Medicare Drug Savings Act of 2015

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. S. 1083, Medicare Drug Savings Act, entire bill 8. Expansion of Medicare benefits to include hearing, vision, and dental benefits 9. Administration of the Medicare State Health Insurance Assistance Program 10.Medicaid Money Follows the Person (MFP) Rebalancing Demonstration Project

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

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

Policies to enhance patient access to medicines in Medicaid; Policies to enhance patient access to medicines in Medicare; H.R. 3061 & S. 31, Medicare Prescription Drug Price Negotiation Act of 2015; H.R. 1102 & S. 117, Medicare Prescription Drug Price Negotiation Act; H.R. 2005 & S. 1083, Medicare Drug Savings Act; H.R. 3261 & S. 1884, Medicare Prescription Drug Savings and Choice Act of 2015; Medicare payment proposals;

Client expense: $2,610,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), 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), Veterans Affairs, Dept of (VA)

Discussed structural changes to Medicaid. Discussed health care quality and measurement. Discussed changes to the Medicare benefit design, such as copays, premiums and deductibles. S. 1083, H.R.2005 - Discussed legislation 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. S. 1488, H.R. 2624, Part D Beneficiary Appeals Fairness Act - Discussed bill that would allow seniors to appeal the placement of their medications on a Medicare Part D specialty tier. Discussed Medicare Part D fraud and abuse legislation including lock-in provisions for high risk enrollees. Discussed legislation to require the addition of unique device identifier (UDI) of medical devices in health insurance claim forms. S. 624, H.R.1220, Removing Barriers to Colorectal Cancer Screening Act - Discussed bill. S. 3040, H.R. 5926, H.R. 5325, Labor, Health and Human Services Appropriations bill, FY2017 - Lobbied in support of increased funding for CMS' state survey and certification program. Discussed the Medicare Part D prescription drug benefit program and changes needed to lower prescription drug costs and related agency proposed rule changes. H.R. 5122 - Discussed the Medicare Part B prescription drug demonstration proposal from the Centers for Medicare and Medicaid Services. Discussed potential benefit and coverage improvements under Medicare and Medicare Savings Programs. Discussed Section 1115 Medicaid expansion demonstration waivers (HHS, CMS). H.R. 2759, Mental Health Access Improvement Act - Discussed support of bill. Discussed MACRA implementation. Discussed Medicare enrollment and coverage issues such as: provider access, direct billing and penalties. Discussed DOJ investigation regarding Olmstead and ADA violations by South Dakota (DOJ, ACL) and related public events. Discussed Olmstead enforcement and older adults at roundtable discussion. S. 3096, Removing Barriers to Person-Centered Care Act of 2016 - Discussed and provided feedback. Discussed possible hearing witnesses. Responded to inquiry regarding MACRA rules and value modifier. H.R. 3298, Post Acute Care Value Based Purchasing Act - Discussed and provided feedback. Discussed arbitration provision in LTC facility requirements proposed rule (OMB, CMS, HHS). Responded to inquiry on Virtual Caregiving Fair. PL 111-148 - Discussed ACA Medicaid HCBS spousal impoverishment provisions. Responded to inquiry on state nursing home legislation. Discussed Medicaid assisted living, HCBS setting rule and follow-up (GAO). Discussed Medicare home health (CMS). Urged support for family caregivers in Medicare and Medicaid and testing modeling. Signed letter to CMS regarding arbitration in LTC facility requirements rule. Discussed family caregiver assessment guidance (CMS). Attended PPI home health roundtable with staff from HHS. Responded to a question about a scorecard and letters to CMS. Responded to an inquiry regarding an arbitration regulatory provision. Responded to an inquiry regarding personal needs allowances. Discussed Medicaid functional assessment tools, family caregiver assessment, and follow-up(GAO). Responded to inquiries regarding Medicaid managed long-term services and supports, best practices, and state ombuds programs. S. 3130, Independence at Home Act - Discussed and sent AARP endorsement letter for bill

Client expense: $2,290,000 · 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), Commerce, Dept of (DOC), Congressional Budget Office (CBO), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), White House Office

