals Support for finalizing Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) 2015-2017 Modifications Rule; support for delaying of Stage 3 Rule Urging Release of New York State Medicaid Vital Access Provider Program Funding Support for changes to liver transplant allocation system 21st Century Cures Act (H.R. 6) and Senate HELP Committee provisions related to interoperability and information blocking Urging release of funding for Ebola preparedness and treatment Support for National Institutes of Health funding Support for Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Support for Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Support for Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Support for Protecting Access to Rural Therapies Act (H.R. 1611/S. 257) Support for Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) Support for Flexibility in Health IT Reporting Act of 2015 (H.R. 270) Support for Resident Physician Shortage Reduction Act of 2015 (H.R. 2124/ S. 1148) Support for Medicare Audit Improvement Act of 2015 (H.R. 2156) Support for Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Support for Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Support for Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227)

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

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

21st Century Cures Act (H.R. 6) and Senate HELP Committee provisions related to interoperability and information blocking Urging release of funding for Ebola preparedness and treatment Support for Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Support for Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Support for Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Support for Protecting Access to Rural Therapies Act (H.R. 1611/S. 257) Support for Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) Support for Flexibility in Health IT Reporting Act of 2015 (H.R. 270) Support for Resident Physician Shortage Reduction Act of 2015 (H.R. 2124/ S. 1148) Support for Medicare Audit Improvement Act of 2015 (H.R. 2156) Support for Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Support for Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Support for Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Protecting 340B Drug Pricing Program in regulatory and legislative proposals Opposing Medicare and Medicaid Payment reductions, including those to Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) payments, CAH payments, IPPS coding offset, rural hospital payments, hospital outpatient department (HOPD) clinics, and sequestration. Support for finalizing Medicare and Medicaid Electronic Health Record Incentive Payment Programs (Meaningful Use) 2015-2017 Modifications Rule; support for delaying of Stage 3 Rule Urging Release of New York State Medicaid Vital Access Provider Program Funding Support for changes to liver transplant allocation system

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

Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) 21st Century Cures Act (H.R. 6) Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83) Funding for Ebola preparedness and treatment Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Protecting Access to Rural Therapies Act (H.R. 1611/S. 257) Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) Flexibility in Health IT Reporting Act of 2015 (H.R. 270) Resident Physician Shortage Reduction Act of 2015 (H.R. 2124/ S. 1148) Medicare Audit Improvement Act of 2015 (H.R. 2156) Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Medicare physician fee schedule fix Medicare and Medicaid Recovery Audit Contractor (RAC) Programs 340B Drug Pricing Program Funding for National Institutes of Health Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) Payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, hospital outpatient department (HOPD) clinics, and sequestration. Medicare and Medicaid Electronic Health Record Incentive Payment Programs Medicaid, New York State Medicaid Vital Access Provider Program Liver transplant allocation system FFY 2015 Inpatient Prospective Payment System Proposed Rule (CMS-1607-P) - Two-Midnight Policy

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

Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83) Funding for Ebola preparedness and treatment Protecting Seniors Access to Medicare Act of 2015 (H.R. 1190 and S.141) Rural Hospital Access Act of 2015 (H.R. 663/S. 332) Critical Access Hospital Relief Act of 2015 (H.R. 169/S. 258) Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 1343/S. 688) Flexibility in Health IT Reporting Act of 2015 (H.R. 270) Resident Physician Shortage Reduction Act of 2013 (H.R. 1180/ S. 577) Medicare Audit Improvement Act of 2013 (H.R. 1250/ S.1012) Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Medicare physician fee schedule fix Medicare and Medicaid Recovery Audit Contractor (RAC) Programs Funding for National Institutes of Health Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) Payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, hospital outpatient department (HOPD) clinics, and sequestration. Medicare and Medicaid Electronic Health Record Incentive Payment Programs Medicaid, New York State Medicaid Vital Access Provider Program Liver transplant allocation system FFY 2015 Inpatient Prospective Payment System Proposed Rule (CMS-1607-P) - Two-Midnight Policy

