Medicare Prescription Drug Savings and Choice Act of 2013

PL 109-442: Lifespan Respite Care Act; PL 109-365: Older Americans Act Amendments of 2006; PL 111148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; PHS 42 USC 254C-8: Healthy Start Reauthorization of 2007; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; PL 111-152, 124 Stat. 1029: Health Care & Education Reconciliation Act; HR 1190: Protecting Seniors Access to Medicare; S 810: Repeal Outpatient Rehab Caps; HR 928/S 408: Medicare Prescription Drug Savings & Choice Act; HR 132: ObamaCare Repeal Act; S 1034/HR 1960: National Defense Authorization Act 2014; S 737/HR 1516: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014; S 192: Older Americans Act Reauthorization Act of 2015; HR 30: Save American Workers Act; HR 2: Medicare Access & CHIP Reauthorization Act; S 157: No Obama Mandate Act; HR 1271: Concussion Awareness & Education Act; HR 1470: SGR Repeal & Medicare Provider Payment Modernization Act; HR 160: Protecting Medical Innovations Act; S 539/HR 775: Medicare Access to Rehabilitation Services Act; and HR 2646: Helping Families in Mental Health Crisis.

Client expense: $60,790 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Defense, Dept of (DOD), Education, Dept of, Equal Employment Opportunity Commission (EEOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

PL 109-442: Lifespan Respite Care Act; PL 109-365: Older Americans Act Amendments of 2006; PL 111148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; PHS 42 USC 254C-8: Healthy Start Reauthorization of 2007; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; PL 111-152, 124 Stat. 1029: Health Care & Education Reconciliation Act; HR 1190: Protecting Seniors Access to Medicare; S 810: Repeal Outpatient Rehab Caps; HR 928/S 408: Medicare Prescription Drug Savings & Choice Act; HR 132: ObamaCare Repeal Act; S 1034/HR 1960: National Defense Authorization Act 2014; S 737/HR 1516: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014; S 192: Older Americans Act Reauthorization Act of 2015; HR 30: Save American Workers Act; HR 2: Medicare Access & CHIP Reauthorization Act; S 157: No Obama Mandate Act; HR 1271: Concussion Awareness & Education Act; HR 1470: SGR Repeal & Medicare Provider Payment Modernization Act; HR 160: Protecting Medical Innovations Act.

Client expense: $64,746 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Defense, Dept of (DOD), Education, Dept of, Equal Employment Opportunity Commission (EEOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

PL 109-442: Lifespan Respite Care Act; PL 109-365: Older Americans Act Amendments of 2006; PL 111148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; PHS 42 USC 254C-8: Healthy Start Reauthorization of 2007; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; PL 111-152, 124 Stat. 1029: Health Care & Education Reconciliation Act; HR 1190: Protecting Seniors Access to Medicare; S 810: Repeal Outpatient Rehab Caps; HR 928/S 408: Medicare Prescription Drug Savings & Choice Act; HR 132: ObamaCare Repeal Act; S 1034/HR 1960: National Defense Authorization Act 2014; S 737/HR 1516: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014; S 192: Older Americans Act Reauthorization Act of 2015; HR 30: Save American Workers Act; HR 2: Medicare Access & CHIP Reauthorization Act; S 157: No Obama Mandate Act; HR 1271: Concussion Awareness & Education Act; and HR 1470: SGR Repeal & Medicare Provider Payment Modernization Act.

Client expense: $91,416 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Defense, Dept of (DOD), Education, Dept of, Equal Employment Opportunity Commission (EEOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) - MA special needs plans H.R. 4998, MA Participant Bill of Rights Act (DeLauro) - MA plan provider networks H.R. 5113, Protecting Seniors' Medicare Choices from Obamacare Act (Coffman) - MA stabilization program H.R. 5183, Value Based Insurance Design for Better Care Act (Black) - MA demonstration to test VBID methodologies H.R. 5364, CHIP Extension and Improvement Act (Pallone) - federal CHIP funding Draft Bill, Protecting the Integrity of Medicare Act (Brady) - preventing fraud in Medicare and Medicaid S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues S. 25 (Hatch) - extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal S. 2361, Stop SCAMS Act (Nelson-Collins) - reducing Medicare fraud S. 2461, CHIP Extension Act (Rockefeller) --- federal CHIP funding S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) - MA plan provider networks S. 2783, Value Based Insurance Design for Better Care Act (Thune) - MA demonstration to test VBID methodologies Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.

Client expense: $2,010,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office

H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes H.R. 1024, Medication Therapy Management Empowerment Act (McMorris Rodgers) - medication therapy management programs H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) - MA special needs plans H.R. 4998, MA Participant Bill of Rights Act (DeLauro) - MA plan provider networks H.R. 5113, Protecting Seniors' Medicare Choices from Obamacare Act (Coffman) - MA stabilization program H.R. 5183, Value Based Insurance Design for Better Care Act (Black) - MA demonstration to test VBID methodologies H.R. 5364, CHIP Extension and Improvement Act (Pallone) - federal CHIP funding Draft Bill, Protecting the Integrity of Medicare Act (Brady) - preventing fraud in Medicare and Medicaid S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues S. 25 (Hatch) - extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal S. 2361, Stop SCAMS Act (Nelson-Collins) - reducing Medicare fraud S. 2461, CHIP Extension Act (Rockefeller) --- federal CHIP funding S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) - MA plan provider networks S. 2783, Value Based Insurance Design for Better Care Act (Thune) - MA demonstration to test VBID methodologies Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues;implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage financing for infectious disease such as Ebola; and other issues relating to health care reform implementation. *AddMACPACtoAgencyList

Client expense: $2,230,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office

H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits. H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi). H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes. H.R. 1024, Medication Therapy Management Empowerment Act (McMorris Rodgers) - medication therapy management programs. H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care. H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations. H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs. H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse. H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules. H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives. H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives. H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review. H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period. H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions. H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay. H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule. H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders . H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) - MA special needs plans. H.R. 4998, MA Participant Bill of Rights Act (DeLauro) - MA plan provider networks. H.R. 5113, Protecting Seniors' Medicare Choices from Obamacare Act (Coffman) - MA stabilization program. H.R. 5183, Value Based Insurance Design for Better Care Act (Black) - MA demonstration to test VBID methodologies. H.R. 5364, CHIP Extension and Improvement Act (Pallone) - federal CHIP funding. Draft Bill, Protecting the Integrity of Medicare Act (Brady) - preventing fraud in Medicare and Medicaid. S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues. S. 25 (Hatch) - extension of Medicare sequestration cuts. S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations. S. 324, Puerto Rico Medicare Part B Equity Act (Schumer). S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes. S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care. S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse. S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives. S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations. S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs. S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions. S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment. S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms. S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders. S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal. S. 2361, Stop SCAMS Act (Nelson-Collins) - reducing Medicare fraud. S. 2461, CHIP Extension Act (Rockefeller) --- federal CHIP funding. S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) - MA plan provider networks. S. 2783, Value Based Insurance Design for Better Care Act (Thune) - MA demonstration to test VBID methodologies.

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

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 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.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 LTSS issues, including financing. (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) 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) Discussed long-term services and supports in Hill briefings. (no bill) H.R. 1173 - Discussed advance care planning, CMS payment for advance care planning, advanced illness, and Personalize Your Care Act.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) H.R. 83, Consolidated and Further Continuing Appropriations, 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 and executive actions related to nursing homes, IMPACT Act, PL 113-185).. 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.J. Res. 124, Continuing Appropriations Resolution - Lobbied to protect funding levels for CMS program management under Continuing Resolution. 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). PL. 113-295 - Responded to inquiry about Medicare offsets on Achieving a Better Life Expense Act.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. Discussed Medicare expansion. (no bill) Discussed Medicaid Labs Spousal Impoverishment provisions (PL. 111-198). Discussed transparency in healthcare. (no bill) Discussed Medicaid managed care regulations. (CMS, no bill) PL.111-148 - Discussed long-term services and supports broadly and Older Americans Act. Submitted comments on Medicare Physician fee schedule final rule and advance care planning (CMS - 1612-FC). Discussed Medicare enrollment and notification of eligibility. (no bill) Discussed Medicare in-office ancillary services exception. (no bill)

Client expense: $2,180,000 · 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