Medicare Program; Part B Drug Payment Model, Proposed rule, CMS-1670-P (March 11, 2016) - Provisions related to the Medicare Part B Drug Payment Model Medicaid Program: Covered Outpatient Drugs (CMS-2345-FC) - Provisions related to line extension drug definition, effective date and other issues S. 31: Medicare Prescription Drug Price Negotiation Act of 2015 - Provisions related to Secretary negotiation authority in Part D program S. 141: Protecting Seniors' Access to Medicare Act of 2015 - Provisions related to Independent Payment Advisory Board (IPAB) repeal S. 480: National All Schedules Prescription Electronic Reporting Reauthorization Act of 2016 - Provisions related to the reauthorization of the national controlled substance monitoring program S. 648: Medicare Formulary Improvement Act of 2015 - Provisions related to codification of six protected classes in Part D program S. 1083: Medicare Drug Savings Act of 2015 - Provisions related to drug rebates in Medicare Part D S. 1913: Stopping Medication Abuse and Protecting Seniors Act of 2015 - Provisions related to programs to prevent prescription drug abuse under the Medicare program S. 2023: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures S. 2981: A bill to amend title XIX of the Social Security Act to add standards for drug compendia for physician use for purposes of Medicaid payment for certain drugs, and for other purposes H.R. 22: FAST Act - Medicare related offsets to the biopharmaceutical industry H.R. 512: The DISARM Act of 2015 H.R. 1190: Protecting Seniors Access to Medicare Act of 2015 - Provisions related to IPAB repeal H.R. 2005: Medicare Drug Savings Act of 2015 - Provisions related to changes to Part D rebates H.R. 2298: Medicare Patient Safety and Drug Abuse Prevention Act - Provisions related to the design of a Part D Lock-in program H.R. 3513: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures H.R. 5122: To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models - Suspending the Part B Drug Payment Model Medicaid and Childrens Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability; Final rule [CMS-2390-F] - Provisions related to Medicaid Proposed Medicare hospital outpatient prospective payment system (OPPS) rule for 2016 (CMS-1633-P) Other: - Department of Health and Human Services (HHS) delivery system reform issues and regulatory barriers to innovation - Medicare Part B Average Sales Price (ASP) policy issues - Medicare Part D rebates policy issues - Drug cost and pricing policy issues - Transparency policy issues - Medication adherence policy issues - Alternative payment models policy issues - Value-based arrangements policy issues - Coding and reimbursement policy issues including for biologics - Center for Medicare and Medicaid Innovation (CMMI) transparency policy issues - MedPAC June Report - Part B and D policy issues - Medicaid rebates/reformulations policy issues - Non-interference policy issues - Prescription drug abuse policy issues

Client expense: $640,000 · 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), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR), Vice President of the U.S.

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. S. 1083, Medicare Drug Savings Act, entire bill 8. Expansion of Medicare benefits to include hearing, vision, and dental benefits 9. Administration of the Medicare State Health Insurance Assistance Program

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), Pension Benefit Guaranty Corporation (PBGC), SENATE