Client expense: $220,000 · Firm income: Not reported

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. 83: Consolidated and Further Continuing Appropriations Act, 2015 (H.R. 83) Funding for Ebola preparedness and treatment Medicare Audit Improvement Act of 2013 (H.R. 1250) Resident Physician Shortage Reduction Act (S. 577/H.R. 1180) Protecting Seniors Access to Medicare Act of 2013 (H.R. 351 and S. 351) The DSH Reduction Relief Act of 2013 (H.R. 1920) Rural Hospital Access Act (H.R. 1787) Rural Hospital Fairness Act (H.R. 2578) Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 4188)/ Hospital Readmissions Program Accuracy and Accountability Act of 2014 (S. 2501) Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Flexibility in Health IT Reporting Act (HR 5481) Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227) Medicare physician fee schedule fix Severe sepsis protocols Medicare and Medicaid Recovery Audit Contractor (RAC) Programs Funding for National Institutes of Health Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) Payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, inpatient coding offset, hospital outpatient department (HOPD) evaluation and management (E/M) services, and sequestration. Medicare and Medicaid Electronic Health Record Incentive Payment Programs Medicaid, New York State Medicaid Vital Access Provider Program Hospital and health system pricing transparency Clinical quality measures and electronic clinical quality measures FY 2014 Inpatient Prospective Payment System Final Rule (CMS-1599-F) - Two-Midnight Policy FFY 2015 Inpatient Prospective Payment System Proposed Rule (CMS-1607-P) - Two-Midnight Policy

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

PPACA implementation; Provider recognition; HR4435/S2410 National Defense Authorization for FY2015; HR 2817 A bill to repeal provider nondiscrimination; HR4874/S1444 Medicare Access to Rural Anesthesiology Act; S 2359 Craig Thomas Rural Hospital and Provider Equity Act; HR 4486 Military and VA Appropriations for FY2015; HR 83 Consolidated and Further Continuing Appropriations Act for FY2015;

Client expense: $260,000 · Firm income: Not reported

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

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

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

HEALTH CARE Mental Health First Aid Act of 2013 (S. 153/H.R. 274), all provisions related to authorizing a demonstration program to train college faculty and staff in Mental Health First Aid, a community education program that helps people identify, understand, and respond to signs of mental illnesses and addictions and deal with psychiatric crises Behavioral Health Information Technology Act (S. 1517/S. 1685/H.R. 2957), all provisions related to expanding federal incentive payments for the adoption and meaningful use of electronic health records to behavioral health providers and facilities Helping Families in Mental Health Crisis Act of 2013 (H.R. 3717), all provisions related to authorizing healthcare providers to bill Medicaid for mental health and primary care services provided to the same patient on the same day, the reauthorization of the Garrett Lee Smith Memorial Act, the reauthorization of MIOTCRA, enactment of a demonstration program based on the Excellence in Mental Health Act, and strengthening the six protected classes language in Medicare Part D. Strengthening Mental Health in Our Communities Act of 2014 (H.R. 4574), all provisions related to the inclusion of the Mental Health First Aid Act, the reauthorization of important Justice Department initiatives as well as critical SAMHSA programs including the National Suicide Prevention Hotline [1-800-273-TALK], the Garrett Lee Smith Memorial Act suicide prevention programs and the Primary Care Behavioral Health Integration Grants. Caring for Americas Heroes Act (S.2276/H.R. 4656), all provisions related to eliminating the limit on the number of days each year impatient mental health services may be provided to military dependents under the Department of Defense TRICARE program. Caring for Military Children with Developmental Disabilities Act of 2014 (H.R. 4630/S. 2333), all provisions related to including in the treatment of military dependents' developmental disabilities under the Department of Defense TRICARE program behavioral health treatment, including applied behavior analysis, that is prescribed by a physician or psychologist. Craig Thomas Rural Hospital and Provider Equity Act of 2014 (S. 2359), all provisions related to ensuring that residents of rural and frontier communities should have access to affordable, quality health care. Restoring Veterans Trust Act of 2014 (S. 2413), all provisions related to including a new project, the Community Mental Health Partnership Pilot Program, which would connect medical centers of the Department of Veterans Affairs with surrounding community mental health and substance use treatment providers to increase access to services, improve health outcomes, and ensure veterans receive behavioral healthcare that meets the minimum clinical mental health guidelines endorsed by the Veterans Health Administration. H. Res. 572, all provisions related to expressing support for designation of the first full week of May as "National Mental Health No Stigma Week". Opioid Overdose Reduction Act of 2014 (S. 2092/H.R. 4288), all provisions related to exempting from liability for harm caused by the emergency administration of an opioid overdose drug. Opioid Abuse Prevention and Treatment Act (H.R.5587) all provisions related to new grants deterring prescription drug abuse and assisting individuals who are receiving addiction treatment. Overdose Prevention Act (S. 2755) all provisions related to the funding of overdose prevention programming and research efforts to reduce opioid overdose deaths, creation of a task force to recommend a national public health campaign and funding of research and testing of new treatment and prevention methods. Breaking Addictions Act (H.R. 5136), all provisions related to establishing a five-year demonstration project for 8-10 states in which federal reimbursement would be permitted for Medicaid services provided in certain residential settings known as Institutes for Mental Disease. Health Equity and Accountability Act (H.R. 5294) all provisions related to the addition of mental and behavioral health social workers to existing loan repayment programs to bolster the behavioral health workforce. Comprehensive Addiction and Recovery Act (S. 2839/H.R. 5845) all provisions related to a series of resources and incentives to help states and local governments expand drug treatment, prevention and recovery efforts. ABLE Act (H.R. 647) all provisions related to allowing families to establish savings accounts for the qualified expenses of people with blindness or physical or mental disabilities who incurred the disabilities before the age of 26.