H.R. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to the Independent Payment Advisory Board H.R. 460, Patients Access to Treatments Act: Provisions related to cost sharing in the specialty tier H.R. 928, Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to Part D issues H.R. 1024, Medication Therapy Management Empowerment Act of 2013: Provisions related to medication therapy management in Part D H.R. 1102, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference H.R. 1588, Medicare Drug Savings Act of 2013: Provisions related to Part D issues H.R. 2753 Securing Care for Seniors Act: Provisions related to Value Based Insurance Design H.R. 2810, Medicare Patient Access and Quality Improvement Act: Provisions related to SGR reform H.R. 2827, To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D: Provisions related to Medicare Part D Drug Tier Formularies H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013: Provisions related to Office of Inspector General (OIG) enforcement of fraud and abuse laws H.R. 3392, Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013: Provisions related to lock-in programs H.R. 3796, Comprehensive Care Payment Innovation Act: Provisions related to alternative payment models H.R. 3890 Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to sustainable growth rate (SGR) and Medicare provider payment reform H.R. 4160, Keep the Promise to Seniors Act of 2014: Provisions related to Part D issues H.R. 4302, Protecting Access to Medicare Act of 2014: Provisions related to the biopharmaceutical industry H.R. 4577, Ensuring Seniors Access to Local Pharmacies Act of 2014: Provisions related to Part D preferred pharmacy networks H.R. 5183, Value Based Insurance Design for Better Care Act of 2014: Provisions related to valued base insurance design demonstration program H.R. 5558 ACO Improvement Act: Provisions related to alternate payment models H.R. 5780, Protecting Integrity in Medicare Act of 2014: Provisions related to addressing fraud and prescription drug abuse S. 117, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference S. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to Independent Payment Advisory Board S. 408, Medicare Prescription Drug Savings and Choice Act of 2013: Provision related to Part D issues S. 557, Medication Therapy Management Empowerment Act of 2013: Provisions related to Part D and medication therapy management S. 740, Medicare Drug Savings Act of 2013: Provisions related to Part D issues Deficit reduction policy issues S. 882, Stop Trafficking of Pills (STOP) Act: Provisions related to lock-in programs (112th Congress) S. 1365, Part D Beneficiary Appeals Fairness Act: Provisions related to the specialty tier in Part D S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013: Provisions related to reforming Medicare physician payments S. 1932, Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to SGR reform S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014: Provisions related to SGR reform Hospital Improvements for Payment (HIP) Act of 2014: Provisions related to Medicare reform (no bill number) Medicare Prescription Drug Diversion and Abuse Prevention Act: Provisions related to diversion and abuse (no bill number) Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs: Provisions related to Part D Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy Medicaid Program, Covered Outpatient Drugs rulemaking Medicare sustainable growth rate policy issues Implementation issues relating to the Physician Payment Sunshine Act, including Medicare, Medicaid, Childrens Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests rulemaking Issues related to better use of medicine and adherence

Client expense: $3,960,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Medicare Payment Advisory Commission (MedPAC), Patent & Trademark Office (PTO), SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

PL 109-442: Lifespan Respite Care Act; PL 109-365: Older Americans Act Amendments of 2006; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; PHS 42 USC 254C-8: Healthy Start Reauthorization of 2007; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; PL 111-152, 124 Stat. 1029: Health Care & Education Reconciliation Act; HR 351: Protecting Seniors Access to Medicare; HR 713/S 367: Repeal Outpatient Rehab Caps; HR 928/S 408: Medicare Prescription Drug Savings & Choice Act; HR 132: ObamaCare Repeal Act; S 1028: Older Americans Act Amendments of 2013; S 1034/HR 1960: National Defense Authorization Act 2014; S 948/HR 942: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; S 1562: Older Americans Act Reauthorization Act of 2013; HR 2667: Authority for Mandate Delay Act; HR 2668: Fairness for American Families Act: HR 2009: Keep the IRS Off Your Healthcare Act; S 1546: Protecting Student Athletes from Concussions Act of 2013; S 152: Older Americans Act Reauthorization Act of 2013; S 423/HR 564: Family-to-Family Health Information Centers; HR 3850/HR 4122: Older Americans Act Reauthorization Act of 2014; HR 3114: Helping Families & Seniors Save on Health Care Act of 2014; HR 4118: SIMPLE (Suspending the Individual Mandate Penalty Law Equals) Fairness Act of 2014; HR 4302: Protecting Access to Medicare Act of 2014; S 2110: Medicare SGR Repeal & Beneficiary Access Improvement Act of 2014; S 2410/HR 4435: National Defense Authorization Act 2015; S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014; S 531: Promoting Physical Activity for Americans Act; S 2539: TBI Reauthorization Act; S 531: Physical Activity Guidelines; and S 1847: National Defense Authorization Act.

Client expense: $74,594 · Firm income: Not reported

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

H.R. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board H.R. 928 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D H.R. 1024 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues H.R. 1102 - Medicare Prescription Drug Price Negotiation Act of 2013; Provisions related to Part D issues and non-interference H.R. 1588 - Medicare Drug Savings Act of 2013; provisions related to Part D issues H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013; Provisions related to SGR reform H.R. 2827 - To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D; provisions related to Medicare Part D Drug Tier Formularies H.R. 3890 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease H.R 4160 - Keep the Promise to Seniors Act of 2014; provisions related to Part D H.R. 4187 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 4302 - Protecting Access to Medicare Act of 2014; provisions related to the biopharmaceutical industry S. 117 - Medicare Prescription Drug Price Negotiation Act of 2013; provisions related to Part D issues S. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board S. 408 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D S. 557 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues S. 740 - Medicare Drug Savings Act of 2013; provisions related to Part D issues S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013; Provisions related to reforming Medicare physician payments S. 1932 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014; Provisions related to SGR reform S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014; Provisions related to SGR reform No bill # assigned - Contract Year 2015 Policy and Technical Cganges to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs; Provisions related to Part D No bill # assigned - Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy No bill # assigned - Issues related to better use of medicines and comprehensive medication management No bill # assigned - Medicaid Program, Covered Outpatient Drugs rulemaking No bill # assigned - Implementation Issues relating to the Physician Payment Sunshine ActNo bill # assigned - Vaccine access and coverage issues

Client expense: $580,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, U.S. Trade Representative (USTR)

Medicare Part D issues. H.R. 928 Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to patent issues. Medicare Drug Savings Act: Part D Issues S. 117 Medicare Prescription Drug Price Negotiation Act of 2013. S. 351 Protecting Seniors Access to Medicare Act of 2013 S. 408 Medicare Prescription Drug Saving and Choice Act of 2013. 340B Drug Program Issues related to changes to the Medicare Part B reimbursement of perscription drugs; issues related to coverage and reimbursementfor those who are covered by the Medicaid program and the Medicare program, including the Part D prescription drug benefit; and general issues related to the Medicare Part D program.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill.) Proposals related to the activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients receiving benefits from both Medicare and Medicaid, i.e., dual-eligibles. Medicare Advantage. S. 2552, H.R.4998, Medicare Advantage Participant Bill of Rights Act of 2014: provisions to establish necessary protections for seniors enrolled in Medicare Advantage plans. Medicare Benefit Redesign. S. 11, Fiscal Sustainability Act of 2013: provisions pertaining to Parts A and B deductibles; premiums, including means-testing; a catastrophic cap on out-of-pocket spending; the eligibility age; and proposals to privatize Medicare. Medicare Drug Savings. S. 740, H.R. 1588, Medicare Drug Savings Act of 2013: provisions to extend the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Part D Negotiation of Drug Prices. S. 408, H.R. 928, Medicare Prescription Drug Savings and Choice Act of 2013: proposals to create a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Physician Fees and Extenders. H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014; S. 2157, Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014: provisions relating to a permanent fix of the sustainable growth rate (SGR) formula used to determine physician fees under Part B; the extension of the Qualified Individual (QI) program; and the therapy caps. Medicare Supplemental Health Insurance. (No bill.) Proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Observation Status. S. 569, H.R. 1179, Improving Access to Medicare Coverage Act of 2013: legislation to count days in the hospital in observation status toward meeting the three-day prior hospitalization requirement for skilled nursing facility (SNF) care eligibility. Nursing Home Staffing. H.R. 5373, Put A Registered Nurse in the Nursing Home Act of 2014: legislation to require nursing homes and skilled nursing facilities that receive Medicare and/or Medicaid reimbursement to have at least one direct care registered nurse on duty at all times. Comprehensive Health Care Reform. P.L. 111-148, Patient Protection and Affordable Care Act; P.L. 111-152, Health Care and Education Reconciliation Act of 2010: implementation of provisions reducing Medicare Advantage plan payments; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); expanding coverage of prevention services; testing payment and delivery system reforms; and providing expanded Medicaid coverage.

Client expense: $230,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Economic Council (NEC), Office of Management & Budget (OMB), President of the U.S., SENATE, Social Security Administration (SSA), Treasury, Dept of, Vice President of the U.S.