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in P.L. 114-10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 and S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Medicare diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Program; Part B Drug Payment Model, Proposed rule, CMS-1670-P (March 11, 2016) - Provisions related to the Medicare Part B Drug Payment Model Medicaid Program: Covered Outpatient Drugs (CMS-2345-FC) - Provisions related to line extension drug definition, effective date and other issues S. 31: Medicare Prescription Drug Price Negotiation Act of 2015 - Provisions related to Secretary negotiation authority in Part D program S. 141: Protecting Seniors' Access to Medicare Act of 2015 - Provisions related to Independent Payment Advisory Board (IPAB) repeal S. 480: National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 - Provisions related to the reauthorization of the national controlled substance monitoring program S. 648: Medicare Formulary Improvement Act of 2015 - Provisions related to codification of six protected classes in Part D program S. 1083: Medicare Drug Savings Act of 2015 - Provisions related to drug rebates in Medicare Part D S. 1913: Stopping Medication Abuse and Protecting Seniors Act of 2015 - Provisions related to programs to prevent prescription drug abuse under the Medicare program S. 2023: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures S. 2646: Veterans Choice Improvement Act of 2016 - Provisions related to TRICARE drug pricing S. 2981: A bill to amend title XIX of the Social Security Act to add standards for drug compendia for physician use for purposes of Medicaid payment for certain drugs, and for other purposes H.R. 22: FAST Act - Medicare related offsets to the biopharmaceutical industry H.R. 1190: Protecting Seniors Access to Medicare Act of 2015 - Provisions related to IPAB repeal H.R. 2005: Medicare Drug Savings Act of 2015 - Provisions related to changes to Part D rebates H.R. 2298: Medicare Patient Safety and Drug Abuse Prevention Act - Provisions related to the design of a Part D Lock-in program H.R. 3513: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures H.R. 5122: To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models - Suspending the Part B Drug Payment Model H.R. 5273: Helping Hospitals Improve Patient Care Act of 2016 - Provisions related to exemption of hospitals that had off-site facilities under development Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability; Final rule [CMS-2390-F] - Provisions related to Medicaid Proposed Medicare hospital outpatient prospective payment system (OPPS) rule for 2016 (CMS-1633-P) Proposed Medicare physician fee schedule (MPFS) rule for 2016 (CMS-1631-P) Department of Health and Human Services (HHS) delivery system reform issues and regulatory barriers to innovation Medicare Part B Average Sales Price (ASP) policy issues Medicare Part D rebates policy issues Drug cost and pricing policy issues Transparency policy issues Medication adherence policy issues Alternative payment models policy issues Value-based arrangements policy issues Coding and reimbursement policy issues including for biologics Center for Medicare and Medicaid Innovation (CMMI) transparency policy issues MedPAC June Report - Part B and D policy issues Medicaid rebates/reformulations policy issues Non-interference policy issues

Client expense: $4,550,000 · 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), Medicare Payment Advisory Commission (MedPAC), Natl Security Council (NSC), Office of the Vice President of the United States, Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR)

Medicare Program; Part B Drug Payment Model, Proposed rule, CMS-1670-P (March 11, 2016) - Provisions related to the Medicare Part B Drug Payment Model Medicaid Program: Covered Outpatient Drugs (CMS-2345-FC) - Provisions related to line extension drug definition, effective date and other issues S. 31: Medicare Prescription Drug Price Negotiation Act of 2015 - Provisions related to Secretary negotiation authority in Part D program S. 141: Protecting Seniors' Access to Medicare Act of 2015 - Provisions related to Independent Payment Advisory Board (IPAB) repeal S. 480: National All Schedules Prescription Electronic Reporting Reauthorization Act of 2016 - Provisions related to the reauthorization of the national controlled substance monitoring program S. 648: Medicare Formulary Improvement Act of 2015 - Provisions related to codification of six protected classes in Part D program S. 1083: Medicare Drug Savings Act of 2015 - Provisions related to drug rebates in Medicare Part D S. 1913: Stopping Medication Abuse and Protecting Seniors Act of 2015 - Provisions related to programs to prevent prescription drug abuse under the Medicare program S. 2023: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures S. 2981: A bill to amend title XIX of the Social Security Act to add standards for drug compendia for physician use for purposes of Medicaid payment for certain drugs, and for other purposes H.R. 22: FAST Act - Medicare related offsets to the biopharmaceutical industry H.R. 1190: Protecting Seniors Access to Medicare Act of 2015 - Provisions related to IPAB repeal H.R. 2005: Medicare Drug Savings Act of 2015 - Provisions related to changes to Part D rebates H.R. 2298: Medicare Patient Safety and Drug Abuse Prevention Act - Provisions related to the design of a Part D Lock-in program H.R. 3513: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures H.R. 5122: To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models - Suspending the Part B Drug Payment Model Medicaid and Childrens Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability; Final rule [CMS-2390-F] - Provisions related to Medicaid Proposed Medicare hospital outpatient prospective payment system (OPPS) rule for 2016 (CMS-1633-P) Department of Health and Human Services (HHS) delivery system reform issues and regulatory barriers to innovation Medicare Part B Average Sales Price (ASP) policy issues Medicare Part D rebates policy issues Drug cost and pricing policy issues Transparency policy issues Medication adherence policy issues Alternative payment models policy issues Value-based arrangements policy issues Coding and reimbursement policy issues including for biologics Prescription drug abuse policy issues Center for Medicare and Medicaid Innovation (CMMI) transparency policy issues MedPAC June Report - Part B and D policy issues Medicaid rebates/reformulations policy issues Non-interference policy issues