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

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

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

Medicare Audit Improvement Act of 2013 (H.R. 1250) Resident Physician Shortage Reduction Act (S. 577/H.R. 1180) Protecting Seniors Access to Medicare Act of 2013 (H.R. 351 and S. 351) The DSH Reduction Relief Act of 2013 (H.R. 1920) Rural Hospital Access Act (H.R. 1787) Rural Hospital Fairness Act (H.R. 2578) Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 4188)/ Hospital Readmissions Program Accuracy and Accountability Act of 2014 (S. 2501) Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Flexibility in Health IT Reporting Act (HR 5481) Making the Education of Nurses Dependable for Schools (MEND) Act (H.R. 5227)? Medicare physician fee schedule fix Structural changes to Medicare - combining Parts A and B Severe sepsis protocols Medicare and Medicaid Recovery Audit Contractor (RAC) Programs Funding for National Institutes of Health Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) Payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, inpatient coding offset, outpatient department hold harmless for certain rural and Sole Community Hospitals, hospital outpatient department (HOPD) evaluation and management (E/M) services, Medicaid provider taxes, and sequestration. Medicare and Medicaid Electronic Health Record Incentive Payment Programs Medicaid, New York State Medicaid Redesign Team, 1115 Waiver Medicare Advantage Plan implementation of sequestration reductions Hospital and health system pricing transparency Clinical quality measures and electronic clinical quality measures FY 2014 Inpatient Prospective Payment System Final Rule (CMS-1599-F) - Two-Midnight Policy FFY 2015 Inpatient Prospective Payment System Proposed Rule (CMS-1607-P) - Two-Midnight Policy Meaningful Use Proposed Rule (CMS-0052-P) Vital Access Provider (VAP) program

