IMPACT Act of 2014

Post-acute care policy. H.R. 1179/S. 569, Improving Access to Medicare Coverage Act of 2013 H.R. 4994/S.2553 Improving Medicare Post Acute Transformation Act of 2014 S. 1871 Medicare Payment for Therapy Services SGR Repeal and Medicare Provider Payment Modernization Act of 2014 H.R. 2 Medicare Access and CHIP Reauthorization Act of 2015 H.R. 1458 BACPAC of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1179/S 569 Improving Access to Medicare Coverage Act of 2013 (observation stay) H.R. 713/S 367 Medicare Access to Rehabilitative Services Act of 2013 (all sections) H.R. 4994/S 2553 Improving Medicare Post Acute Transformation Act of 2014 (all sections) H.R. 647/S 313 Achieving a Better Life Experience Act of 2013 (all sections) S 1871 Medicare Payment for Therapy Services SGR Repeal and Medicare Provider Payment Modernization Act of 2014, Title II, Section 202 H.R. 5110 SAVE Medicare Home Health Act of 2014 (all sections) H.R. 3245 Medicare Home Health Fraud Reduction Act (all sections) H.R. 5780 Protecting the Integrity of the Medicare Act of 2014, Sec 15 Modification of Medicare Home Health Surety Bond Condition of Participation Requirement H.R. 2 Medicare Access and CHIP Reauthorization Act of 2015 (all sections) H.R. 1458 BACPAC of 2015 (all sections) H.R. 1250/S 1211 A bill to amend title XVIII of the Social Security Act to provide that payment under the Medicare program to a long-term care hospital for inpatient services shall not be made at the applicable site neutral payment rate for certain discharges involving severe wounds, and for other purposes (all sections) H.R. 2208 Hospice CARE (all sections) H.R. 6 21st Century Cures Act H.R. 2196/S 971 Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (all sections) H.R. 441/S 202 To provide for a technical change to the Medicare long-term care hsopital moratorium exception (all sections) S 1549 Care Planning Act of 2015 (all sections) Other Issues Related to Post-Acute Care Policy

Client expense: $412,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

Site neutral payment issues; implementation of the Continuing Care Hospital; medical necessity to post-acute care reform; H.R. 1250/S. 1012, Medicare Audit Improvement Act of 2013; Protecting Access to Medicare Act (P.L. 113-93); Common Sense Medicare SGR Repeal and Beneficiary Access Improvement Act, S. 2157; H.R. 2994/S. 2553, IMPACT Act of 2014 (P.L. 113-185); Protecting Integrity in Medicare Act of 2014 (H.R. 5780); draft Hospital Improvements for Payment act of 2014; H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015; H.R. 775/S. 539 , Medicare Access to Rehabilitation Services Act of 2015

Client expense: Not reported · Firm income: $160,000

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

Site neutral payment issues; implementation of the Continuing Care Hospital; medical necessity to post-acute care reform; H.R. 1250/S. 1012, Medicare Audit Improvement Act of 2013; Protecting Access to Medicare Act (P.L. 113-93); Common Sense Medicare SGR Repeal and Beneficiary Access Improvement Act, S. 2157; H.R. 2994/S. 2553, IMPACT Act of 2014 (P.L. 113-185); Protecting Integrity in Medicare Act of 2014 (H.R. 5780); draft Hospital Improvements for Payment act of 2014; SGR and H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015; H.R. 775/S. 539 , Medicare Access to Rehabilitation Services Act of 2015

Client expense: Not reported · Firm income: $160,000

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

Supports Ensuring Quality Access to Complex Rehab Technology Act - working to reintroduce House and Senate legislation. HR 1516 was introduced in March. Working on reintroducing Senate legislation. The bill provides separate recognition for customized wheelchairs under Medicare for indiduals with significant disabilities. Supports Steve Gleason Act, 2015, HR 628 - provides Medicare beneficiary access to eye-tracking accessories for speech genearating devices and removes the rental cap restriction for SGDs. Supports Medicare Access to Rehabilitation Services Act - HR 773/S.539 - amends title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps. Supports Patient Access to Disposable Medical Technology Act of 2015/HR 1018 which amends title XVIII (Medicare) of the Social Security Act to cover substitute disposable medical technology, subject it to a special payment rule, and exempt it from competitive acquisition. Supports HR 729 Medicare Demonstration of Coverage for Low Vision Devices Act of 2015 which directs the Secretary of Health and Human Services to commence a project to demonstrate and evaluate the fiscal impact of covering low vision devices under part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act in the same or similar manner as coverage is provided for durable medical equipment under such part. Directs the Secretary of Health and Human Services to commence a project to demonstrate and evaluate the fiscal impact of covering low vision devices under part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act in the same or similar manner as coverage is provided for durable medical equipment under such part. Discussed improvements to orthotics and prosthetics rules and essential health benefits regulations. Discussed support of the Affordable Care Act, definitions of the summary of benefits and coverage for rehabilitation and habilitation services to prescription drug formularies. Discussed removing competitive acquisition pricing from complex rehab technology accessories. Support HR 2 - the Medicare Access and CHIP Reauthorization Act of 2015 which amends title XVIII (Medicare) of the Social Security Act (SSAct) to: (1) remove sustainable growth rate (SGR) methodology. Supports Improving Medicare Post-Acute Care Transformation Act of 2014 (S. 2553/HR 4994) - amends title XVIII of the Social Security Act to provide for standardized post-acute care assessment data for quality, payment, and discharge planning. Discussion of postponement of consideration of site-neutral payment policy for inpatient rehabilitation hospitals and units (IRFs) and skilled nursing facilities (SNFs).

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), Natl Highway Traffic Safety Administration (NHTSA), SENATE, Social Security Administration (SSA), Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), White House Office

HR 1179/S 569 Improving Access to Medicare Coverage Act of 2013 (observation stay) HR 713/S 367 Medicare Access to Rehabilitative Services Act of 2013 (all sections) HR 4994/S2553 Improving Medicare Post Acute Transformation Act of 2014 (all sections) HR 647/S 313 Achieving a Better Life Experience Act of 2013 (all sections) S1871 Medicare Payment for Therapy Services SGR Repeal and Medicare Provider Payment Modernization Act of 2014, Ttile II, Section 202 HR 5110 SAVE Medicare Home Health Act of 2014 (all sections) HR 3245 Medicare Home Health Fraud Reduction Act (all sections) Other Issues Related to Post-Acute Care Policy HR 5780 Protecting the Integrity of the Medicare Act of 2014, Sec 15 Modification of Medicare Home Health Surety Bond Condition of Participation Requirement HR2 Medicare Access and CHIP Reauthorization Act of 2015 (all sections) HR1458 BACPAC of 2015 (all sections)