Medicare medicaid legislationH.R. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board H.R. 928 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D H.R. 1024 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues H.R. 1102 - Medicare Prescription Drug Price Negotiation Act of 2013; Provisions related to Part D issues and non-interference H.R. 1588 - Medicare Drug Savings Act of 2013; provisions related to Part D issues H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013; Provisions related to SGR reform H.R. 2827 - To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D; provisions related to Medicare Part D Drug Tier Formularies H.R. 3890 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease H.R 4160 - Keep the Promise to Seniors Act of 2014; provisions related to Part D H.R. 4187 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 4302 - Protecting Access to Medicare Act of 2014 - provisions related to the biopharmaceutical industry S. 117 - Medicare Prescription Drug Price Negotiation Act of 2013; provisions related to Part D issues S. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board S. 408 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D S. 557 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues S. 740 - Medicare Drug Savings Act of 2013; provisions related to Part D issues S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013; Provisions related to reforming Medicare physician payments S. 1932 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014; Provisions related to SGR reform S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014; Provisions related to SGR reform

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to the Independent Payment Advisory Board H.R. 460, Patients Access to Treatments Act: Provisions related to cost sharing in the specialty tier H.R. 928, Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to Part D issues H.R. 1024, Medication Therapy Management Empowerment Act of 2013: Provisions related to medication therapy management in Part D H.R. 1102, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference H.R. 1588, Medicare Drug Savings Act of 2013: Provisions related to Part D issues H.R. 2753 Securing Care for Seniors Act: Provisions related to Value Based Insurance Design H.R. 2810, Medicare Patient Access and Quality Improvement Act: Provisions related to SGR reform H.R. 2827, To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D: Provisions related to Medicare Part D Drug Tier Formularies H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013: Provisions related to fraud and abuse H.R. 3392, Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013: Provisions related to lock-in programs H.R. 3796, Comprehensive Care Payment Innovation Act: Provisions related to alternative payment models H.R. 3890 Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to sustainable growth rate (SGR) and Medicare provider payment reform H.R. 4160, Keep the Promise to Seniors Act of 2014: Provisions related to Part D issues H.R. 4302, Protecting Access to Medicare Act of 2014: Provisions related to the biopharmaceutical industry H.R. 4577, Ensuring Seniors Access to Local Pharmacies Act of 2014: Provisions related to Part D preferred pharmacy networks H.R. 5183, Value Based Insurance Design for Better Care Act of 2014: Provisions related to valued base insurance design demonstration program H.R. 5558 ACO Improvement Act: Provisions related to alternate payment models S. 117, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference S. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to Independent Payment Advisory Board S. 408, Medicare Prescription Drug Savings and Choice Act of 2013: Provision related to Part D issues S. 557, Medication Therapy Management Empowerment Act of 2013: Provisions related to Part D and medication therapy management S. 740, Medicare Drug Savings Act of 2013: Provisions related to Part D issues Deficit reduction policy issues S. 882, Stop Trafficking of Pills (STOP) Act: Provisions related to lock-in programs (112th Congress) S. 1365, Part D Beneficiary Appeals Fairness Act: Provisions related to the specialty tier in Part D S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013: Provisions related to reforming Medicare physician payments S. 1932, Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to SGR reform S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014: Provisions related to SGR reform Medicare Prescription Drug Diversion and Abuse Prevention Act: Provisions related to diversion and abuse (no bill number) Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs: Provisions related to Part D Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy Medicaid Program, Covered Outpatient Drugs rulemaking Medicare sustainable growth rate policy issues Implementation issues relating to the Physician Payment Sunshine Act, including Medicare, Medicaid, Childrens Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests rulemaking Issues related to better use of medicine and adherence Protecting Integrity in Medicare Act of 2014 (no bill number): Provisions related to addressing fraud, prescription drug abuse, and other issues Lock-in concepts generally

Client expense: $3,680,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Patent & Trademark Office (PTO), SENATE, U.S. Trade Representative (USTR)

H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) - MA special needs plans H.R. 4998, MA Participant Bill of Rights Act (DeLauro) - MA plan provider networks H.R. 5113, Protecting Seniors' Medicare Choices from Obamacare Act (Coffman) - MA stabilization program H.R. 5183, Value Based Insurance Design for Better Care Act (Black) - MA demonstration to test VBID methodologies H.R. 5364, CHIP Extension and Improvement Act (Pallone) - federal CHIP funding Draft Bill, Protecting the Integrity of Medicare Act (Brady) - preventing fraud in Medicare and Medicaid S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues S. 25 (Hatch) - extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal S. 2361, Stop SCAMS Act (Nelson-Collins) - reducing Medicare fraud S. 2461, CHIP Extension Act (Rockefeller) --- federal CHIP funding S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) - MA plan provider networks S. 2783, Value Based Insurance Design for Better Care Act (Thune) - MA demonstration to test VBID methodologies Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.

Client expense: $2,010,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office

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

H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits. H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi). H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes. H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care. H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations. H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs. H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse. H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules. H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives. H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives. H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review. H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period. H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions. H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay. H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule. H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders. H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) - MA special needs plans. H.R. 4998, MA Participant Bill of Rights Act (DeLauro) - MA plan provider networks. H.R. 5113, Protecting Seniors' Medicare Choices from Obamacare Act (Coffman) - MA stabilization program. H.R. 5183, Value Based Insurance Design for Better Care Act (Black) - MA demonstration to test VBID methodologies. H.R. 5364, CHIP Extension and Improvement Act (Pallone) - federal CHIP funding. Draft Bill, Protecting the Integrity of Medicare Act (Brady) - preventing fraud in Medicare and Medicaid. S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues. S. 25 (Hatch) - extension of Medicare sequestration cuts. S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations. S. 324, Puerto Rico Medicare Part B Equity Act (Schumer). S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes. S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care. S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse. S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives. S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations. S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs. S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions. S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment. S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms. S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders. S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal. S. 2361, Stop SCAMS Act (Nelson-Collins) - reducing Medicare fraud. S. 2461, CHIP Extension Act (Rockefeller) --- federal CHIP funding. S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) - MA plan provider networks. S. 2783, Value Based Insurance Design for Better Care Act (Thune) - MA demonstration to test VBID methodologies.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PL 109-442: Lifespan Respite Care Act; PL 109-365: Older Americans Act Amendments of 2006; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; PHS 42 USC 254C-8: Healthy Start Reauthorization of 2007; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; PL 111152, 124 Stat. 1029: Health Care & Education Reconciliation Act; HR 351: Protecting Seniors Access to Medicare;HR 713/S 367: Repeal Outpatient Rehab Caps; HR 928/S 408: Medicare Prescription Drug Savings & Choice Act; HR 132: ObamaCare Repeal Act; S 1028: Older Americans Act Amendments of 2013; S 1034/HR 1960: National Defense Authorization Act 2014; S 948/HR 942: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; S 1562: Older Americans Act Reauthorization Act of 2013; HR 2667: Authority for Mandate Delay Act; HR 2668: Fairness for American Families Act: HR 2009: Keep the IRS Off Your Healthcare Act; S 1546: Protecting Student Athletes from Concussions Act of 2013; S 152: Older Americans Act Reauthorization Act of 2013; S 423/HR 564: Family-to-Family Health Information Centers; HR 3850/HR 4122: Older Americans Act Reauthorization Act of 2014; HR 3114: Helping Families & Seniors Save on Health Care Act of 2014; HR 4118: SIMPLE (Suspending the Individual Mandate Penalty Law Equals) Fairness Act of 2014; HR 4302: Protecting Access to Medicare Act of 2014; S 2110: Medicare SGR Repeal & Beneficiary Access Improvement Act of 2014; S 2410/HR 4435: National Defense Authorization Act 2015; S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014; and S 531: Promoting Physical Activity for Americans Act.

Client expense: $52,871 · Firm income: Not reported

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

H.R. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board H.R. 928 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D H.R. 1024 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues H.R. 1102 - Medicare Prescription Drug Price Negotiation Act of 2013; Provisions related to Part D issues and non-interference H.R. 1588 - Medicare Drug Savings Act of 2013; provisions related to Part D issues H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013; Provisions related to SGR reform H.R. 2827 - To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D; provisions related to Medicare Part D Drug Tier Formularies H.R. 3890 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease H.R 4160 - Keep the Promise to Seniors Act of 2014; provisions related to Part D H.R. 4187 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 4302 - Protecting Access to Medicare Act of 2014 - provisions related to the biopharmaceutical industry S. 117 - Medicare Prescription Drug Price Negotiation Act of 2013; provisions related to Part D issues S. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board S. 408 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D S. 557 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues S. 740 - Medicare Drug Savings Act of 2013; provisions related to Part D issues S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013; Provisions related to reforming Medicare physician payments S. 1932 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014; Provisions related to SGR reform S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014; Provisions related to SGR reform No bill # assigned - Contract Year 2015 Policy and Technical Cganges to the Medicare Advantage and the Medicare Prescription Drug Benefits ProgramsProvisions related to Part D No bill # assigned - Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy No bill # assigned - Issues related to better use of medicines and comprehensive medication management No bill # assigned - Medicaid Program, Covered Outpatient Drugs rulemaking No bill # assigned - Implementation Issues relating to the Physician Payment Sunshine Act No bill # assigned - Vaccine access and coverage issues

Client expense: $1,140,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, U.S. Trade Representative (USTR)