Client expense: $4,130,000 · 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), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Security Council (NSC), Office of Management & Budget (OMB), Office of the Vice President of the United States, Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR)

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in P.L. 114-10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 and S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Continuous Glucose Monitoring (CGM); Medicare reimbursement of A1C for diabetes screening, and diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015; Physician Quality and Reporting System (PQRS); CMMI Part B Demonstration

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Indian Health Service, Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Treasury, Dept of

Medicare Program; Part B Drug Payment Model, Proposed rule, CMS-1670-P (March 11, 2016) - Provisions related to the Medicare Part B Drug Payment Model Medicaid Program: Covered Outpatient Drugs (CMS-2345-FC) - Provisions related to line extension drug definition, effective date and other issues S. 31: Medicare Prescription Drug Price Negotiation Act of 2015 - Provisions related to Secretary negotiation authority in Part D program S. 141: Protecting Seniors' Access to Medicare Act of 2015 - Provisions related to Independent Payment Advisory Board (IPAB) repeal S. 480: National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 - Provisions related to the reauthorization of the national controlled substance monitoring program S. 648: Medicare Formulary Improvement Act of 2015 - Provisions related to codification of six protected classes in Part D program S. 1083: Medicare Drug Savings Act of 2015 - Provisions related to drug rebates in Medicare Part D S. 1913: Stopping Medication Abuse and Protecting Seniors Act of 2015 - Provisions related to programs to prevent prescription drug abuse under the Medicare program S. 2023: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures S. 2646: Veterans Choice Improvement Act of 2016 - Provisions related to TRICARE drug pricing S. 2981: A bill to amend title XIX of the Social Security Act to add standards for drug compendia for physician use for purposes of Medicaid payment for certain drugs, and for other purposes H.R. 22: FAST Act - Medicare related offsets to the biopharmaceutical industry HR. 512 - the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms Act of 2014 H.R. 1190: Protecting Seniors Access to Medicare Act of 2015 - Provisions related to IPAB repeal H.R. 2005: Medicare Drug Savings Act of 2015 - Provisions related to changes to Part D rebates H.R. 2298: Medicare Patient Safety and Drug Abuse Prevention Act - Provisions related to the design of a Part D Lock-in program H.R. 3513: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures H.R. 5122: To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models - Suspending the Part B Drug Payment Model H.R. 5273: Helping Hospitals Improve Patient Care Act of 2016 - Provisions related to exemption of hospitals that had off-site facilities under development Other: - Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability; Proposed rules [CMS-2390-P] - Provisions related to Medicaid - Proposed Medicare hospital outpatient prospective payment system (OPPS) rule for 2016 (CMS-1633-P) - Proposed Medicare physician fee schedule (MPFS) rule for 2016 (CMS-1631-P) - Department of Health and Human Services (HHS) delivery system reform issues and regulatory barriers to innovation - Medicare Part B Average Sales Price (ASP) policy issues - Medicare Part D rebates policy issues - Drug cost and pricing policy issues - Transparency policy issues - Medication adherence policy issues - Alternative payment models policy issues - Value-based arrangements policy issues - Coding and reimbursement policy issues including for biologics - Center for Medicare and Medicaid Innovation (CMMI) transparency policy issues - MedPAC June Report - Part B and D policy issues - Medicaid rebates/reformulations policy issues - Non-interference policy issues

Client expense: $1,070,000 · Firm income: Not reported

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

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in P.L. 114-10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 and S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Medicare diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015.