Client expense: $630,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

H.R. 713/S. 367-Medicare Access to Rehabilitation Services Act (Repeal of Therapy Caps) Payments to Physical Therapists under the Medicare Physician Fee Schedule Permanent Repeal of/alternatives to the Sustainable Growth Rate (SGR) Formula H.R. 574 Medicare Physician Payment Innovation Act Opposition of Multiple Procedure Payment Reduction for PT Services Physician Quality Reporting System H.R. 2914 Promoting Integrity in Medicare Act H.R. 1310 and S. 236 Medicare Patient Empowerment Act Prevention Initiatives for Fraud and Abuse in the Medicare program Accountable Care Organizations/Patient Centered Medical Homes Electronic Health Records/ Health Information Technology incentives for Physical Therapists Development of Alternatives to Medicare Therapy Cap Medicare Payment Reform Local Coverage Determinations NCCI Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage PCORI National Priority for Research and Research Agenda Health Information Technology Medicare Physician Payment Innovation Act Functional Limitation Reporting Therapy Cap: Manual Medical Review Essential Health Benefits Sustainable Growth Rate Reform H.R. 1179/S. 569 Improving Access to Medicare Coverage Act Medicaid Essential Health Benefits EHR/LTPAC Settings: Transitions of Care Medicare Improvement Standards Bundled Payment Models Common assessment tool for Medicare post-acute care Medicare appeals process H.R. 3426 Prevent Interruptions in Physical Therapy Act/S.2818 H.R. 942 and S. 948 Ensuring Access to Quality Complex Rehabilitation Technology H.R. 2810 Medicare Patient Access and Quality Improvement Act Inclusion of physical therapists in quality programs in SGR Reform H.R. 4015 and S.2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014 FTC Anti-competition Self-referral S.1871 SGR Repeal and Medicare Beneficiary Access Act S.2110 Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2157 Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act H.R.4302 Protecting Access to Medicare Act Statement for the record on Ways and Means Health Subcommittee Current Hospital Issues in Medicare H.R. 4755 Access to In-patient Rehabilitation Therapy Act H.R. 4994/S.2553 IMPACT Act Able Act Comments on CY2015 OPPS rule H.R. 5380 Medicare Telehealth Parity Act Comments on draft Fraud & Abuse Legislation Hospital Improvements for Payment Act H.R. 5380 Medicare Telehealth Parity Act

Client expense: $308,338 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), 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, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

Oppose home health and hospice payment cuts and co-pays. Legislative and regulatory proposals affecting home care and hospice. S. 596, Fostering Independence Through Technology Act of 2013.H.R. 2504/S. 1332, Home Health Care Planning Improvement Act. H.R. 2302/S. 1053, Hospice Evaluation and Legitimate Payment Act. Proposals to fix the Medicare Sustainable Growth Rate (SGR). Labor/Health and Human Services/Education Appropriations, FY2015, provisions relating to Lifespan Respite Program, caregiver, and falls prevention matters. Recognition and payment for telehealth services under Medicare and Medicaid. H.R. 3616, Protecting Seniors From Health Care Fraud Act of 2013. Face to Face Physician Encounter Requirement. Hospice/Part D Coordination of Care. H.R. 4994/S. 2553, IMPACT Act of 2014. H.R. 4625, Medicare Home Health Rebasing Relief and Reassessment Act. S. 2491, Medicare Protection Act H.R. 4673, BACPAC Act of 2014 H.R. 5558, ACO Improvement Act of 2014 H.R. 3306, Telehealth Enhancement Act of 2013 H.R. 5380, Medicare Telehealth Parity Act of 2014 H.R. 5110, SAVE Medicare Home Health Act of 2014 Home health rural add on payment. Protecting the Integrity of Medicare Act (PIMA) (draft legislation), provisions on home health surety bond.

Client expense: $110,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

Oppose efforts to repeal certain provisions of the Patient Protection and Affordable Care Act relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. Bad Debt Payments to Hospitals - Lawmakers have proposed lowering the amount of Medicare Bad Debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. Direct and Indirect Graduate Medical Education Payments - Lawmakers have proposed changes to the way that hospitals are reimbursed for the costs of training physicians and other medical professionals. Advocate for the extension the Medicare Dependent Hospital (MDH) and current Low-Volume Hospital (LVH) programs. S. 842, the Rural Hospital Access Act of 2013 and H.R. 1787, the Rural Hospital Access Act of 2013 Oppose the lowering of Medicare outpatients rates for Evaluation and Management visits in a hospital S. 1680 - Craig Thomas Rural Hospital and Provider Equity Act of 2011 - A bill to amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program, and for other purposes. Oppose any cuts to the Medicaid DSH funds above and beyond what was legislated in the Affordable Care Act Support a long-term patch or full repeal of the Sustainable Growth Rate for Physician payments in Medicare that does not cut hospitals. Oppose the proposal of lowering Medicare reimbursements to Inpatient Rehabilitation Facilities. Support a reasonable one-time budget neutrality adjustment for long-term care hospitals. Sequestration - against extending the Medicare Sequester. Advocate in support of reauthorization of funding for quality measure development, endorsement, pre-rulemaking review and recommendations, and collection of data analyzing measure implementation under MIPPA (P.L. 110-275, Section 1980 ) and ACA (P.L. 111-148, Section 3014) for the consensus-based entity (National Quality Forum). H.R.1250 and S. 1012, "Medicare Audit Improvement Act of 2013" -- supports legislation to improve Medicare audits. Price Transparency - advocate for meaningful price transparency for consumers by ensuring they have access to out of pocket price information. CMS "2 Midnight" Policy - advocate for policy to allow for physician judgment on whether a patient should be considered inpatient or outpatient status, and other modifications to the policy. National Quality Forum -Advocated for inclusion of private-sector multi-stakeholder processes in development, endorsement and use of quality measures in federal payment programs under consideration. H.R. 4994 and S. 2553, "IMPACT Act of 2014"- legislation intended to improve post acute care for Medicare beneficiaries by collecting and using standardized quality data; advocate to ensure stakeholder input appropriately included in measure endorsement and review. Protecting the Integrity of Medicare Act of 2014 - Bill to combat fraud, waste and abuse in the Medicare program by streamlining processes and improving program payment accuracy. Meaningful Use - Advocate for reasonable Stage 3 meaningful use requirements as part of the EHR Incentive Program. Unique Device Identifier (UDI) - Advocate against including UDI on Medicare claims. FLEX IT ACT - HR 5481 - legislation to require CMS to implement a 90-day reporting period to qualify for incentive payments under the HITECH EHR Incentive Programs; advocate for passage of the bill in the House and introduction of a companion bill in the Senate. Provided advocacy comments regarding a House Ways and Means discussion draft, the Hospital Improvements for Payment Act of 2014 concerning hospital payment, self-referral, quality, accreditation and data release issues.

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

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

S 367/HR 713 - Medicare Access to Rehabilitation Services Act: Advocate for removal of cap on occupational therapy services and passage. HR 942/S 948 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013: Advocate for inclusion of occupational therapy professionals as providers of complex rehabilitation technology. No bill# - Educate about role of occupational therapy in primary care. HR 2810 - The Medicare Patient Access and Quality Improvement Act of 2013: Advocated regarding sustainable growth rate and educate about the role of occupational therapy in health care and need for improving Medicare to assure that patients receive appropriate care, especially occupational therapy services, and that payment is fair and equitable. No bill# - Multiple Procedure Payment Reduction (MPPR): Advocate the separation of occupational therapy from physical therapy/speech language pathology in application of MPPR policy. No bill# - Manual Medicare Review (MMR: Advocate for improved MMR procedures including electronic submission and 10 day turn around. S 1871/S 2110 - the Sustainable Growth Rate (SGR) Repeal and Medicare Beneficiary Access Improvement Act of 2013 AND HR 4015/S 2000 - SGR Repeal and Medicare Provider payment Modernization Act of 2014: Advocated for improvements to the bills that address policies that pertain to beneficiaries' access to occupational therapy services and how occupational therapy services are reimbursed under the Medicare program. Advocate for repeal of the Medicare Part B outpatient therapy cap on occupational therapy services. HR 3749 - The Medicare Demonstration of Coverage for Low Vision Devices Act: Support for greater attention to low vision coverage and highlight role of occupational therapy in ensuring the devices are utilized properly and to their full potential. S 1932/HR 3890 - Better Care, Lower Cost Act: Educate about role of occupational therapy in helping people with chronic conditions. Support including occupational therapy in the chronic care innovation centers. HR 4994/S 2553 0 The Improving Medicare post-Acute Care transformation Act of 2014 "IMPACT Act of 2014": Advocated for improvements in the bill that would help ensure Medicare beneficiaries' access to quality post-acute care in the right setting is preserved. Advocated to ensure data collection program includes elements that reflect the contributions of occupational therapy across the various post-acute settings. HR 5380 - Medicare Telehealth Parity Act: Support passage and inclusion of occupational therapy services. HR 3306 - The Telehealth Enhancement Act of 2013: educate about how occupational therapy can be utilized in telehealth. HR 3877 - Lymphedema Treatment Act: Support passage and educate about role of occupational therapy services. No. bill# (PL 113-93) - Advocate for inclusion of occupational therapy in the Excellence in Mental Health Act's Medicaid Demonstration by encouraging Members of Congress to send a letter of support to the Substance Abuse and Mental Health Administration. HR 5547/S 2515 - Community Integration Act: Discussed Act's aims to strengthen Medicaid beneficiaries' opportunities to receive home and community-based services. Met with staff from the Health Resources and Services Administration (HRSA), including Dr. Marcia Brand, HRSA Deputy Administrator, along with other representatives of allied health professionals, to discuss recent restructuring of HRSA that appears to deemphasize allied health professions and lack of funding for allied health training programs. Also discussed the need to clearly define "allied health professionals" both for existing policies and new programs being developed at the Centers for Medicare and Medicaid Innovation; and the role of allied health professionals in the changing health care landscape.