Medicare Part D issues. H.R. 928 Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to patent issues. Medicare Drug Savings Act: Part D Issues S. 117 Medicare Prescription Drug Price Negotiation Act of 2013. S. 351 Protecting Seniors Access to Medicare Act of 2013 S. 408 Medicare Prescription Drug Saving and Choice Act of 2013. 340B Drug Program Issues related to changes to the Medicare Part B reimbursement of perscription drugs; issues related to coverage and reimbursementfor those who are covered by the Medicaid program and the Medicare program, including the Part D prescription drug benefit; and general issues related to the Medicare Part D program.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage. S. 2552: provisions to establish necessary protections for seniors enrolled in Medicare Advantage plans. Medicare Protection Act. S. 2087, S. 2491: provisions protecting Medicare beneficiaries from changes that would reduce benefits or restrict eligibility. Medicare Benefit Redesign. (No bill.) Proposals to combine Part A and B deductibles along with a catastrophic cap on Medicare out-of-pocket spending to be paid for by increased out-of-pocket costs for Medicare beneficiaries. Medicare Drug Savings. S. 740, H.R. 1588: provisions to extend the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Equality. H.R. 5182: provisions to require recognition of same-sex marriage for the purposes of Medicare benefits eligibility. Medicare Fraud, Waste and Abuse. S. 2361: provisions to require the Centers for Medicare and Medicaid Services (CMS) to verify that health care providers wishing to participate in Medicare have not owned a company that previously defrauded the government, allow private insurers to share information about potentially fraudulent providers with Medicare and require new medical coding systems to be tested before they are deployed to ensure Medicares fraud prevention systems function properly. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Premium Support. H. Con. Res. 96: proposals to privatize Medicare. Medicare Income-Relating. H. Con. Res. 96: proposals to increase the cost of Medicare to higher-income beneficiaries. Medicare Eligibility Age. H. Con. Res. 96: proposals to increase the Medicare eligibility age. Medicare Part D Negotiation of Drug Prices. S. 117, S. 408, H.R. 1102, H.R. 928: proposals to create a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Physician Fees and Extenders. H.R. 4015, S. 2157: provisions relating to a permanent fix of the sustainable growth rate (SGR) formula used to determine physician fees under Part B; the extension the Qualified Individual (QI) program; and the therapy caps. Medicare Supplemental Health Insurance. (No bill.) Proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Observation Status. S. 569, H.R. 1179: legislation to count days in the hospital in observation status toward meeting the three-day prior hospitalization requirement for skilled nursing facility (SNF) care eligibility. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: implementation of provisions reducing Medicare Advantage plan payments; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); expanding coverage of prevention services; testing payment and delivery system reforms; and providing expanded Medicaid coverage. Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill.) Proposals related to the activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients receiving benefits from both Medicare and Medicaid, i.e., dual-eligibles. Registered Nurses. H.R. 5373: provisions to require nursing homes and skilled nursing facilities that receive Medicare and/or Medicaid reimbursement to have at least one direct care registered nurse (RN) on duty 24 hours a day, 7 days per week. The Commission on Long-Term Care. (No bill). Proposals and recommendations made to Congress by the Long-Term Care Commission, established under Section 643 of the American Taxpayer Relief Act of 2012 (P.L. 112-240).

Client expense: $210,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Economic Council (NEC), Office of Management & Budget (OMB), President of the U.S., SENATE, Social Security Administration (SSA), Treasury, Dept of, Vice President of the U.S.

PL 109-442: Lifespan Respite Care Act; PL 109-365: Older Americans Act Amendments of 2006; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; PHS 42 USC 254C-8: Healthy Start Reauthorization of 2007; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; PL 111152, 124 Stat. 1029: Health Care & Education Reconciliation Act; HR 351: Protecting Seniors Access to Medicare;HR 713/S 367: Repeal Outpatient Rehab Caps; HR 928/S 408: Medicare Prescription Drug Savings & Choice Act; HR 132: ObamaCare Repeal Act; S 1028: Older Americans Act Amendments of 2013; S 1034/HR 1960: National Defense Authorization Act 2014; S 948/HR 942: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; S 1562: Older Americans Act Reauthorization Act of 2013; HR 2667: Authority for Mandate Delay Act; HR 2668: Fairness for American Families Act: HR 2009: Keep the IRS Off Your Healthcare Act; S 1546: Protecting Student Athletes from Concussions Act of 2013; S 152: Older Americans Act Reauthorization Act of 2013; S 423/HR 564: Family-to-Family Health Information Centers; HR 3850/HR 4122: Older Americans Act Reauthorization Act of 2014; HR 3114: Helping Families & Seniors Save on Health Care Act of 2014; HR 4118: SIMPLE (Suspending the Individual Mandate Penalty Law Equals) Fairness Act of 2014; HR 4302: Protecting Access to Medicare Act of 2014; S 2110: Medicare SGR Repeal & Beneficiary Access Improvement Act of 2014; S 2410/HR 4435: National Defense Authorization Act 2015; and S 2449/HR 4631: Autism CARES (Collaboration, Accountability, Research, Education and Support) Act of 2014.

Client expense: $86,759 · Firm income: Not reported

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

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.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. H.R. 1173 - Discussed Personalize Your Care Act. Discussed Medicaid expansion and estate recovery. (no bill) Discussed Medicaid and asset transfers. (no bill) Discussed the Improving Medicare Post-Acute Care Transformation Act of 2014 and provided feedback on the draft bill. (no bill number at the time, but later bill number was H.R. 4944/S. 2553) S. 2491, Discussed Medicare Protection Act. Submitted comment letter on FYIS Medicare Skilled Nursing Facility payment rule. (no bill) 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, Improving Access to Medicare Act - Discussed support of Improving Access to Medicare Coverage Act and urged cosponsorship and advancement of the bill. Discussed comments regarding Medicare and You handbook. (no 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, 2014 - 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 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) Discussed nursing home staffing data in meeting with CMS. (no bill) Discussed advanced care planning, Welcome to Medicare visit, and Medicare wellness visits. Discussed language access in managed long-term services and supports in meeting with the HHS Office for Civil Rights. S. 2240, Discussed Medicare Choices Empowerment and Protection Act. S. 1439, Discussed support for Care Planning Act. Discussed LTSS Scorecard and reserving a room/logistics for Hill briefing on the LTSS Scorecard. (no bill). Discussed managed LTSS and language access. (no bill) H.R. 3024, Discussed the Medicare Common Access Card Act. H.R. 9673, Discussed the Bundling and Coordinating Post Acute Care (BACPAC) Act and shared views on post-acute care return. Discussed Medicare expansion. (no bill) H.R. 1179/S. 569, Improving Access to Medicare Coverage Act - Submitted written statement for the record for the current hospital ---in the Medicare program hearings. Shared draft witness questions with some subcommittee members and committee staff. Discussed Medicaid Labs Spousal Impoverishment provisions (PL. 111-198). S. 2361, Discussed Stop Schemes and cons against Medicare and seniors. Invited Hill staff to attend the LTSS Scorecard briefing. (no bill) Participated in a roundtable discussion on long-term services and supports. (no bill) Discussed Welcome to Medicare Visit and advance care planning. (no bill) Discussed transparency in healthcare. (no bill) Discussed New York State Community first choice option and workforce issues. (no bill)

Client expense: $2,360,000 · 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), 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

H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits16. Specific Lobbying Issues (continued): H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) MA payment and enrollment issues, wellness incentives H.R. 2810, Medicare Patient Access and Quality Improvement Act (Burgess/Camp) SGR repeal, quality- and value-based payment reforms H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) MA special needs plans H.R. 4998, MA Participant Bill of Rights Act (DeLauro) MA plan provider networks H.Con.Res. 96, Budget Resolution (Ryan) Medicare, Medigap, Medicaid, ACA issues S. 11, Fiscal Sustainability Act (Corker) Medicare, Medigap, Medicaid issues S. 25 (Hatch) extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal S. 2361, Stop SCAMS Act (Nelson-Collins) reducing Medicare fraud S. 2461, CHIP Extension Act (Rockefeller) --- CHIP reauthorization S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) MA plan provider networks16. Specific Lobbying Issues (continued): Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation. 17. Houses of Congress and Federal Agencies (continued): Medicaid and CHIP Payment and Access Commission (MACPAC)

Client expense: $2,530,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Social Security Administration (SSA), Treasury, Dept of, White House Office

H.R. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to the Independent Payment Advisory Board H.R. 460, Patients Access to Treatments Act: Provisions related to cost sharing in the specialty tier H.R. 928, Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to Part D issuesH.R. 1024, Medication Therapy Management Empowerment Act of 2013: Provisions related to medication therapy management in Part D H.R. 1102, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference H.R. 1588, Medicare Drug Savings Act of 2013: Provisions related to Part D issues H.R. 2810, Medicare Patient Access and Quality Improvement Act: Provisions related to SGR reform H.R. 2827, To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D: Provisions related to Medicare Part D Drug Tier Formularies H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013: Provisions related to fraud and abuse H.R. 3392, Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013: Provisions related to lock-in programs H.R. 3796, Comprehensive Care Payment Innovation Act: Provisions related to alternative payment models H.R. 4160, Keep the Promise to Seniors Act of 2014: Provisions related to Part D issues H.R. 4302, Protecting Access to Medicare Act of 2014: Provisions related to the biopharmaceutical industry S. 117, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference S. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to Independent Payment Advisory Board S. 408, Medicare Prescription Drug Savings and Choice Act of 2013: Provision related to Part D issues S. 740, Medicare Drug Savings Act of 2013: Provisions related to Part D issues Deficit reduction policy issues S. 882, Stop Trafficking of Pills (STOP) Act: Provisions related to lock-in programs (112th Congress) S. 1365, Part D Beneficiary Appeals Fairness Act: Provisions related to the specialty tier in Part D S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013: Provisions related to reforming Medicare physician payments S. 1932, Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to SGR reform S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014: Provisions related to SGR reform Medicare Prescription Drug Diversion and Abuse Prevention Act: Provisions related to diversion and abuse (no bill number) Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs: Provisions related to Part D Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy Medicaid Program, Covered Outpatient Drugs rulemaking Medicare sustainable growth rate policy issues Implementation issues relating to the Physician Payment Sunshine Act, including Medicare, Medicaid, Childrens Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests rulemaking Issues related to better use of medicine and adherence