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

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

Responded to inquiry regarding in-home supportive services programs. S. 1549, Care Planning Act - Discussed the bill and urged cosponsorship. Discussed structural changes to Medicaid. Discussed health care quality and measurement. Discussed changes to the Medicare benefit design, such as copays, premiums and deductibles. H.R.1571, Improving Access to Medicare Coverage Act - Discussed bill. S.578, Home Health Planning Improvement Act - Discussed bill and urged cosponsorship. Discussed the Medicare Part D prescription drug benefit program and changes needed to lower prescription drug costs and related agency proposed rule changes. S. 1083, H.R.2005 - Discussed legislation 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. S. 1488, H.R. 2624, Part D Beneficiary Appeals Fairness Act - Discussed bill that would allow seniors to appeal the placement of their medications on a Medicare Part D specialty tier. Discussed Medicare Part D fraud and abuse legislation including lock-in provisions for high risk enrollees. Discussed legislation to require the addition of unique device identifier (UDI) of medical devices in health insurance claim forms. Discussed the Medicare Part B prescription drug demonstration proposal from the Centers for Medicare and Medicaid Services. S. 624, H.R.1220,Removing Barriers to Colorectal Cancer Screening Act - Discussed bill. S. 3040, Labor, Health and Human Services,FY2017 - Lobbied in support of increased funding for CMS' state survey and certification program. S. 1549 - Discussed support of Care Planning Act. Discussed the Medicare Part B prescription drug benefit program and changes needed to lower prescription drug costs and related agency proposed rule changes. H.R. 5122 - Discussed the Medicare Part B prescription drug demonstration proposal. Discussed potential benefit and coverage improvements under Medicare and Medicaid Savings Programs. H.R. 2759, Mental Health Access Improvement Act - Discussed support of bill. Discussed MACRA implementation. Discussed Medicare enrollment and coverage issues such as: provider access, direct billing and penalties. S. 1719, H.R. 3099, RAISE Act - Discussed CMS' efforts regarding family caregiving. Provided feedback on advanced directive registry bill. (no bill #) Discussed independence at home legislation. S. 2961, Compassionate Care Act - Discussed our position and provided feedback. Discussed DOJ investigation regarding Olmstead and ADA violations by South Dakota and provided feedback (DOJ). Responded to inquiry regarding roundtable (ACL). S. 3096, Removing Barriers to Person-Centered Care Act of 2016 - Discussed and provided feedback. Discussed possible hearing witnesses. Discussed Medicaid HCBS spousal impoverishment bill. (no bill #) Responded to inquiry regarding MACRA rules and value modifier. Discussed Medicare's 180-day coverage of skilled nursing facility care. S. 2836, H.R. 5036, Protecting Families with Disabilities Act - Signed letter in support of bill.

Client expense: $2,060,000 · 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), Commerce, Dept of (DOC), Congressional Budget Office (CBO), Equal Employment Opportunity Commission (EEOC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), White House Office

Medicare Program; Part B Drug Payment Model, Proposed rule, CMS-1670-P (March 11, 2016) - Provisions related to the Medicare Part B Drug Payment Model Medicaid Program: Covered Outpatient Drugs (CMS-2345-FC) - Provisions related to line extension drug definition, effective date and other issues S. 31: Medicare Prescription Drug Price Negotiation Act of 2015 - Provisions related to Secretary negotiation authority in Part D program S. 141: Protecting Seniors' Access to Medicare Act of 2015 - Provisions related to Independent Payment Advisory Board (IPAB) repeal S. 480: National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 - Provisions related to the reauthorization of the national controlled substance monitoring program S. 648: Medicare Formulary Improvement Act of 2015 - Provisions related to codification of six protected classes in Part D program S. 1083: Medicare Drug Savings Act of 2015 - Provisions related to drug rebates in Medicare Part D S. 1913: Stopping Medication Abuse and Protecting Seniors Act of 2015 - Provisions related to programs to prevent prescription drug abuse under the Medicare program S. 2023: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures S. 2646: Veterans Choice Improvement Act of 2016 - Provisions related to TRICARE drug pricing S. 2981: A bill to amend title XIX of the Social Security Act to add standards for drug compendia for physician use for purposes of Medicaid payment for certain drugs, and for other purposes H.R. 22: FAST Act - Medicare related offsets to the biopharmaceutical industry H.R. 1190: Protecting Seniors Access to Medicare Act of 2015 - Provisions related to IPAB repeal H.R. 2005: Medicare Drug Savings Act of 2015 - Provisions related to changes to Part D rebates H.R. 2298: Medicare Patient Safety and Drug Abuse Prevention Act - Provisions related to the design of a Part D Lock-in program H.R. 3513: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures H.R. 5122: To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models - Suspending the Part B Drug Payment Model H.R. 5273: Helping Hospitals Improve Patient Care Act of 2016 - Provisions related to exemption of hospitals that had off-site facilities under development Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability; Final rule [CMS-2390-F] - Provisions related to Medicaid Proposed Medicare hospital outpatient prospective payment system (OPPS) rule for 2016 (CMS-1633-P) Proposed Medicare physician fee schedule (MPFS) rule for 2016 (CMS-1631-P) Department of Health and Human Services (HHS) delivery system reform issues and regulatory barriers to innovation Medicare Part B Average Sales Price (ASP) policy issues Medicare Part D rebates policy issues Drug cost and pricing policy issues Transparency policy issues Medication adherence policy issues Alternative payment models policy issues Value-based arrangements policy issues Coding and reimbursement policy issues including for biologics Center for Medicare and Medicaid Innovation (CMMI) transparency policy issues MedPAC June Report - Part B and D policy issues Medicaid rebates/reformulations policy issues Non-interference policy issues