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

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

Part D prior authorization for prescriptions unrelated to terminal illness; H.R. 4994 / S. 2553, IMPACT Act of 2014; hospice surveys, program integrity; issues around "relatedness" in Part D drug program; hospice Medicare Advantage "carve-in"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 713/S. 367-Medicare Access to Rehabilitation Services Act (Repeal of Therapy Caps) Payments to Physical Therapists under the Medicare Physician Fee Schedule Permanent Repeal of/alternatives to the Sustainable Growth Rate (SGR) Formula H.R. 574 Medicare Physician Payment Innovation ActOpposition of Multiple Procedure Payment Reduction for PT Services Physician Quality Reporting System H.R. 2914 Promoting Integrity in Medicare Act H.R. 1310 and S. 236 Medicare Patient Empowerment Act Prevention Initiatives for Fraud and Abuse in the Medicare program Accountable Care Organizations/Patient Centered Medical Homes Electronic Health Records/ Health Information Technology incentives for Physical Therapists Development of Alternatives to Medicare Therapy Cap Medicare Payment Reform Local Coverage Determinations NCCI Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage PCORI National Priority for Research and Research Agenda Health Information Technology Medicare Physician Payment Innovation Act Functional Limitation Reporting Therapy Cap: Manual Medical Review Essential Health Benefits Sustainable Growth Rate Reform H.R. 1179/S. 569 Improving Access to Medicare Coverage Act Medicaid Essential Health Benefits EHR/LTPAC Settings: Transitions of Care Medicare Improvement Standards Bundled Payment Models Common assessment tool for Medicare post-acute care Medicare appeals process H.R. 3426 Prevent Interruptions in Physical Therapy Act/S.2818 H.R. 942 and S. 948 Ensuring Access to Quality Complex Rehabilitation Technology H.R. 2810 Medicare Patient Access and Quality Improvement Act Inclusion of physical therapists in quality programs in SGR Reform H.R. 4015 and S.2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014 FTC Anti-competition Self-referral S.1871 SGR Repeal and Medicare Beneficiary Access Act S.2110 Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2157 Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act H.R.4302 Protecting Access to Medicare Act Statement for the record on Ways and Means Health Subcommittee Current Hospital Issues in Medicare H.R. 4755 Access to In-patient Rehabilitation Therapy Act H.R. 4994/S.2553 IMPACT Act Able Act Comments on CY2015 OPPS rule H.R. 5380 Medicare Telehealth Parity Act Comments on draft Fraud & Abuse Legislation Hospital Improvements for Payment Act H.R. 5380 Medicare Telehealth Parity Act

Client expense: $308,338 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), 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, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

Long term acute hospital payment reform, post acute care payment reform, Part B Therapy Payments, S. 2553- IMPACT Act of 2014, H.R. 4994- IMPACT Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Patient Protection and Affordable Care Act Implementation, Reimbursement for rehabilitation facilities, H.R. 4994-IMPACT Act of 2014, S. 2553-IMPACT Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Improving Medicare Post-Acute Care Transformation Act H.R. 4944/S. 2553 entire legislation

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.5464 and draft Senate legislation, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015, Title II H.R. 83, P.L.113-235, Consolidated and Further Continuing Appropriations Act, 2015, Division G, Title II Issues: Support funding for NIH, Title VII and Title VIII health professions and nursing education programs, Agency for Healthcare Research and Quality (AHRQ), National Health Service Corps (NHSC), Children's Hospitals Graduate Medical Education program (CHGME), HRSA, biodefense and public health preparedness programs, and CDC's National Healthcare Safety Network (NHSN) and the Prevention Epicenters Program. Maintain NIH salary cap at Executive Level II. Encourage the highest possible allocation for the Labor-HHS Subcommittee. Support emergency supplemental funding to prepare and respond to Ebola and to reimburse for Ebola Virus Disease treatment. H.R. 4486 and draft Senate legislation, Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2015, Title II H.R. 83, P.L.113-235, Consolidated and Further Continuing Appropriations Act, 2015, Division I, Title II President's Budget, FY 2016 Issues: Support funding for Veterans Affairs medical research, research infrastructure, and health care. Issue: Funding for Community Health Centers and the NHSC. Debt in Health Education Loan programs (DebtHELP) bill (draft) Issues: Expand National Health Service Corps State Loan Repayment program, align Department of Education and Health Resources and Services Administration student loan programs. S. 577, Resident Physician Shortage Reduction Act of 2013 H.R. 1180, Resident Physician Shortage Reduction Act of 2013 Issue: Support lifting the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education and Indirect Medical Education payments. H.R. 1201, Training Tomorrow's Doctors Today Act Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments and increase Graduate Medical Education (GME) accountability and transparency. H.R. 487, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings. P.L. 111-148, Affordable Care Act, Sections 5503 and 5506 Issue: Redistribution of residency positions. Issue: Implementation of and funding for Teaching Health Center Graduate Medical Education program under section 340G of the Public Health Service Act. Issue: Development and implementation of new Medicare Disproportionate Share Hospital (DSH) formula required under the Affordable Care Act. H.R. 2810/S. 1871, SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013. Issues: Support repeal of Medicare's sustainable growth rate (SGR) formula; Medicare physician payment reform. Issue: Support the use of animals in medical research. S. 2553/H.R. 4994, Improving Medicare Post-Acute Care Transformation Act of 2014 Issue: Standardization of post-acute care assessment data for quality, payment, and discharge planning. Issue: Promote interprofessional education and training of the health care workforce. Issue: Support funding for the National Healthcare Workforce Commission. Issue: Implementation of Health Insurance Exchanges mandated by the Affordable Care Act (ACA) to recognize and not penalize the unique missions of medical schools and teaching hospitals. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose discretionary spending cuts through sequestration, including NIH, Titles VII and VIII health professions and nursing education programs, and other science programs. Issue: Support primary care workforce development S. 1759, Teaching Health Center Reauthorization Act Issue: Legislation to reauthorize the Teaching Health Center Program and payments. Issue: Draft legislation on pain education in undergraduate and graduate medical education. H.R.548/S. 1152, The Building A Health Care Workforce for the Future Act Issue: Support bill to increase scholarship opportunities for medical students and encourage primary care workforce development. H.R. 5294, Health Equity and Accountability Act of 2014 Issue: Support bill to improve health equity. Issue: Oppose inclusion of Medicare add-on payments in Hospital-Acquired Condition (HAC) program. H.R. 3698, Two Midnight Rule Delay Act of 2013 S. 2082, Two Midnight Rule Coordination and Improvement Act of 2014 Issue: Support delay of enforcement of new CMS inpatient criteria (e.g., "Two-Midnight" rule) in FY 2014 Inpatient Prospective Payment System (IPPS) final rule. Issue: Support Medicare GME per Resident Amount and cap trigger technical corrections and administrative relief. H.R. 4188, Establishing Beneficiary Equity in the Hospital Readmissions Program Act. S. 2501, Hospital Readmission Accuracy and Accountability Act. Issue: Support inclusion of socioeconomic status as part of hospital readmissions program, including support for adoption of National Quality Forum (NQF) recommendations. Issue: Educating health professionals regarding prescription drug abuse and appropriate use of antibiotics. Issue: Support report language and efforts of HHS agencies to support efforts of urban-based institutions to improve health equity. Support use of holistic review in admissions. Issue: Support ACA consumer outreach and enrollment efforts. Issue: Implementation of the 340B drug discount program. Issue: Oppose Medicare payment reductions as offsets for non-Medicare spending. Issue: Support preservation of funding for the Primary Care Residency Expansion program. S. 2229, Expanding Primary Care Access and Workforce Act Issue: Offer comments on primary care workforce legislation. H.R. 5411, Trafficking Awareness Training for Health Care Act of 2014 Issue: Medical education curricula content pertaining to human trafficking. S. 2658/H.R.5580, Accelerating Biomedical Research Act Issue: To increase discretionary spending cap to increase funding for the National Institutes of Health (NIH). S. 2450, Veterans' Access to Care through Choice, Accountability, and Transparency Act H.R. 4810, Veteran Access to Care Act Issue: Addressing VA backlogs by increasing care for veterans provided by non-VA facilities. S. 2115, American Cures Act H.R. 4384, America HEALS ACT Issue: Support establishment of a fund to provide an expanded and sustained investment in biomedical research. H.R. 4879, Research for All Act Issues: Support inclusion of male and female cells, tissues and animals in basic biomedical research. Support update of NIH guidelines to increase participation of women in clinical trials. Issue: FDA regulation of Laboratory Developed Tests (LDTs) S. 2728, Community Based Medical Education Act of 2014 Issue: Oppose reduction of Medicare GME/IME payments S. 2645, The Recovery Enhancement for Addiction Treatment (TREAT) Act Issue: Support legislation to increase access to care for patients addicted to opioids S. 2942, The Infectious Disease Hospitals Hubs Act Issue: Support legislation to establish a network of hospitals in preparing for and responding to infectious diseases. Issue: Support nomination of Dr. Vivek Murthy as U.S. Surgeon General Draft Hospital Improvements for Payment (HIP) Act of 2014 Issues: Support repeal of CMS Two-Midnights Rule, extending RAC audit moratorium for short stays, and permanent bundle program. Issue: Oppose further delays in the implementation of the ICD-10 system Submitted comments to: U.S. Census Bureau on the American Community Survey CMS on the Hospital Acquired Conditions Reduction Program (HAC)s technical expert panel (TEP)s report regarding the scoring of hospitals in the HAC program CMS on final rule regarding definition of uninsured for purposes of Medicaid DSH limits HHS on revisions to the safe harbors under the anti-kickback statute and civil monetary penalty rules (gainsharing, etc.) FDA on strategies for increasing patient involvement in regulatory processes. White House Ebola Response Coordinator offering to work with federal and state officials to prepare and respond to Ebola cases. NIH in response to an RFI related to the development of grant program to help facilitate the transition from training to independence. NIH on the consideration of sex as a biological variable in biomedical research The Patient-Centered Outcomes Research Institute (PCORI) on the proposed process for peer review and public release of its primary research finding. DEA on delaying the Disposal of Controlled Substances Final Rule.