Client expense: $4,190,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Security Council (NSC), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR), White House Office

H.R. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board H.R. 928 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D H.R. 1024 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues H.R. 1102 - Medicare Prescription Drug Price Negotiation Act of 2013; Provisions related to Part D issues and non-interference H.R. 1588 - Medicare Drug Savings Act of 2013; provisions related to Part D issues H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013; provisions related to SGR reform H.R. 2827 - To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D; provisions related to Medicare Part D Drug Tier Formularies H.R. 3890 - Better Care, Lower Cost Act; provisions related to Part D, value-based insurance design, and chronic disease H.R 4160 - Keep the Promise to Seniors Act of 2014; provisions related to Part D H.R. 4187 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 4302 - Protecting Access to Medicare Act of 2014; provisions related to the biopharmaceutical industry S. 117 - Medicare Prescription Drug Price Negotiation Act of 2013; provisions related to Part D issues S. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board S. 408 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D S. 557 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues S. 740 - Medicare Drug Savings Act of 2013; provisions related to Part D issues S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013; Provisions related to reforming Medicare physician payments S. 1932 - Better Care, Lower Cost Act; Provisions related to Part D, value-based insurance design, and chronic disease S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014; Provisions related to SGR reform S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014; Provisions related to SGR reform No bill # assigned - Contract Year 2015 Policy and Technical Cganges to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs; provisions related to Part D No bill # assigned - Legislative proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy No bill # assigned - Issues related to comprehensive medication management No bill # assigned - Medicaid Program, Covered Outpatient Drugs rulemaking No bill # assigned - Implementation Issues relating to the Physician Payment Sunshine Act No bill # assigned - Vaccine access and coverage issues

Client expense: $1,020,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR)

Medicare Part D issues. H.R. 928 Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to patent issues. Medicare Drug Savings Act: Part D Issues S. 117 Medicare Prescription Drug Price Negotiation Act of 2013. S. 351 Protecting Seniors Access to Medicare Act of 2013 S. 408 Medicare Prescription Drug Saving and Choice Act of 2013. 340B Drug Program Issues related to changes to the Medicare Part B reimbursement of perscription drugs; issues related to coverage and reimbursementfor those who are covered by the Medicaid program and the Medicare program, including the Part D prescription drug benefit; and general issues related to the Medicare Part D program.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits. H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi). H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes. H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care. H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations. H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs. H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse. H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules. H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives. H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives. H.R. 2810, Medicare Patient Access and Quality Improvement Act (Burgess/Camp) - SGR repeal, quality- and value-based payment reforms. H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review. H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period. H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions. H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule. H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders." H.R. 4484, Strengthening Healthcare Options for Vulnerable Populations Act (Sinema) - MA special needs plans. H.R. 4998, MA Participant Bill of Rights Act (DeLauro) - MA plan provider networks. H.Con.Res. 96, Budget Resolution (Ryan) - Medicare, Medigap, Medicaid, ACA issues. S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues. S. 25 (Hatch) - extension of Medicare sequestration cuts. S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations. S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes. S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care. S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse. S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives. S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations. S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs. S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions. S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment. S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Senate Finance Committee) - SGR repeal, quality- and value-based payment reforms. S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders." S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal. S. 2361, Stop SCAMS Act (Nelson-Collins) - reducing Medicare fraud S. 2461, CHIP Extension Act (Rockefeller) --- CHIP reauthorization. S. 2552, MA Participant Bill of Rights Act (Brown-Blumenthal) - MA plan provider networks.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Protection Act. S. 2087, S. 2491: provisions protecting Medicare beneficiaries from changes that would reduce benefits or restrict eligibility. Medicare Benefit Redesign. (No bill.) Proposals to combine Part A and B deductibles along with a catastrophic cap on Medicareout-of-pocket spending to be paid for by increased out-of-pocket costs for Medicare beneficiaries. Medicare Drug Savings. S. 740, H.R. 1588: provisions to extend the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Fraud, Waste and Abuse. S. 2361: provisions to require the Centers for Medicare and Medicaid Services (CMS) to verify that health care providers wishing to participate in Medicare have not owned a company that previously defrauded the government, allow private insurers to share information about potentially fraudulent providers with Medicare and require new medical coding systems to be tested before they are deployed to ensure Medicares fraud prevention systems function properly. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Premium Support. H. Con. Res. 96: proposals to privatize Medicare. Medicare Income-Relating. H. Con. Res. 96: proposals to increase the cost of Medicare to higher-income beneficiaries. Medicare Eligibility Age. H. Con. Res. 96: proposals to increase the Medicare eligibility age. Medicare Part D Negotiation of Drug Prices. S. 117, S. 408, H.R. 1102, H.R. 928: proposals to create a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Supplemental Health Insurance. (No bill.) Proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Observation Status. S. 569, H.R. 1179: legislation to count days in the hospital in observation status toward meeting the three-day prior hospitalization requirement for skilled nursing facility (SNF) care eligibility. Medicare Advantage Payment Rate. (No bill). Proposals to decrease Medicare Advantage (MA) 2015 payment rates. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: implementation of provisions reducing Medicare Advantage plan payments; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); expanding coverage of prevention services; testing payment and delivery system reforms; and providing expanded Medicaid coverage. Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill.) Proposals related to the activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients receiving benefits from both Medicare and Medicaid, i.e., dual-eligibles. The Commission on Long-Term Care. (No bill). Proposals and recommendations made to Congress by the Long-Term Care Commission, established under Section 643 of the American Taxpayer Relief Act of 2012 (P.L. 112-240).

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Economic Council (NEC), Office of Management & Budget (OMB), President of the U.S., SENATE, Social Security Administration (SSA), Treasury, Dept of, Vice President of the U.S.

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 Medicaid long-term services and supports. (no bill) 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) Discussed measures for re-balancing in medicaid managed LTSS waivers and dual demonstration programs in sign on letter to CMS. (no bill) H.R. 1717 - Discussed Medicare DMEPOS Market Pricing Program Act. H.R. 3531 - Discussed Creating Access to Rehabilitation for Every Senior (CARES) Act. Discussed implementation of regulations regarding minimum wage and overtime for home care workers and consumer-directed care.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 Medicaid managed care and long-term services and supports broadly. 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) Discussed the AARP Initiative called "You've Earned a Say". (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. H.R. 1173 - Discussed Personalize Your Care Act. Discussed observation issues. (no bill) Discussed rebalancing measures in Medicaid managed LTSS in 1115 waivers and duals demonstration programs. (no bill) Discussed proposed regulation relating to Medicaid expansion coverage and minimum essential coverage. (no bill) Discussed Medicaid expansion and estate recovery. (no bill) Discussed Medicaid and asset transfers. (no bill) Discussed draft legislation regarding Dual Eligible Special Need Plans (D-SNP) - Strengthing Healthcare Options for Vulnerable Populations Act. (no bill) Discussed post-acute care reform. (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. Participated on press call on the bill. Discussed comments regarding Medicare and You handbook. (no bill) Discussed CMS information regarding healthcare marketplaces. H. R. 933, Consolidated and Further Continuing Appropriations Act, 2013 - 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. S. Con. Res. 8, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. H.Con. Res. 25, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation.Lobbied on expected "QM" safe harbor amendment. (The amendment was not offered) 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) H.R. 3547/H.J.R. 59/H.R. 2775/H.J.R. 106, Consolidated Appropriations Act, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. S. 1284, Labor, Health and Human Services Appropriations Act, 2014 - 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. 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) H.R. 2810/S. 1871 - Discussed SGR repeal and health care extender provisions, including the Qualified Individual low-income Medicare beneficiary assistance program. 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, prescriotion drugs, waste, fraud and abuse). Discussed implementation of provision to require reporting of nursing home staffing data based on payroll data. (no bill) S. 1932/H.R. 3890 - Discussed logistics and attended event to introduce the Better Care, Lower Cost Act. Discussed non-residential settings and Medicaid home and community-based setting final regulation. (no bill) Discussed person-centered planning and family caregiver assessment in Medicaid HCBS state plan option final rule. Submitted comment letter on distaster preparedness requirements for Medicare and Medicaid providers. (no bill) Discussed Money Follows the Person Rebalancing Demonstration and Balancing Incentive Payments Program. (no bill)Discussed Medicare Advantage. H.R. 3616, Protecting Seniors from Medicare Act- Sent letters endorsing bill. H.R. 2810, The SGR Repeal and Medicare Beneficiary Improvement Act - Sent letters endorsing bill. Discussed observation care and "two-midnight rule". 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.