Client expense: $5,820,000 · 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), Medicare Payment Advisory Commission (MedPAC), Natl Security Council (NSC), Office of the Vice President of the United States, Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), U.S. Trade Representative (USTR)

Policies to enhance patient access to medicines in Medicaid; Policies to enhance patient access to medicines in Medicare; H.R. 3061 & S. 31, Medicare Prescription Drug Price Negotiation Act of 2015; H.R. 1102 & S. 117, Medicare Prescription Drug Price Negotiation Act; H.R. 2005 & S. 1083, Medicare Drug Savings Act; H.R. 3261 & S. 1884, Medicare Prescription Drug Savings and Choice Act of 2015; Medicare payment proposals;

Client expense: $2,600,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), 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), Veterans Affairs, Dept of (VA)

Policies to enhance patient access to medicines in Medicaid; Policies to enhance patient access to medicines in Medicare; H.R. 3061 & S. 31, Medicare Prescription Drug Price Negotiation Act of 2015; H.R. 1102 & S. 117, Medicare Prescription Drug Price Negotiation Act; H.R. 2005 & S. 1083, Medicare Drug Savings Act; H.R. 3261 & S. 1884, Medicare Prescription Drug Savings and Choice Act of 2015; Medicare payment proposals;

Client expense: $26,000,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), 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), Veterans Affairs, Dept of (VA)

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. S. 1083, Medicare Drug Savings Act, entire bill 8. Medicare Part B Premiums and Deductibles for 2016 9. Expansion of Medicare benefits to include hearing, vision, and dental benefits 10. Administration of the Medicare State Health Insurance Assistance Program 11.Proposed CMS rule to test value-driven payment and delivery system models for Medicare Part D prescription drugs

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Pension Benefit Guaranty Corporation (PBGC), SENATE

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in P.L. 114-10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 and S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Continuous Glucose Monitoring (CGM); Medicare diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015; Physician Quality and Reporting System (PQRS); CMMI Part B Demonstration

Client expense: $690,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Indian Health Service, Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Treasury, Dept of