Client expense: $1,540,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Bureau of the Census, Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Drug Enforcement Administration (DEA), Federal Reserve System, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Interior, Dept of (DOI), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), Patent & Trademark Office (PTO), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA), White House Office

S. 577, Resident Physician Shortage Reduction Act of 2013 H.R. 1180, Resident Physician Shortage Reduction of 2013. Issue: Support lifting the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education and Indirect Medical Education payments. H.R. 1201, Training Tomorrow's Doctors Today Act Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments and increase GME accountability and transparency. Issue: Implementation and funding for Teaching Health Center Graduate Medical Education program under section 340G of the Public Health Service Act. Issue: Health Insurance Exchanges mandated by the Affordable Care Act (ACA) to recognize and not penalize the unique missions of medical schools and teaching hospitals. Issue: Support Medicare physician payment reform. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. H.R. 487, Primary Care Workforce Access Improvement Act. Issue: Residency training in community-based settings. Issue: Primary Care Workforce Development. President's Budget, FY 2015 Issue: Oppose proposed reductions in Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments; oppose use of Medicare GME funding for creation of new GME grant program. Issue: Oppose inclusion of Medicare add-on payments in Hospital-Acquired Condition (HAC) program. Issue: Oppose Medicare payment reductions as offsets for non-Medicare spending. S. 2082, Two Midnight Rule Coordination and Improvement Act of 2014 H.R. 3698, Two Midnight Rule Delay Act of 2013 Issue: Support delay of Enforcement of new Centers for Medicare and Medicaid Services inpatient criteria (e.g., "Two-Midnight" rule) in FY 2014 Inpatient Prospective Payment System (IPPS) final rule. Issue: Support Medicare Graduate Medical Education (GME) per resident amount technical corrections and administrative relief. H.R. 4188, Establishing Beneficiary Equity in the Hospital Readmissions Program Act S. 2501, Hospital Readmission Accuracy and Accountability Act Issue: Support inclusion of socioeconomic status as part of hospital readmissions program. H.R. 2810/S. 1871, SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013 Issues: Support repeal of Medicares Sustainable Growth Rate (SGR) formula; Medicare physician payment reform. Issue: Draft legislation on educating health professionals regarding appropriate use of antibiotics. Issue: Support report language and efforts of HHS agencies to support efforts of urban-based institutions to improve health equity. Issue: Implementation of the 340B drug discount program. H.R. 4302, Protecting Access to Medicare Act of 2013. Issues: Support Medicare physician payment relief and extended delay of Medicare's "two-midnights" policy for hospital admissions; support the addition of GME language related to establishing Medicare caps and PRA; support delayed implementation of Medicaid DSH cuts. H.R. 4282, Creating Access to Residency Education Act of 2014 Issue: Create CMS grant program for new residency programs. Issue: Support inclusion of socioeconomic status as part of hospital readmissions program including support for adoption of National Quality Forum (NQF) recommendations. Issue: Support Medicaid expansion advocacy efforts. Issue: Draft legislation on pain education in undergraduate and graduate medical education. S. 2229, Expanding Primary Care Access and Workforce Act Issue: Offer comments on primary care workforce legislation. H.R. 4942, Underserved Veterans Access to Health Care Act Issue: Increasing funding for VA GME and Medicare GME. S. 2553/H.R. 4994, Improving Medicare Post-Acute Care Transformation Act of 2014. Issue: Standardization of post-acute care assessment data for quality, payment, and discharge planning. S. 2728, Community Based Medical Education Act of 2014 Issue: Oppose reduction of Medicare GME/IME payments. Issue: Development and implementation of new Medicare Disproportionate Share Hospital (DSH) formula required under the ACA. Draft Hospital Improvements for Payment (HIP) Act of 2014 Issues: Support repeal of CMS Two-Midnights Rule, extending RAC audit moratorium for short stays, and permanent bundle program. Issue: Oppose further delays in the implementation of the ICD-10 system Submitted comments to: Centers for Medicare & Medicaid Services (CMS) on the Hospital Acquired Conditions Reduction Program (HAC)s technical expert panel (TEP)s report regarding the scoring of hospitals in the HAC program. Centers for Medicare & Medicaid Services (CMS) on final rule regarding definition of uninsured for purposes of Medicaid DSH limits The Department of Health and Human Services (HHS) on revisions to the safe harbors under the anti-kickback statute and civil monetary penalty rules (gainsharing, etc.)