Client expense: $1,990,000 · 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), 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

PL 109-442: Lifespan Respite Care Act; PL 109-365: Older Americans Act Amendments of 2006; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; PHS 42 USC 254C-8: Healthy Start Reauthorization of 2007; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; PL 111152, 124 Stat. 1029: Health Care & Education Reconciliation Act; HR 351: Protecting Seniors Access to Medicare;HR 713/S 367: Repeal Outpatient Rehab Caps; HR 928/S 408: Medicare Prescription Drug Savings & Choice Act; HR 132: ObamaCare Repeal Act; S 1028: Older Americans Act Amendments of 2013; S 1034/HR 1960: National Defense Authorization Act 2014; S 948/HR 942: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; S 1562: Older Americans Act Reauthorization Act of 2013; HR 2667: Authority for Mandate Delay Act; HR 2668: Fairness for American Families Act: HR 2009: Keep the IRS Off Your Healthcare Act; S 1546: Protecting Student Athletes from Concussions Act of 2013; S 152: Older Americans Act Reauthorization Act of 2013; S 423/HR 564: Family-to-Family Health Information Centers; HR 3850/HR 4122: Older Americans Act Reauthorization Act of 2014; HR 3114: Helping Families & Seniors Save on Health Care Act of 2014; HR 4118: SIMPLE (Suspending the Individual Mandate Penalty Law Equals) Fairness Act of 2014; HR 4302: Protecting Access to Medicare Act of 2014; and S 2110: Medicare SGR Repeal & Beneficiary Access Improvement Act of 2014.

Client expense: $80,535 · Firm income: Not reported

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

H.R. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to the Independent Payment Advisory Board H.R. 928, Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to Part D issues H.R. 1024, Medication Therapy Management Empowerment Act of 2013: Provisions related to medication therapy management in Part DH.R. 1102, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference H.R. 1588, Medicare Drug Savings Act of 2013: Provisions related to Part D issues H.R. 2810, Medicare Patient Access and Quality Improvement Act: Provisions related to SGR reform H.R. 2827, Part D Beneficiary Appeals Fairness Act: Provisions related to the specialty tier in Part D H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013: Provisions related to fraud and abuse H.R. 3392, Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013: Provisions related to lock-in programs H.R. 3796, Comprehensive Care Payment Innovation Act: Provisions related to alternative payment models H.R. 4160, Keep the Promise to Seniors Act of 2014: Provisions related to Part D issues H.R. 4302, Protecting Access to Medicare Act of 2014: Provisions related to the biopharmaceutical industry S. 117, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues and non-interference S. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to Independent Payment Advisory Board S. 408, Medicare Prescription Drug Savings and Choice Act of 2013: Provision related to Part D issues S. 740, Medicare Drug Savings Act of 2013: Provisions related to Part D issues Deficit reduction policy issues S. 882, Stop Trafficking of Pills (STOP) Act: Provisions related to lock-in programs (112th Congress) S. 1365, Part D Beneficiary Appeals Fairness Act: Provisions related to the specialty tier in Part D S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013: Provisions related to reforming Medicare physician payments S. 1932, Better Care, Lower Cost Act: Provisions related to Part D, value-based insurance design, and chronic disease S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014: Provisions related to SGR reform S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014: Provisions related to SGR reform Medicare Prescription Drug Diversion and Abuse Prevention Act: Provisions related to diversion and abuse (no bill number) Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefits Programs: Provisions related to Part D Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy Medicaid Program, Covered Outpatient Drugs rulemaking Medicare sustainable growth rate policy issues Implementation issues relating to the Physician Payment Sunshine Act, including Medicare, Medicaid, Childrens Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests rulemaking

Client expense: $4,680,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Security Council (NSC), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR), White House Office

H.R. 351 - Protecting Seniors' Access to Medicare Act of 2013, provisions related to the Independent Payment Advisory Board H.R. 928 - Medicare Prescription Drug Savings and Choice Act of 2013, provisions related to Medicare Part D H.R. 1024 - Medication Therapy Empowerment Act of 2013, provisions related to Part D issuesH.R. 1102 - Medicare Prescription Drug Price Negotiation Act of 2013, Provisions related to Part D issues and non-interference H.R. 1588 - Medicare Drug Savings Act of 2013, provisions related to Part D issues H.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013, provisions related to SGR reform H.R. 2827 - To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D, provisions related to Medicare Part D Drug Tier Formularies H.R. 3890 - Better Care, Lower Cost Act, provisions related to Part D, value-based insurance design, and chronic disease H.R 4160 - Keep the Promise to Seniors Act of 2014, provisions related to Part D H.R. 4187 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 4302 - Protecting Access to Medicare Act of 2014, provisions related to the biopharmaceutical industry S. 117 - Medicare Prescription Drug Price Negotiation Act of 2013, provisions related to Part D issues S. 351 - Protecting Seniors' Access to Medicare Act of 2013, provisions related to the Independent Payment Advisory Board S. 408 - Medicare Prescription Drug Savings and Choice Act of 2013, provisions related to Medicare Part D S. 557 - Medication Therapy Empowerment Act of 2013, provisions related to Part D issues S. 740 - Medicare Drug Savings Act of 2013, provisions related to Part D issues S. 1871 - SGR Repeal and Medicare Beneficiary Access Act of 2013, provisions related to reforming Medicare physician payments S. 1932 - Better Care, Lower Cost Act, provisions related to Part D, value-based insurance design, and chronic disease S. 2000 - SGR Repeal and Medicare Provider Payment Modernization Act of 2014, provisions related to SGR reform S. 2110 - Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014, provisions related to SGR reform No bill # assigned - Dual eligibles coordination policy issues No bill # assigned - Deficit reduction policy issues, provisions related to Medicare No bill # assigned - Medicaid Program, Covered Outpatient Drugs rulemaking No bill # assigned - Implementation Issues relating to the Physician Payment Sunshine Act No bill # assigned - Vaccine access and coverage issues

Client expense: $1,630,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR)

Medicare Part D issues. H.R. 928 Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to patent issues. Medicare Drug Savings Act: Part D Issues S. 117 Medicare Prescription Drug Price Negotiation Act of 2013S. 351 Protecting Seniors Access to Medicare Act of 2013 S. 408 Medicare Prescription Drug Savings and Choice Act of 2013 340B Drug Program Issues related to changes to the Medicare Part B reimbursement of prescription drugs; issues related to coverage and reimbursement for those who are covered by the Medicaid program and the Medicare program, including the Part D prescription drug benefit; and general issues related to the Medicare Part D program.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits16. Specific Lobbying Issues (continued): H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) MA payment and enrollment issues, wellness incentives H.R. 2810, Medicare Patient Access and Quality Improvement Act (Burgess/Camp) SGR repeal, quality- and value- based payment reforms H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) MA open enrollment period H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) delivery models for Medicare beneficiaries with chronic conditions H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay H.R. 4160, Keep the Promise to Seniors Act (Ellmers) blocking Medicare Part D proposed rule H.R. 4302, Protecting Access to Medicare Act (Pitts) 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders H.J.Res. 59, Bipartisan Budget Act (Rogers) MA Special Needs Plans, Cost Plans, Medicare physician payment, QI and TMA programs S. 11, Fiscal Sustainability Act (Corker) Medicare, Medigap, Medicaid issues S. 25 (Hatch) extension of Medicare sequestration cuts S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Baucus) SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) delivery models for Medicare beneficiaries with chronic conditions S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) 12 month continuous enrollment S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Baucus) SGR repeal, quality- and value-based payment reforms S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal U.S. Senate Special Committee on Aging Draft of Stop SCAMS Act (not yet introduced) - anti-fraud activities, including coding, Healthcare Fraud Prevention Partnership, and MEDPAC report16. Regulatory Issues (continued): Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation. 17. Houses of Congress and Federal Agencies (continued): Medicaid and CHIP Payment and Access Commission (MACPAC) 18. Name of Lobbyists (con't): C. Lawrence: Assistant, Legislative Director for Rep. Bill Cassidy (LA-6); May 2008-July 200: Staff Assistant, Legislative Correspondent for Rep. Tom Price (GA-6)

Client expense: $2,430,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office