Mental Health First Aid Act of 2013 (S. 153/H.R. 274), all provisions related to authorizing a demonstration program to train college faculty and staff in Mental Health First Aid, a community education program that helps people identify, understand, and respond to signs of mental illnesses and addictions and deal with psychiatric crises Behavioral Health Information Technology Act (S. 1517/S. 1685/H.R. 2957), all provisions related to expanding federal incentive payments for the adoption and meaningful use of electronic health records to behavioral health providers and facilities Helping Families in Mental Health Crisis Act of 2013 (H.R. 3717), all provisions related to authorizing healthcare providers to bill Medicaid for mental health and primary care services provided to the same patient on the same day, the reauthorization of the Garrett Lee Smith Memorial Act, the reauthorization of MIOTCRA, enactment of a demonstration program based on the Excellence in Mental Health Act, and strengthening the six protected classes language in Medicare Part D. Strengthening Mental Health in Our Communities Act of 2014 (H.R. 4574), all provisions related to the inclusion of the Mental Health First Aid Act, the reauthorization of important Justice Department initiatives as well as critical SAMHSA programs including the National Suicide Prevention Hotline [1-800-273-TALK], the Garrett Lee Smith Memorial Act suicide prevention programs and the Primary Care Behavioral Health Integration Grants. Caring for Americas Heroes Act (S.2276/H.R. 4656), all provisions related to eliminating the limit on the number of days each year impatient mental health services may be provided to military dependents under the Department of Defense TRICARE program. Caring for Military Children with Developmental Disabilities Act of 2014 (H.R. 4630/S. 2333), all provisions related to including in the treatment of military dependents' developmental disabilities under the Department of Defense TRICARE program behavioral health treatment, including applied behavior analysis, that is prescribed by a physician or psychologist. Craig Thomas Rural Hospital and Provider Equity Act of 2014 (S. 2359), all provisions related to ensuring that residents of rural and frontier communities should have access to affordable, quality health care. Restoring Veterans Trust Act of 2014 (S. 2413), all provisions related to including a new project, the Community Mental Health Partnership Pilot Program, which would connect medical centers of the Department of Veterans Affairs with surrounding community mental health and substance use treatment providers to increase access to services, improve health outcomes, and ensure veterans receive behavioral healthcare that meets the minimum clinical mental health guidelines endorsed by the Veterans Health Administration. H. Res. 572, all provisions related to expressing support for designation of the first full week of May as "National Mental Health No Stigma Week". Opioid Overdose Reduction Act of 2014 (S. 2092/H.R. 4288), all provisions related to exempting from liability for harm caused by the emergency administration of an opioid overdose drug. Opioid Abuse Prevention and Treatment Act (H.R.5587) all provisions related to new grants deterring prescription drug abuse and assisting individuals who are receiving addiction treatment. Overdose Prevention Act (S. 2755) all provisions related to the funding of overdose prevention programming and research efforts to reduce opioid overdose deaths, creation of a task force to recommend a national public health campaign and funding of research and testing of new treatment and prevention methods. Breaking Addictions Act (H.R. 5136), all provisions related to establishing a five-year demonstration project for 8-10 states in which federal reimbursement would be permitted for Medicaid services provided in certain residential settings known as Institutes for Mental Disease. Health Equity and Accountability Act (H.R. 5294) all provisions related to the addition of mental and behavioral health social workers to existing loan repayment programs to bolster the behavioral health workforce. Comprehensive Addiction and Recovery Act (S. 2839) all provision related to a series of resources and incentives to help states and local governments expand drug treatment, prevention and recovery efforts.

PPACA implementation; Provider recognition; HR 1427 Truth in Healthcare Marketing Act of 2013; S 959 Pharmaceutical Compounding Quality & Accountability Act; HR4435/S2410 National Defense Authorization for FY2015; HR 2817 A bill to repeal provider nondiscrimination; HR 3204 Drug Quality & Security Act; HR4874/S1444 Medicare Access to Rural Anesthesiology Act; S 2359 Craig Thomas Rural Hospital and Provider Equity Act; HR 4486 Military and VA Appropriations for FY2015

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

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

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

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. 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

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

PPACA implementation; Provider recognition; HR 1427 Truth in Healthcare Marketing Act of 2013; S 959 Pharmaceutical Compounding Quality & Accountability Act; HR4435/S2410 National Defense Authorization for FY2015; HR 2817 A bill to repeal provider nondiscrimination; HR 3204 Drug Quality & Security Act; HR4874/S1444 Medicare Access to Rural Anesthesiology Act; S 2359 Craig Thomas Rural Hospital and Provider Equity Act.

Client expense: $220,000 · Firm income: Not reported

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

PPACA implementation; Provider recognition; HR 1427 Truth in Healthcare Marketing Act of 2013; S 959 Pharmaceutical Compounding Quality & Accountability Act; HR4435/S2410 National Defense Authorization for FY2015; HR 2817 A bill to repeal provider nondiscrimination; HR 3204 Drug Quality & Security Act; HR4874/S1444 Medicare Access to Rural Anesthesiology Act; S 2359 Craig Thomas Rural Hospital and Provider Equity Act.