Medicare Privatization. (No bill.) Proposals to transform traditional Medicare to a private insurance carrier program. Medicare Benefit Redesign. (No bill.) Proposals 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 Eligibility Age. (No bill.) Proposals to raise the eligibility age for Medicare from 65 to 67. Medicare Drug Savings. S. 1083, H.R. 2005, the Medicare Drug Savings Act: proposals to extend the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by Medicare-Medicaid eligible beneficiaries (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Prescription Drug Price Negotiation. H.R. 3061, S. 31, the Medicare Prescription Drug Price Negotiation Act of 2015: proposals to authorize the Secretary of the Department of Health and Human Services to negotiate discounts, rebates, and other price concessions to lower the cost paid by Medicare to pharmaceutical manufacturers. Medicare Prescription Drug Price Negotiation. H.R. 4207, Medicare Fair Drug Pricing Act of 2015: proposal to allow the Secretary of HHS to negotiate prices with manufacturers where little or no competition exists for drugs. Medicare Prescription Drug Plan Option. H.R. 3261, S. 1884, the Medicare Prescription Drug Savings and Choice Act of 2015: proposals to create one or more Medicare-administered drug plans with uniform premiums, providing seniors with the opportunity to purchase drugs directly through the Medicare program; requires the federal government to use its purchasing power to negotiate lower prices on prescription drugs for beneficiaries who enroll in the Medicare-administered plan. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Observation Status. S. 843, H.R. 1571, Improving Access to Medicare Coverage Act of 2015: proposal 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, 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. Patent Reform. S. 1137, Patent Act; H.R. 9, Innovation Act: proposal to carve brand-named pharmaceutical manufacturers out of an expedited United States Patent and Trademark Office (USPTO) review process that allows generic companies to bypass costly litigation when challenging drug patents. Expanding Drug Monopolies. H.R. 6, 21st Century Cures Act: proposal to extend orphan drug market exclusivity for existing drugs to new indications. Reducing Prescription Drug Costs. S. 2023, H.R. 3513, Prescription Drug Affordability Act: proposals to allow Medicare to negotiate drug prices, to allow Medicare and Medicaid to receive additional rebates from brand and generic drugs, and to allow for the re-importation of drugs from Canada. Reducing the cost of biologics. H.R. 5573, S. 3094, Price, Innovation and Competition for Essential Drugs (PRICED) Act: proposal to reduce the marketing exclusivity period for biologics from 12 to 7 years. Drug payment under Medicare Part B. H.R. 5122, to prohibit further action on the proposed rule regarding testing of Medicare Part B prescription drug models: proposal to prohibit implementation of a proposed demonstration testing new ways of paying physicians for drugs in order to eliminate incentives to unnecessarily prescribe high cost drugs. Medicare Fraud. H.R. 5340, Fighting Medicare Fraud Act: Legislation to close off a loophole allowing Medicare fraud offenders to evade enforcement authority when they move to a new company. Out-of-pocket drug costs. S.2864, RXCAP Act of 2016: proposal to cap out-of-pocket costs for Part D enrollees. Chronic Care Coordination. (No bill.) Proposals to facilitate the delivery of high-quality care for people with Medicare living with multiple chronic conditions. Medicare Vision, Dental and Hearing Coverage. H.R. 3308, Seniors Have Eyes, Ears and Teeth Act; H.R. 5396, the Medicare Dental, Vision, and Hearing Benefit Act of 2016: proposals to provide Medicare coverage for vision, hearing and dental services. Medicare Hearing Coverage. H.R. 1653, the Medicare Hearing Aid Coverage Act of 2015; H.R. 2748, the Help Extend Auditory Relief (HEAR) Act of 2015: proposals to provide Medicare coverage for the cost of hearing aids and examinations, to amend Medicare to cover aural rehabilitation services, hearing aids, audiology rehabilitation services, and related hearing services. Medicare Dental Coverage. S. 570, H.R. 1055, the Comprehensive Dental Reform Act: proposal to extend comprehensive dental coverage to all Medicare, Medicaid, and VA beneficiaries. Medicare Care Planning. S. 1549, the Care Planning Act of 2015: proposals to create a Medicare benefit for care planning, the coordination of services, to fill gaps in quality measurement in the advanced illness field. Medicare Private Plan Notification Improvements. (No bill.) Proposals to improve the annual notification Medicare private plans promulgate to Parts C and D enrollees pertaining to plan changes that will raise enrollee costs or limit access to products and services. Medicare Part B Payment Reforms. H.R. 5122: proposals to change the way Medicare pays doctors for administering drugs to eliminate incentives to prescribe drugs based on their expense instead of clinical need. Medicare Advantage Payment Reforms. (No bill.) Proposals to eliminate discrepancies in how much Medicare pays for services for similarly situated individuals in traditional Medicare and in Medicare Advantage plans. Medicare Access and CHIP Reauthorization Act. (Public Law 114-10). Comments to CMS/HHS proposing ways the proposed rule can be strengthened to ensure the new Quality Payment Program delivers on the promise of health system transformation. Medicaid Expansion. H.R. 4588 and S. 2787: proposal to provide a higher level of federal Medicaid funding for states that did not choose to expand Medicaid when the Affordable Care Act (ACA) first launched Medicaid expansion in 2014.