H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits; H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi); H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes; H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care; H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations; H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs; H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse; H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules; H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives; H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives; H.R. 2810, Medicare Patient Access and Quality Improvement Act (Burgess/Camp) - SGR repeal, quality- and value-based payment reforms; H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review; H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period; H.R. 3890, Better Care, Lower Cost Act (Paulsen-Welch) - delivery models for Medicare beneficiaries with chronic conditions; H.R. 4015, SGR Repeal and Medicare Provider Payment Modernization Act (Burgess) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate delay; H.R. 4160, Keep the Promise to Seniors Act (Ellmers) - blocking Medicare Part D proposed rule; H.R. 4302, Protecting Access to Medicare Act (Pitts) - 12-month Medicare SGR patch, Medicare Advantage Special Needs Plans, Appropriate Use Criteria for Advanced Diagnostic Imaging, Medicare sequestration cuts, Other Medicare-Medicaid Extenders; H.J.Res. 59, Bipartisan Budget Act (Rogers) - MA Special Needs Plans, Cost Plans, Medicare physician payment, QI and TMA programs; S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues; S. 25 (Hatch) - extension of Medicare sequestration cuts; S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations; S. 324, Puerto Rico Medicare Part B Equity Act (Schumer); S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes; S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care; S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse; S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives; S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations; S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Baucus) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs; S. 1932, Better Care, Lower Cost Act (Wyden-Isakson) - delivery models for Medicare beneficiaries with chronic conditions; S. 1980, Medicaid and CHIP Continuous Quality Act (Rockefeller) - 12 month continuous enrollment; S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act (Baucus) - SGR repeal, quality- and value-based payment reform; S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act (Wyden) - SGR repeal, quality- and value-based payment reforms, Medicare and Medicaid extenders; S. 2122, Responsible Medicare SGR Repeal and Beneficiary Access Improvement Act (Hatch) - SGR repeal, quality- and value-based payment reforms, ACA individual mandate repeal.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Benefit Redesign. (No bill.) Proposals to combine Part A and B deductibles along with a catastrophic cap on Medicare out-of-pocket spending to be paid for by increased out-of-pocket costs for Medicare beneficiaries. Medicare Drug Savings. S. 740, H.R. 1588: provisions to extend the application of Medicaid drug rebates to prescription drugspaid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Premium Support. (No bill.) Proposals to privatize Medicare. Medicare Income-Relating. (No bill.) Proposals to increase the cost of Medicare to higher-income beneficiaries. Medicare Eligibility Age. (No bill.): Proposals to increase the Medicare eligibility age. Medicare Part D Negotiation of Drug Prices. S. 117, S. 408, H.R. 1102, H.R. 928: proposals to create a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Supplemental Health Insurance. (No bill.) Proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Physician Fees and Extenders. H.R. 2810, S. 1871, S. 2110, S. 2157: provisions relating to a permanent fix of the sustainable growth rate (SGR) formula used to determine physician fees under Part B; the extension the Qualified Individual (QI) program; and the therapy caps. Medicare Physician Fees and Extenders. H.R. 4302 ( P.L.113-93): provisions pertaining to extending physician payments through March 2015; extending the Qualified Individual program through March 2015; and extending the therapy cap exceptions process through March 2015. Medicare Observation Status. S. 569, H.R. 1179: legislation to count days in the hospital in observation status toward meeting the three-day prior hospitalization requirement for skilled nursing facility (SNF) care eligibility. Medicare Fraud. H.R. 3616: legislation requiring an annual report to Congress and the public on health care fraud schemes targeted to seniors and steps being taken to combat such schemes and to educate seniors about them. Medicare Advantage Payment Rate. (No bill). Proposals to decrease Medicare Advantage (MA) 2015 payment rates. Medicare Advantage and Medicare Part D. (No bill). Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs: Proposals related to: Medicare Part D six protected drug classes, plan consolidation, oversight, drug price fairness, accuracy and affordability. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: implementation of provisions reducing Medicare Advantage plan payments; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); expanding coverage of prevention services; testing payment and delivery system reforms; establishing a Medicare Commission; providing expanded Medicaid coverage; authorizing the collection of data regarding disparities in the provision of care; providing safeguards and subsidies to assure affordability of health coverage for seniors. Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill.) Proposals related to the activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients receiving benefits from both Medicare and Medicaid, i.e, "dual-eligibles." The Commission on Long-Term Care. (No bill). Proposals and recommendations made to Congress by the Long-Term Care Commission, established under Section 643 of the American Taxpayer Relief Act of 2012 (P.L. 112-240).

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Economic Council (NEC), Office of Management & Budget (OMB), President of the U.S., SENATE, Social Security Administration (SSA), Treasury, Dept of, Vice President of the U.S.

H.Con.Res. 25, House Budget Resolution (Ryan) public program issues, deficit reduction proposals16. Specific Lobbying Issues (continued): S.Con.Res. 8, Senate Budget Resolution (Murray) public program issues, deficit reduction proposals H.R. 162, Medicaid Integrity Act (Bachmann) Medicaid health plan audits H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) Medicare coverage of skilled nursing care H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) Medicare Part D price negotiations H.R. 1853, Medicaid Accountability and Care Act (Cassidy) federal financing of state Medicaid programs H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) fighting fraud and abuse H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) MA enrollment rules H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) wellness incentives H.R. 2753, Securing Care for Seniors Act (Black) MA payment and enrollment issues, wellness incentives H.R. 2810, Medicare Patient Access and Quality Improvement Act (Burgess/Camp) SGR repeal, quality- and value-based payment reforms H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) Part D drug utilization review H.R. 3512, Seniors' Health Care Choice Act (Heck) MA open enrollment period H.J.Res. 59, Bipartisan Budget Act (Rogers) MA Special Needs Plans, Cost Plans, Medicare physician payment, QI and TMA programs S. 11, Fiscal Sustainability Act (Corker) Medicare, Medigap, Medicaid issues S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Medicare Part D price negotiations S. 324, Puerto Rico Medicare Part B Equity Act (Schumer) S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 569, Improving Access to Medicare Coverage Act (Brown) Medicare coverage of skilled nursing care S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) fighting fraud and abuse S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) wellness incentives S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) medical loss ratio requirement for Medicaid managed care organizations S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Baucus) SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative;Regulatory Issues (con't): issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans ; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation. 17. Houses of Congress and Federal Agencies (con't): Medicaid and CHIP Payment and Access Commission (MACPAC)

Client expense: $3,630,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Bureau of Investigation (FBI), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Pension & Welfare Benefits Administration, SENATE, Treasury, Dept of, White House Office

H.R. 351, Protecting Seniors' Access to Medicare Act of 2013: Provisions related to the Independent Payment Advisory Board H.R. 460, Patients' Access to Treatments Act of 2013: Provisions related to capping specialty tier drugs and no cost-sharing above the non-preferred brand tier H.R. 928, Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to Part D issuesH.R. 1588, Medicare Drug Savings Act of 2013: Provisions related to Part D issues H.R. 2810, Medicare Patient Access and Quality Improvement Act: Provisions related to Sustainable Growth Rate (SGR) reform H.R. 2827, To amend title XVIII of the Social Security Act to allow for fair application of the exceptions process for drugs in tiers in formularies in prescription drug plans under Medicare part D: Provisions related to Medicare Part D Drug Tier Formularies H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act of 2013: Provisions related to fraud and abuse H.R. 3392, Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013: Provisions related to lock-in programs H.R. 3796, Comprehensive Care Payment Innovation Act: Provisions related to alternative payment models S. 117, Medicare Prescription Drug Price Negotiation Act of 2013: Provisions related to Part D issues S. 351, Protecting Seniors Access to Medicare Act of 2013: Provisions related to Independent Payment Advisory Board S. 408, Medicare Prescription Drug Savings and Choice Act of 2013: Provision related to Part D issues S. 740, Medicare Drug Savings Act of 2013: Provisions related to Part D issues Deficit reduction policy issues S. 882, Stop Trafficking of Pills (STOP) Act: Provisions related to lock-in programs (112th Congress) S. 1365, Part D Beneficiary Appeals Fairness Act: Provisions related to the specialty tier in Part D S. 1871, SGR Repeal and Medicare Beneficiary Access Act of 2013: Provisions related to reforming Medicare physician payments Medicare Prescription Drug Diversion and Abuse Prevention Act: Provisions related to diversion and abuse (no bill number) Proposals to increase co-payments for Part D beneficiaries receiving the low-income subsidy Medicaid Program, Covered Outpatient Drugs rulemaking Medicare sustainable growth rate policy issues Implementation issues relating to the Physician Payment Sunshine Act, including Medicare, Medicaid, Childrens Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests rulemaking

Client expense: $4,050,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Security Council (NSC), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR), White House Office

PL 109-442: Lifespan Respite Care Act; PL 109-365: Older Americans Act Amendments of 2006; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; PHS 42 USC 254C-8: Healthy Start Reauthorization of 2007; PL 111-192: Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act; PL 111152, 124 Stat. 1029: Health Care & Education Reconciliation Act; HR 351: Protecting Seniors Access to Medicare;HR 713/S 367: Repeal Outpatient Rehab Caps; HR 928/S 408: Medicare Prescription Drug Savings & Choice Act; HR 132: ObamaCare Repeal Act; S 1028: Older Americans Act Amendments of 2013; S 1034/HR 1960: National Defense Authorization Act 2014; S 948/HR 942: Ensuring Access to Quality Complex Rehabilitation Technology Act of 2013; S 1562: Older Americans Act Reauthorization Act of 2013; HR 2667: Authority for Mandate Delay Act; HR 2668: Fairness for American Families Act: HR 2009: Keep the IRS Off Your Healthcare Act; S 1546: Protecting Student Athletes from Concussions Act of 2013; S 1562: Older Americans Act Reauthorization Act of 2013; and S 423/HR 564: Family-to-Family Health Information Centers.