Client expense: $1,540,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Bureau of the Census, Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Drug Enforcement Administration (DEA), Federal Reserve System, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Interior, Dept of (DOI), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), Patent & Trademark Office (PTO), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA), White House Office

H.R. 3245- Medicare Home Health Fraud Reduction Act, Home Health Payment Reform, Copays, Medicare Rebasing, Post Acute Care Payment Reform, Face to Face Regulations, H.R. 4994- IMPACT Act of 2014, S.2553- IMPACT Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare and Medicaid disproportionate share hospital cuts, including DSH Reduction Relief Act - support amendments to mitigate the impact of cuts on losing hospitals, postpone Medicaid DSH cuts; Graduate Medical Education issues (including Resident Physician Shortage Reduction Act (S.577/H.R.1180) - support; Amendments to the Medicare hospital readmissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.4188/S.2501 - support; IMPACT Act (S.2553/H.R.4994), support reducing burdensome hospital requirements in original bill; support of final bill; Medicare Audit Improvement Act (H.R.1250/S.1012) and other issues related Medicare claims appeal backlogs - support; Proposals to amend the 2 Midnight Policy (CMS-1599-F)(H.R. 3698/S.2082) - support; comments on House Ways and Means discussion draft legislation, Hospital Improvements for Payment Act of 2014, concerns about new proposed short stay payment methdology and impact on teaching hospitals; CMS Disallowance to NYS File No.:NY-2014-03-MAP - oppose, support NYS Congressional delegation letter to CMS; legislation to create a comprehensive Medicare home infusion benefit (H.R.5435) - support; comments on physician services pertaining to non-face-to-face chronic care management services (CMS-1612-P); support NYS Congressional delegation letter to CMS on NYS State plan amendments on Medicaid rates for hospitals (2% cut restoration, Vital Access Provider funds).

Client expense: $290,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), 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), Housing & Urban Development, Dept of (HUD), SENATE, White House Office

Federal issues related to the regulation of long term acute care hospitals and inpatient rehabilitation facilities,including patient admission criteria and rules,and other Medicare payment issues. Inclusion of provisions related to long term acute care hospitals in the Bipartisan Budget Act of 2013,(H.J. Res. 59). Issues related to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT),(H.R. 4994/S. 2553).

Client expense: $720,000 · Firm income: Not reported

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

Federal issues related to the regulation of long term acute care hospitals and inpatient rehabilitation facilities,including patient admission criteria and rules,and other Medicare payment issues. Inclusion of provisions related to long term acute care hospitals in the Bipartisan Budget Act of 2013,(H.J. Res. 59). Issues related to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT),(H.R. 4994/S. 2553).

Client expense: $720,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), 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

Health care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits. Monitor and advocate funding of Medicare/Medicaid benefits. Quality care of standards, survey and certification standards and procedures for long term care providers of Medicare/Medicaid programs; Nursing Homes, Hospice, Long Term Care Hospitals, Inpatient Rehab Facilities, and related businesses. Medicare reimbursement for skilled nursing facilities, Medicare Conditions of Participation forHospice. Improving Medicare Post-Acute Care Transformation Act of 2014, H.R. 4994/S. 2553; Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014, S. 2122; Discussion Draft - Protecting Integrity in Medicare Act of 2014.

Client expense: $95,997 · Firm income: Not reported

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), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), SENATE, Veterans Affairs, Dept of (VA)

Site neutral payment issues; implementation of the Continuing Care Hospital; medical necessity, H.R. 713/S. 367; Medicare Access to Rehabilitation Services Act of 2013; post-acute care reform; H.R. 1250/S. 1012, Medicare Audit Improvement Act of 2013; Protecting Access to Medicare Act (P.L. 113-93); Common Sense Medicare SGR Repeal and Beneficiary Access Improvement Act, S. 2157; H.R. 4994/S. 2553, IMPACT Act of 2014 (P.L. 113-185); Protecting Integrity in Medicare Act of 2014 (H.R. 5780); draft Hospital Improvements for Payment Act of 2014

Client expense: Not reported · Firm income: $160,000

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

Site neutral payment issues; implementation of the Continuing Care Hospital; medical necessity, H.R. 713/S. 367; Medicare Access to Rehabilitation Services Act of 2013; post-acute care reform; H.R. 1250/S. 1012, Medicare Audit Improvement Act of 2013; Protecting Access to Medicare Act (P.L. 113-93); Common Sense Medicare SGR Repeal and Beneficiary Access Improvement Act, S. 2157; H.R. 4994/S. 2553, IMPACT Act of 2014 (P.L. 113-185); Protecting Integrity in Medicare Act of 2014 (H.R. 5780); draft Hospital Improvements for Payment Act of 2014

Client expense: Not reported · Firm income: $160,000

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

H.R.2504/S.1332, Home Health Care Planning Improvement Act of 2013. H.R.4994/S.2553, IMPACT Act of 2014. Issues related to coverage and reimbursement of home health and hospice services, including payment and delivery reforms. Issues related to Medicare Advantage, including the Star Rating program and Special Needs Plans. Issues related to Medicaid managed care. Issues relating to dual eligibles.

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

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

HR 1179/S 569 Improving Access to Medicare Coverage Act of 2013 (observation stay) HR 713/S 367 Medicare Access to Rehabilitative Services Act of 2013 (all sections) HR 4994/S 2553 Improving Medicare Post Acute Transformation Act of 2014 (all sections) HR 647/S 313 Achieving a Better Life Experience Act of 2013 (all sections) S1871 Medicare Payment for Therapy Services SGR Repeal and Medicare Provider Payment Modernization Act of 2014, Title II, Section 202 HR 5110 SAVE Medicare Home Health Act of 2014 (all sections) HR 3245 Medicare Home Health Fraud Reduction Act (all sections) Other issues related to Post-Acute Care Policy HR 5780 Protecting the Integrity of the Medicare Act of 2014, Sec 15 modification of Medicare Home Health surety bond condition of participation requirement

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

H.R.3531, Creating Access to Rehabilitation for Every Senior (CARES) Act of 2013. Issues related to Medicare and Medicaid reimbursement for post-acute care services. Issues related to support for federal funding and demonstration applications. Issues related to reimbursement for dialysis services. H.R.4994/S.2553, IMPACT Act of 2014. Issues relating to Medicare Advantage participation.

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

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

S.577/H.R.1180, Resident Physician Shortage Reduction Act of 2013. H.R.1201, Training Tomorrow's Doctors Today Act. H.R.3698, Two-Midnight Rule Delay Act of 2013/S.2082, Two-Midnight Rule Coordination and Improvement Act of 2014. H.R.4188, Establishing Beneficiary Equity in the Hospital Readmission Program Act.S.2501, Hospital Readmissions Program Accuracy and Accountability Act of 2014. S.2553/H.R.4994, Improving Medicare Post-Acute Care Transformation Act of 2014. H.R.83, Consolidated and Further Continuing Appropriations Act, 2015. Medicare funding for graduate medical education. Medicare reimbursement for hospital outpatient services.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to NCHC's policy priorities of health care transparency, SGR and physician payment reform, care coordination in Medicare, prescription drug pricing, consumer engagement and CHIP reauthorization; Advocacy related to specific legislation including HR 5183, the VBID for Better Care Act of 2014, HR 4994/S 2553 the IMPACT Act of 2014, and the discussion draft of the Protecting Integrity in Medicare Act of 2014; a proposed community-based Medicare Advantage Special Needs Plan demonstration designed to provide better care at lower cost to low-income beneficiaries with LTSS needs; issues related to a strong biosimilar pathway and the use of identical international non-propietary names (INNs) for biosimilar products

Client expense: Not reported · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), 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

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

Federal issues related to the regulation of long term acute care hospitals and inpatient rehabilitation facilities, including patient admission criteria and rules, and other Medicare payment issues. Inclusion of provisions related to long term acute care hospitals in the Bipartisan BudgetAct of 2013, (H.J. Res. 59). Issues related to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT), (H.R. 4994/S. 2553).