Client expense: $220,000 · Firm income: Not reported

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

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

"Medicare Audit Improvement Act of 2013 (H.R. 1250) "Resident Physician Shortage Reduction Act (S. 577/H.R. 1180) "Protecting Seniors' Access to Medicare Act of 2013 (H.R. 351 and S. 351) "The DSH Reduction Relief Act of 2013 (H.R. 1920)Rural Hospital Access Act (H.R. 1787) Rural Hospital Fairness Act (H.R. 2578) Two Midnight Rule Delay Act (H.R. 3698)/Two-Midnight Rule Coordination and Improvement Act of 2014 (S. 2082) Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 4188)/ Hospital Readmissions Program Accuracy and Accountability Act of 2014 (S. 2501) Craig Thomas Rural Hospital and Provider Equity Act (S. 2359) Medicare physician fee schedule fix Structural changes to Medicare combining Parts A and B Severe sepsis protocols Medicare and Medicaid Recovery Audit Contractor (RAC) Programs Funding for National Institutes of Health Medicare and Medicaid Payment reductions, including Graduate Medical Education, bad debt payments, post-acute care payments, Disproportionate Share Hospital (DSH) Payments, CAH payments, IPPS coding offset, rural hospital payments, Medicare Dependent Hospital authorization, inpatient coding offset, outpatient department hold harmless for certain rural and Sole Community Hospitals, hospital outpatient department (HOPD) evaluation and management (E/M) services, Medicaid provider taxes, and sequestration. Medicare and Medicaid Electronic Health Record Incentive Payment Programs Medicaid, New York State Medicaid Redesign Team, 1115 Waiver Medicare Advantage Plan implementation of sequestration reductions Hospital and health system pricing transparency Clinical quality measures and electronic clinical quality measures FY 2014 Inpatient Prospective Payment System Final Rule (CMS-1599-F) Two-Midnight Policy FFY 2015 Inpatient Prospective Payment System Proposed Rule (CMS-1607-P) Two-Midnight Policy Meaningful Use Proposed Rule (CMS-0052-P) Vital Access Provider (VAP) program

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

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

Mental Health First Aid Act of 2013 (S. 153/H.R. 274), all provisions related to authorizing a demonstration program to train college faculty and staff in Mental Health First Aid, a community education program that helps people identify, understand, and respond to signs of mental illnesses and addictions and deal with psychiatric crisesBehavioral Health Information Technology Act (S. 1517/S. 1685/H.R. 2957), all provisions related to expanding federal incentive payments for the adoption and meaningful use of electronic health records to behavioral health providers and facilities Recidivism Reduction and Public Safety Act of 2014 (S. 1675), all provisions related to amending the federal criminal code to direct the Bureau of Prisons to offer evidence-based recidivism reduction programs to prisoners who have been assessed to need to participate in such programs. Helping Families in Mental Health Crisis Act of 2013 (H.R. 3717), all provisions related to authorizing healthcare providers to bill Medicaid for mental health and primary care services provided to the same patient on the same day, the reauthorization of the Garrett Lee Smith Memorial Act, the reauthorization of MIOTCRA, enactment of a demonstration program based on the Excellence in Mental Health Act, and strengthening the six protected classes language in Medicare Part D. Strengthening Mental Health in Our Communities Act of 2014 (H.R. 4574), all provisions related to the inclusion of the Mental Health First Aid Act, the reauthorization of important Justice Department initiatives as well as critical SAMHSA programs including the National Suicide Prevention Hotline [1-800-273-TALK], the Garrett Lee Smith Memorial Act suicide prevention programs and the Primary Care Behavioral Health Integration Grants. Caring for Americas Heroes Act (S.2276/H.R. 4656), all provisions related to eliminating the limit on the number of days each year impatient mental health services may be provided to military dependents under the Department of Defense TRICARE program. Caring for Military Children with Developmental Disabilities Act of 2014 (H.R. 4630/S. 2333), all provisions related to including in the treatment of military dependents' developmental disabilities under the Department of Defense TRICARE program behavioral health treatment, including applied behavior analysis, that is prescribed by a physician or psychologist. Craig Thomas Rural Hospital and Provider Equity Act of 2014 (S. 2359), all provisions related to ensuring that residents of rural and frontier communities should have access to affordable, quality health care. Restoring Veterans Trust Act of 2014 (S. 2413), all provisions related to including a new project, the Community Mental Health Partnership Pilot Program, which would connect medical centers of the Department of Veterans Affairs with surrounding community mental health and substance use treatment providers to increase access to services, improve health outcomes, and ensure veterans receive behavioral healthcare that meets the minimum clinical mental health guidelines endorsed by the Veterans Health Administration. H. Res. 572, all provisions related to expressing support for designation of the first full week of May as "National Mental Health No Stigma Week". Opioid Overdose Reduction Act of 2014 (S. 2092/H.R. 4288), all provisions related to exempting from liability for harm caused by the emergency administration of an opioid overdose drug.