Client expense: $65,018 · Firm income: Not reported

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

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 family caregiving, long-term care, Older Americans Act, private LTC insurance. (no bill) Discussed Medicaid long-term services and supports. (no bill) 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) S. 1439 - Discussed and endorsed the Care Planning Act of 2013. Discussed status of regulations regarding disclosure of nursing home ownership. (no bill) Discussed regulations defining whether a home and community-based setting in medicaid and state data on ome and community-based services spending. (no bill) Discussed family caregiver assessment in proposed regulations and shared a report on the topics. (no bill) Discussed measures for re-balancing in medicaid managed LTSS waivers and dual demonstration programs in sign on letter to CMS. (no bill) H.R. 1717 - Discussed Medicare DMEPOS Market Pricing Program Act. H.R. 3531 - Discussed Creating Access to Rehabilitation for Every Senior (CARES) Act.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 Medicaid managed care and long-term services and supports broadly. 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) Discussed the AARP Initiative called "You've Earned a Say". (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 and Florida 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.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 comments regarding Medicare and You handbook. (no bill) Discussed CMS information regarding healthcare marketplaces. H. R. 933, Consolidated and Further Continuing Appropriations Act, 2013 - 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. S. Con. Res. 8, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. H.Con. Res. 25, Concurrent Resolution on the Budget, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation.Lobbied on expected "QM" safe harbor amendment. (The amendment was not offered) 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) Discussed the Medicare Adult Day Services Act. (no bill) Discussed the Commission on Long-Term Care and Senate Aging Committee hearing and long-term care generally. H.J.R. 59/H.R. 2775, Continuing Appropriations Resolution, 2014 - Lobbied to prevent inclusion of Medicare, Medicaid and Social Security benefit cuts and to protect vital health, social services, housing and transportation programs from enhanced reductions from the prior year baseline, and to prevent repeal of certain financial and health care-related regulation. S. 1284, Labor, Health and Human Services Appropriations Act, 2014 - 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. 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) H.R. 2810/S. 1871 - Discussed SGR repeal and health care extender provisions, including the Qualified Individual low-income Medicare beneficiary assistance program. Discussed fraud, Medicare home healthcare, ways to find savings in Medicare without harming Medicare beneficiaries (care coordination, prescription drugs, waste, fraud and abuse). Discussed new report on observation services that included policy recommendations. Discussed you've earned a say, ways to find savings in medicare without harming medicare beneficiaries (care coordination, prescriotion drugs, waste, fraud and abuse).Discussed and shared invitation for a Hill briefing on innovation and progress in long-term services and supports. (no bill) Submitted and shared written testimony for the record for the Senate Aging Committee hearing on the future of Long-Term Care Policy and Continuing the Conversation. (no bill) Discussed Medicare Advantage. H.R. 3616, Protecting Seniors from Medicare Act- Sent letters endorsing bill. H.R. 2810, The SGR Repeal and Medicare Beneficiary Improvement Act - Sent letters endorsing bill. Discussed observation care and "two-midnight rule".

Client expense: $2,500,000 · 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), 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 Council on Disability, 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

H.R. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board H.R. 928 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D H.R. 1024 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues H.R. 1588 - Medicare Drug Savings Act of 2013; provisions related to Part D issuesH.R. 2810 - Medicare Patient Access and Quality Improvement Act of 2013 S. 117 - Medicare Prescription Drug Price Negotiation Act of 2013; provisions related to Part D issues S. 351 - Protecting Seniors' Access to Medicare Act of 2013; provisions related to the Independent Payment Advisory Board S. 408 - Medicare Prescription Drug Savings and Choice Act of 2013; provisions related to Medicare Part D S. 557 - Medication Therapy Empowerment Act of 2013; provisions related to Part D issues S. 740 - Medicare Drug Savings Act of 2013; provisions related to Part D issues Dual eligibles coordination policy issues Deficit reduction policy issues ; issues related to Medicare Implementation Issues relating to the Physician Payment Sunshine Act Vaccine access and coverage issues

Client expense: $420,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR)

H.Con.Res. 25, House Budget Resolution (Ryan) - public program issues, deficit reduction proposals. S.Con.Res. 8, Senate Budget Resolution (Murray) - public program issues, deficit reduction proposals. H.R. 162, Medicaid Integrity Act (Bachmann) - Medicaid health plan audits. H.R. 670, Puerto Rico Medicare Part B Equity Act (Pierluisi). H.R. 928, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes. H.R. 1179, Improving Access to Medicare Coverage Act (Courtney) - Medicare coverage of skilled nursing care. H.R. 1102, Medicare Prescription Drug Price Negotiation Act (Welch) - Medicare Part D price negotiations. H.R. 1853, Medicaid Accountability and Care Act (Cassidy) -federal financing of state Medicaid programs. H.R. 2305, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - fighting fraud and abuse. H.R. 2453, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment rules. H.R. 2524, Medicare Better Health Rewards Program Act (Paulsen-Kind) - wellness incentives. H.R. 2753, Securing Care for Seniors Act (Black) - MA payment and enrollment issues, wellness incentives. H.R. 2810, Medicare Patient Access and Quality Improvement Act (Burgess/Camp) - SGR repeal, quality- and value-based payment reforms. H.R, 2960, Medicare Prescription Drug Integrity Act of 2013 (Pallone) - Part D drug utilization review. H.R. 3512, Seniors' Health Care Choice Act (Heck) - MA open enrollment period. H.J.Res. 59, Bipartisan Budget Act (Rogers) - MA Special Needs Plans, Cost Plans, Medicare physician payment, QI and TMA programs. S. 11, Fiscal Sustainability Act (Corker) - Medicare, Medigap, Medicaid issues. S. 117, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Medicare Part D price negotiations. S. 324, Puerto Rico Medicare Part B Equity Act (Schumer). S. 408, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes. S. 569, Improving Access to Medicare Coverage Act (Brown) - Medicare coverage of skilled nursing care. S. 1123, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Coburn) - fighting fraud and abuse. S. 1228, Medicare Better Health Rewards Program Act (Wyden-Portman) - wellness incentives. S. 1787, Medicaid Managed Care Responsibility and Equity Act (Rockefeller) - medical loss ratio requirement for Medicaid managed care organizations. S. 1871, SGR Repeal and Medicare Beneficiary Access Act (Baucus) - SGR repeal, quality- and value-based payment reforms, MA Special Needs Plans, Cost Plans, QI and TMA programs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Part D issues. H.R. 928 Medicare Prescription Drug Savings and Choice Act of 2013: Provisions related to patent issues. H.R. 2190 Medicare Drug Savings Act: Part D Issues S. 117 Medicare Prescription Drug Price Negotiation Act of 2013S. 351 Protecting Seniors Access to Medicare Act of 2013 S. 408 Medicare Prescription Drug Savings and Choice Act of 2013 340B Drug Program Issues related to changes to the Medicare Part B reimbursement of prescription drugs; issues related to coverage and reimbursement for those who are covered by the Medicaid program and the Medicare program, including the Part D prescription drug benefit; and general issues related to the Medicare Part D program.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Benefit Redesign. (No bill.) Proposals to combine Part A and B deductibles along with a catastrophic cap on Medicare out-of-pocket spending to be paid for by increased out-of-pocket costs for Medicare beneficiaries. Medicare Drug Savings. S. 740, H.R. 1588: provisions to extend the application of Medicaid drug rebates to prescription drugspaid for by Medicare and used by people eligible for both Medicare and Medicaid (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Premium Support. H. Con. Res. 25: proposal to privatize Medicare. Medicare Income-Relating. H. Con. Res. 25: proposals to increase the cost of Medicare to higher-income beneficiaries. Medicare Eligibility Age. H. Con. Res. 25: proposals to increase the Medicare eligibility age. Medicare Part D Negotiation of Drug Prices. S. 117, S. 408, H.R. 1102, H.R. 928: proposals to create a Medicare-operated prescription drug plan, allowing or requiring the Secretary of the Department of Health and Human Services to negotiate price concessions from pharmaceutical manufacturers for drugs purchased under the Part D program. Medicare Supplemental Health Insurance. (No bill.) Proposals to increase costs for Medicare beneficiaries who purchase Medigap insurance. Medicare Physician Fees. H.J. Res. 59: legislation pertaining to preventing cuts in Medicare payments to physicians for a three month period that would otherwise be required on January 1, 2014 by the sustainable growth rate (SGR) formula. Medicare Physician Fees. H.R. 2810: legislation pertaining to a permanent fix of the sustainable growth rate (SGR) formula to determine physician fees under Part B. Medicare Physician Fees and Extenders. S. 1871: provisions pertaining to a permanent fix of the sustainable growth rate (SGR) formula to determine physician fees under Part B; extending the Qualified Individual (QI) program; and repealing the therapy caps. Medicare Observation Status. S. 569, H.R. 1179: legislation to count days in the hospital in observation status toward meeting the three-day prior hospitalization requirement for skilled nursing facility (SNF) care eligibility. Medicare Fraud. H.R. 3616: legislation requiring an annual report to Congress and the public on health care fraud schemes targeted to seniors and steps being taken to combat such schemes and to educate seniors about them. Comprehensive Health Care Reform. P.L. 111-148, P.L. 111-152: implementation of provisions reducing Medicare Advantage plan payments; requiring higher income Medicare beneficiaries to pay an increased share of Medicare Parts B and D premium costs; expanding benefits for low-income beneficiaries under the Medicare Savings Programs and the Part D Low-Income Subsidy (LIS); expanding coverage of prevention services; testing payment and delivery system reforms; establishing a Medicare Commission; providing expanded Medicaid coverage; authorizing the collection of data regarding disparities in the provision of care; providing safeguards and subsidies to assure affordability of health coverage for seniors. Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office). (No bill.) Proposals related to the activities of the Federal Coordinated Health Care Office intended to improve the quality of care for recipients receiving benefits from both Medicare and Medicaid, i.e, dual-eligibles. The Commission on Long-Term Care. (No bill). Proposals and recommendations made to Congress by the Long-Term Care Commission, established under Section 643 of the American Taxpayer Relief Act of 2012 (P.L. 112-240).

Client expense: $245,000 · Firm income: Not reported

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Economic Council (NEC), Office of Management & Budget (OMB), President of the U.S., SENATE, Social Security Administration (SSA), Treasury, Dept of, Vice President of the U.S.