Client expense: $410,000 · Firm income: Not reported

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

Federal issues related to the regulation of long term acute care hospitals and inpatient rehabilitation facilities, including patient admission criteria and rules, and other Medicare payment issues. Inclusion of provisions related to long term acute care hospitals in the Bipartisan Budget Act of 2013, (H.J. Res. 59). Issues related to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT), (H.R. 4994/S. 2553).

Client expense: $410,000 · Firm income: Not reported

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

H.R. 713/S. 367-Medicare Access to Rehabilitation Services Act (Repeal of Therapy Caps) Payments to Physical Therapists under the Medicare Physician Fee Schedule Permanent Repeal of/alternatives to the Sustainable Growth Rate (SGR) Formula H.R. 574 Medicare Physician Payment Innovation ActOpposition of Multiple Procedure Payment Reduction for PT Services Physician Quality Reporting System H.R. 2914 Promoting Integrity in Medicare Act H.R. 1310 and S. 236 Medicare Patient Empowerment Act Prevention Initiatives for Fraud and Abuse in the Medicare program Accountable Care Organizations/Patient Centered Medical Homes Electronic Health Records/ Health Information Technology incentives for Physical Therapists Development of Alternatives to Medicare Therapy Cap Medicare Payment Reform Local Coverage Determinations NCCI Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage PCORI National Priority for Research and Research Agenda Health Information Technology Medicare Physician Payment Innovation Act Functional Limitation Reporting Therapy Cap: Manual Medical Review Essential Health Benefits Sustainable Growth Rate Reform H.R. 1179/S. 569 Improving Access to Medicare Coverage Act Medicaid Essential Health Benefits EHR/LTPAC Settings: Transitions of Care Medicare Improvement Standards Bundled Payment Models Common assessment tool for Medicare post-acute care Medicare appeals process H.R. 3426 Prevent Interruptions in Physical Therapy Act/S.2818 H.R. 942 and S. 948 Ensuring Access to Quality Complex Rehabilitation Technology H.R. 2810 Medicare Patient Access and Quality Improvement Act Inclusion of physical therapists in quality programs in SGR Reform H.R. 4015 and S.2000: SGR Repeal and Medicare Provider Payment Modernization Act of 2014 FTC Anti-competition Self-referral S.1871 SGR Repeal and Medicare Beneficiary Access Act S.2110 Medicare SGR Repeal and Beneficiary Access Improvement Act S. 2157 Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act H.R.4302 Protecting Access to Medicare Act Statement for the record on Ways and Means Health Subcommittee Current Hospital Issues in Medicare H.R. 4755 Access to In-patient Rehabilitation Therapy Act H.R. 4994/S.2553 IMPACT Act Able Act Comments on CY2015 OPPS rule H.R. 5380 Medicare Telehealth Parity Act Comments on draft Fraud & Abuse Legislation

Client expense: $308,338 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), 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, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

Oppose home health and hospice payment cuts and co-pays. Legislative and regulatory proposals affecting home care and hospice. S. 596, Fostering Independence Through Technology Act of 2013.H.R. 2504/S. 1332, Home Health Care Planning Improvement Act. H.R. 2302/S. 1053, Hospice Evaluation and Legitimate Payment Act. Proposals to fix the Medicare Sustainable Growth Rate (SGR). Labor/Health and Human Services/Education Appropriations, FY2015, provisions relating to Lifespan Respite Program, caregiver, and falls prevention matters. Recognition and payment for telehealth services under Medicare and Medicaid. H.R. 3616, Protecting Seniors From Health Care Fraud Act of 2013. Qualified Individual Medicaid program. Face to Face Physician Encounter Requirement. H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014, provisions on home care technologies. S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014, provisions on home care technologies. Hospice/Part D Coordination of Care. H.R. 4994/S. 2553, IMPACT Act of 2014. H.R. 4625, Medicare Home Health Rebasing Relief and Reassessment Act.

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

Oppose home health and hospice payment cuts and co-pays. Legislative and regulatory proposals affecting home care and hospice. S. 596, Fostering Independence Through Technology Act of 2013.H.R. 2504/S. 1332, Home Health Care Planning Improvement Act. H.R. 2302/S. 1053, Hospice Evaluation and Legitimate Payment Act. Proposals to fix the Medicare Sustainable Growth Rate (SGR). Labor/Health and Human Services/Education Appropriations, FY2015, provisions relating to Lifespan Respite Program, caregiver, and falls prevention matters. Recognition and payment for telehealth services under Medicare and Medicaid. H.R. 3616, Protecting Seniors From Health Care Fraud Act of 2013. Face to Face Physician Encounter Requirement. Hospice/Part D Coordination of Care. H.R. 4994/S. 2553, IMPACT Act of 2014. H.R. 4625, Medicare Home Health Rebasing Relief and Reassessment Act. S. 2491, Medicare Protection Act H.R. 4673, BACPAC Act of 2014 H.R. 5558, ACO Improvement Act of 2014 H.R. 3306, Telehealth Enhancement Act of 2013 H.R. 5380, Medicare Telehealth Parity Act of 2014 H.R. 5110, SAVE Medicare Home Health Act of 2014 Home health rural add on payment. Hospice cost report.

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

H.R. 3245- Medicare Home Health Fraud Reduction Act, Home Health Payment Reform, Copays, Medicare Rebasing, Post Acute Care Payment Reform, Face to Face Regulations, H.R. 4994- IMPACT Act of 2014, S. 2553- IMPACT Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care issues related to Medicare/Medicaid Long Term Care and Post Acute Care services and benefits. Monitor and advocate funding of Medicare/Medicaid benefits. Quality care of standards, survey and certification standards and procedures for long term care providers of Medicare/Medicaid programs; Nursing Homes, Hospice, Long Term Care Hospitals, Inpatient Rehab Facilities, and related businesses. Medicare reimbursement for skilled nursing facilities, Medicare Conditions of Participation forHospice. Improving Medicare Post-Acute Care Transformation Act of 2014, H.R. 4994/S. 2553; Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014, S. 2122; Discussion Draft - Protecting Integrity in Medicare Act of 2014.

Client expense: $95,997 · Firm income: Not reported

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), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), SENATE, Veterans Affairs, Dept of (VA)

Any federal legislation or agency regulations impacting federal rules or regulations for home health care and hospice services including: HR5110 (Securing Access via Excellence in Medicare Home Health Act); HR2302, S1053 (HELP Act); HR4302 (Protecting Access to Medicare Act); HR 1173 (Personalize Your Care Act); HR 4673 (BACPAC Act); S2553, HR4994 (IMPACT Act); S1332, HR2504 (Home Health Care Planning Improvement Act), HR5393 Hospice Act of 2014; S1439 Care Planning Act

Client expense: $254,900 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

Long term acute hospital payment reform, post acute care payment reform, Part B Therapy Payments, S. 2553- IMPACT Act of 2014, H.R. 4994- IMPACT Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Any federal legislation or agency regulations impacting federal rules or regulations for home health care and hospice services including: HR5110 (Securing Access via Excellence in Medicare Home Health Act); HR2302, S1053 (HELP Act); HR4302 (Protecting Access to Medicare Act); HR 1173 (Personalize Your Care Act); HR 4673 (BACPAC Act); S2553, HR4994 (IMPACT Act); S1332, HR2504 (Home Health Care Planning Improvement Act), HR5393 Hospice Act of 2014; S1439 Care Planning Act

Client expense: $254,900 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office

Patient Protection and Affordable Care Act Implementation, Reimbursement for rehabilitation facilities, H.R.4994- IMPACT Act of 2014, S. 2553-IMPACT Act of 2014

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Pub.Law 111-148 & 111-152 - Discussed implementation of health care law that would reform the health care system to provide affordable quality health care, reduce drug costs and expand access to long-term services and supports. Discussed how to implement Medicaid provisions of Affordable Care Act. (PL. 111-148)S. 374, Medicare Mental Health Inpatient Equity Act - Lobbied in support of this legislation to eliminate the 190-day lifetime limit on Medicare coverage for in-patient psychiatric hospital services (112th). Discussed improving access to care for underserved population. (no bill) Discussed importance of maintaining low income subsididies and supports in Medicare. (no bill) Discussed the importance of coordinating services for those who qualify for both Medicare and Medicaid in order to ensure that beneficiaries receive all needed benefits but there is no duplication. (no bill) Discussed whether, and under what circumstances, managed care could effectively be used to provide benefits to dual eligible beneficiaries. (no bill) Discussed additional methods for fighting fraud and waste in Health Care. (no bill) Discussed Medigap and need for guaranteed issue for all populations and need to increase medical loss ratio. Discussed durable medical equipment bidding. (no bill) Lobbied for legislation to provide Medicare beneficiaries with additional opportunities to enroll in Medicare Part B.(no bill) Lobbied against the use of the Social Security account number on Government-issued identification cards issued in connection with Medicare, Medicaid, and SCHIP benefits and for other purposes. (no bill) Discussed support to curb waste and fraud from the Medicare and Medicaid programs. (no bill) H.R. 3630, Middle Class Tax Relief and Job Creation Act of 2012 - Discussed the legislation as it pertained to SGR. Discussed Medicare Reform. (no bill) H.R. 2305/S. 1123, PRIME ACT (Preventing and Reducing Improper Medicare Expenditures) - Discussed support for bill and urged cosponsorship. Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs. (no bill) H.R. 1588/S. 740, Medicare Drug Savings Act - Discussed the Medicare Drug Savings Act to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed potential improvements to the Medicare Savings Programs for low-income befeficiaries. (no bill) Discussed proposals that would establish per-capita caps under Medicaid as well as other Medicaid financing proposals including block grants and changes to the current FMAP structure. (no bill) H.R. 1717 - Discussed Medicare DMEPOS Market Pricing Program Act. Discussed implementation of regulations regarding minimum wage and overtime for home care workers and consumer-directed care. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H. R. 1588/S.740 - Discussed the Medicare Drug Savings Act to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. H.R.3830/S.1900 - Discussed pending U.S. trade agreement negotiations and trade promotional or "fast track" authority legislation and their potential impact on Medicare and Medicaid prescription drug programs. S. 2461 - Discussed Children's Health Insurance Program (CHIP) extension and CHIP Extension Act of 2014. Discussed Part D Payment for Drugs for Beneficiaries Enrolled in Hospice - Final 2014 CMS Guidance. H.R.5294, Health Equity & Accountability Act of 2014 - Addresses health care disparities; no endorsement due to budget impact. Medicare Advantage- Answered questions from some Hill offices. (no bill) Medicare Supplemental Insurance - Stated opposition to the elimination of first dollar coverage. (no bill)Discussed Medicare Graduate Nursing Education pilot design. (no bill) Discussed Prescription Drug Affordability. (no bill) Discussed Prescription Drug Shortages. (no bill) H.R. 3342, Affordable Medicines Utilization Act of 2011 - Lobbied to encourage state Medicaid programs to use safe, effective generic medications. H.R. 2576 - Discussion to amend the Internal Revenue Code of 1986 to modify the calculation of modified adjusted gross income for purposes of determining eligibility for certain healthcare-related programs. Discussed opposition to caps on dual eligibles; discussed managed care and dual eligibles. (no bill) Discussed with CMS demonstration programs for dual eligibles and process related to the demonstrations, as well as other work of the Medicare-Medicaid Coordination Office, discussed consumer choice and continuity of care in Medicaid managed long-term services and supports programs, discussed focus groups on dual eligibles. Discussed Hospital & Critical Access Hospitals Conditions of Participation proposed regulations; requested that advanced practice registered nurses and physicians assistants be allowed the full scope of services in hospital admitting and visiting privileges. (no bill) Discussed Hospital Outpatient Therapeutic Services Final Rule underscoring that advanced practice registered nurses and physicians should be allowed to supervise such outpatient service clinics without physician oversight as long as in line with state scope of practice laws. (no bill) Discussed health disparities. (no bill) Discussed Medicaid reform, Medicare/Medicaid "dual eligibles" integration efforts and financial alignment demonstrations; and other CMS demonstration initiatives. (no bill) S. 3586, Recruiting Individuals to Drive Elders (RIDE) Act - Discussed Medicaid non-emergency transportation bill (112th). Discussed proposals that would establish per-capita caps under Medicaid as well as other Medicaid financing proposals including block grants and changes to the current FMAP structure. (no bill) Discussed extension of funding originally provided under the Medicare Improvement for Patients and Providers Act (P.L. 110-275) to State Health Insurance Assistance Programs (SHIPs), Aging and Disability Resource Centers (ADRICs), and Area Agencies on Aging (AAAs) for Medicare outreach and enrollment counseling. (no bill) Discussed the prevention of cuts to beneficiaries in the Medicare program. (no bill) Discussed the prevention of an increase in the age of eligibility in the Medicare program. (no bill) Discussed the patch to the Sustainable Growth Rate (SGR) in the Medicare program. (no bill) Discussed concerns of block granting Medicaid. (no bill) Discussed the Kansas managed long-term services and supports waiver proposals and related implementation issues. (no bill). H.R.928/S.408, the Medicare Drug Savings Act - Discussed requirement for drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed Health Disparities. (no bill) Discussed medicare demonstration project replacing standard medicare cards with Smart Card technology. (no bill) H.R. 574 - The Medicare Physician Payment Innovation Act of 2013. Discussed Medicaid expansion and estate recovery. (no bill) Discussed Medicaid and asset transfers. (no bill) H.R.4994/S. 2553, Improving Medicare Post-Acute Care Transformation Act of 2014 - Discussed the bill and AARP support for the bill. Shared our letter of support. S. 2491, Discussed Medicare Protection Act. Discussed concern about CMS guidance on prescription drugs for medicare beneficiaries receiving hospice and coordination between hospice providers and medicare Part D sponsors. (no bill) H.R. 1179/S.569 - Submitted statement for the record for Senate Aging Committee hearing on Observation Improving Access to Medicare Coverage Act and Notice of Observation Treatment and Implication for Care Eligibility Act (H.R. 5232). Discussed aging in place, HCBS, family caregiving. (no bill)H.R. 1179/S.569, Improving Access to Medicare Act - Discussed support of Improving Access to Medicare Coverage Act and urged cosponsorship and advancement of the bill. Discussed CMS information regarding healthcare marketplaces. H.R. 2305/S.1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act. Bill reduces waste, fraud, and abuse in Medicare and Medicaid programs. Discussed Competitive bidding of durable medical equipment, prosthetics, orthotics, and supplies. (no bill) Discussed repeal of Affordable Care Act provision making prescriptions necessary for over-the-counter drugs purchased with flexible spending accounts. (no bill) Discussed Medicare supplemental coverage. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug cost. (no bill) Discussed potential improvements to the Medicare Savings Programs for low-income beneficiaries. (no bill) Discussed Recruiting Individuals to Drive Our Elders Act (RIDE) would increase state flexibility by giving states the option to receive federal assistance to reimburse their volunteer drivers for no-load miles. (no bill) Labor, Health and Human Services Appropriations Act, 2015 - Lobbied to protect vital health and social services programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation.(no bill) Discussed potential improvements to the Medicare Savings Programs for low-income beneficiares. (no bill) Discussed pending U.S. trade agreement negotiations, including trade promotional or 'fast track' authority, and their potential impact on Medicare and Medicaid prescription drug programs. (no bill) Discussed fraud, Medicare home healthcare, ways to find savings in Medicare without harming Medicare beneficiaries (care coordination, prescription drugs, waste, fraud and abuse). Discussed You've Earned A Say, ways to find savings in medicare without harming medicare beneficiaries (care coordination, prescription drugs, waste, fraud and abuse). PL.111-148 - Discussed implementation of provision to require reporting of nursing home staffing data based on payroll data. Discussed the draft legislation on Medicare fraud and abuse. Protecting the Integrity of Medicare Act. (no bill) Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H.R. 1588/S.740 - Discussed the Medicare Drug Savings Act to require drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. H.R. 3830/S. 1900 - Discussed pending U.S. trade agreement negotiations and trade promotional or "fast track" authority legislation and their potential impact on Medicare and Medicaid prescription drug programs. S. 2461 - Discussed Children's Health Insurance Program (CHIP) Extension Act of 2014. Discussed Part D Payment for Drugs for Beneficiaries Enrolled in Hospice-Final 2014 CMS Guidance. Discussed the Protecting Integrity of Medicare Act. (no bill) H.R.5435, Home Infusion Site of Care Act - Sent letter of endorsement H.R. 5958 - Discussed the ACO Improvement Act. H.R. 5232 - Discussed and sent letter on the Notice of Observation Treatment and Implication for Care Eligibility Act. Met with Centers for Medicare and medicaid services to discuss three-day stay requirement for medicare skilled nursing coverage. H.J. Res. 124, Continuing Appropriations Resolution - Lobbied to protect funding levels for CMS program management under Continuing Resolution. Discussed coordination with hospice providers and Medicare Part D plans guidance for Medicare beneficiaries receiving hospice. (no bill) H.R. 1179/S. 569 - Discussed observation impace on Medicare beneficiaries, counting time in observation toward Medicare's three-day inpatient hospital stay requirement for Medicare skilled nursing facility coverage, and the Improving Access to Medicare Coverage Act (CMS & MedPAC). Discussed caucus for military/veteran family caregivers and support for family caregivers. (no bill) Discussed draft working paper on impact of observation on Medicare beneficiary out of pocket. (no bill)Discussed District of Columbia EPD Medicaid HCBS waiver. (no bill) H.R. 5232 - Discussed legislation and shared letter of support for the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act of 2014. Discussed Medicare Advantage. (no bill) Discussed H.R. 3616, Protecting Seniors from Healthcare Fraud Act. Discussed observation care and "two-midnight rule". (no bill) H.R. 1070, the Removing Barriers to Colorectal Cancer Screening Act - Discussed and sent letter of endorsement to bill. Discussed the Medicare Part D prescription drug benefit program and changes needed to further lower prescription drug costs and related agency proposed rule changes. (no bill) H.R. 1588/S.740, Medicaid Drug Savings Act - Discussed the requirement for drug manufacturers to provide rebates for drugs provided to Medicare Part D low-income subsidy beneficiaries, including those who are dually eligible for Medicare and Medicaid. Discussed potential improvements to the Medicare Savings Programs for low-income beneficiaries. (no bill) Discussed pending U.S. Trade agreement negotiations, including trade promotional or "fast track" authority, and their potential impact on Medicare and Medicaid prescription drug programs. (no bill) H.R. 2810/S.1871/H.R. 4015/S.2110 - Discussed SGR repeal and health care extender provisions, including the Qualified Individual low-income Medicare beneficiary assistance program. H.R. 4418, The Expanding Availability of Medicare Data Act - Sent letter of endorsement. Discussed Medicare data and billing transparency. (no bill) Discussed socio-economic risk adjustment. (no bill) S. 2240 - Discussed Medicare Choices Empowerment and Protection Act. H.R. 3024 - Discussed the Medicare Common Access Card Act. H.R. 4673-Discussed the Bundling and Coordinating Post Acute Care (BACPAC) Act and shared views on post-acute care return. Discussed Medicare expansion. (no bill) Discussed Medicaid Labs Spousal Impoverishment provisions (PL. 111-198). S. 2361, Discussed Stop Schemes and cons against Medicare and seniors. Discussed transparency in healthcare. (no bill) Discussed LTSS Hill briefing series. (no bill) Met with CMS on observation status. (no bill) Submitted comment letter to CMS on the FY2015 Medicare Hospice proposed regulation. Shared comment letter with some Hill staff. H.R. 4994/S.2553 - Shared letter of support for Improving Medicare Post-Acute Care Transformation Act and discussed the status of the bill. Discussed long-term survey and supports Hill briefings. (no bill) Submitted comment letter to CMS on the FY 2015 Medicare Home Health proposed regulation. Shared draft working paper on impact of observation on Medicare beneficiary out of pocket cost. (no bill) Responded to inquiry on observation. (no bill)

Client expense: $2,380,000 · Firm income: Not reported

Government targets: Administration on Aging, Agriculture, Dept of (USDA), Bureau of the Census, Centers For Medicare and Medicaid Services (CMS), Commodity Futures Trading Commission (CFTC), Congressional Budget Office (CBO), Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Highway Administration (FHA), Federal Reserve System, Federal Trade Commission (FTC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Highway Traffic Safety Administration (NHTSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Comptroller of the Currency (OCC), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

S 367/HR 713 - Medicare Access to Rehabilitation Services Act: Advocate for removal of cap on occupational therapy services and passage of bills. HR 942/S 948 - Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013: Advocate for inclusion of occupational therapy professionals as providers of Complex Rehabilitation Technology. No bill# - Educate about role of occupational therapy in primary care. HR 2810 - The Medicare Patient Access and Quality Improvement Act of 2013: Advocated regarding Sustainable growth rate and educate about the role of occupational therapy in health care and need for improving Medicare to assure that patients receive appropriate care, especially occupational therapy services, and that payment is fair and equitable. No bill# - Multiple Procedure Payment Reduction (MPPR): Advocate for separation of occupational therapy from physical therapy/speech language pathology in application of MPPR policy. No bill# Manual Medicare Review (MMR): Advocate for improved MMR procedures including electronic submission and 10 day turn around. S 1871/S 2110 - the Sustainable Growth Rate (SGR) Repeal and Medicare Beneficiary Access Improvement Act of 2013 AND HR 4015/S 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Advocated for improvements to the bills that address policies that pertain to beneficiaries' access to occupational therapy services and how occupational therapy services are reimbursed under the Medicare program. Advocate for repeal of the Medicare Part B outpatient therapy cap on occupational therapy services. HR 3749 - The Medicare Demonstration of Coverage for Low Vision Devices Act: Support for greater attention to low vision coverage and highlight role of occupational therapy in ensuring the devices are utilized properly and to their full potential. S 1932/HR 3890 - Better Care, Lower Cost Act: Educate about role of occupational therapy in helping people with chronic conditions. Support including occupational therapy in the chronic care innovation centers. HR 4994/S 2553 - The Improving Medicare Post-Acute Care Transformation Act of 2014 "IMPACT Act of 2014": Advocated for improvements in the bill that would help ensure Medicare beneficiaries' access to quality post-acute care in the right setting is preserved. Advocated to ensure data collection program included elements that reflected the contributions of occupational therapy across the various post-acute settings. HR 5380 - Medicare Telehealth Parity Act: Support passage and inclusion of occupational therapy services. HR 3306 - The Telehealth Enhancement Act of 2013: Educate about how occupational therapy can be utilized in telehealth. HR 3877 - Lymphedema Treatment Act - support passage and educate about role of occupational therapy services. No bill# (PL 113-93) - Advocate for inclusion of occupational therapy in the Excellence in Mental Health Act's Medicaid Demonstration by encouraging Members of Congress to send a letter of support to the Substance Abuse and Mental Health Administration.

Client expense: $170,000 · Firm income: Not reported

Government targets: Education, Dept of, HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), SENATE