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), Labor, Dept of (DOL), 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.

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in P.L. 114-10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 and S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Continuous Glucose Monitoring (CGM); Medicare diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015; Physician Quality and Reporting System (PQRS)

Client expense: $970,000 · Firm income: Not reported

Medicare Program; Part B Drug Payment Model, Proposed rule, CMS-1670-P (March 8, 2016) - Provisions related to the Medicare Part B Drug Payment Model Medicaid Program: Covered Outpatient Drugs (CMS-2345-FC) - Provisions related to line extension drug definition, effective date and other issues S. 31: Medicare Prescription Drug Price Negotiation Act of 2015 - Provisions related to Secretary negotiation authority in Part D program S. 141: Protecting Seniors' Access to Medicare Act of 2015 - Provisions related to Independent Payment Advisory Board (IPAB) repeal S. 275: Medicare Home Infusion Site of Care Act of 2015 - Provisions related to Medicare coverage S. 480: National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 - Provisions related to the reauthorization of the national controlled substance monitoring program S. 648: Medicare Formulary Improvement Act of 2015 - Provisions related to codification of six protected classes in Part D program S. 1083: Medicare Drug Savings Act of 2015 - Provisions related to drug rebates in Medicare Part D S. 1253: Patient Access to Disposable Medical Technology Act of 2015 - Provisions related to capitated payments for disposable medical technology S. 1396: Value-Based Insurance Design Seniors Copayment Reduction Act of 2015 - Provisions related to changes to the Medicare Advantage Program S. 1884: Medicare Prescription Drug Savings and Choice Act of 2015 - Provisions related to the Medicare Operated Prescription Drug Plan Option S. 1913: Stopping Medication Abuse and Protecting Seniors Act of 2015 - Provisions related to programs to prevent prescription drug abuse under the Medicare program S. 2023: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures S. 2409: Medicare and Medicaid Improvements and Adjustments Act of 2015 - Provisions related to outpatient reimbursement rates S. 2646: Veterans Choice Improvement Act of 2016 - Provisions related to TRICARE drug pricing H.R. 22: FAST Act - Medicare related offsets to the biopharmaceutical industry HR. 512 - the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms Act of 2014 H.R. 1190: Protecting Seniors Access to Medicare Act of 2015 - Provisions related to IPAB repeal H.R. 2005: Medicare Drug Savings Act of 2015 - Provisions related to changes to Part D rebates H.R. 2298: Medicare Patient Safety and Drug Abuse Prevention Act - Provisions related to the design of a Part D Lock-in program H.R. 3513: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures H.R. 4273: Medicare and Medicaid Improvements and Adjustments Act of 2015 - Provisions related to outpatient reimbursement rates Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability; Proposed rules [CMS-2390-P] - Provisions related to Medicaid Proposed Medicare hospital outpatient prospective payment system (OPPS) rule for 2016 (CMS-1633-P) Proposed Medicare physician fee schedule (MPFS) rule for 2016 (CMS-1631-P) Hospital Improvements for Payment Act (discussion draft) - Provisions related to Medicare Parts A and B reform Department of Health and Human Services (HHS) delivery system reform issues and regulatory barriers to innovation Medicare Part B Average Sales Price (ASP) policy issues Medicare Part D rebates policy issues Drug cost and pricing policy issues Transparency policy issues Medication adherence policy issues Alternative payment models policy issues Value-based arrangements policy issues Coding and reimbursement policy issues including for biologics Center for Medicare and Medicaid Innovation (CMMI) transparency policy issues Chronic Care Working Group - Medicare policy affecting drugs

Client expense: $1,490,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, U.S. Trade Representative (USTR), Vice President of the U.S.

Medicare Program; Part B Drug Payment Model, Proposed rule, CMS-1670-P (March 8, 2016) - Provisions related to the Medicare Part B Drug Payment Model Medicaid Program: Covered Outpatient Drugs (CMS-2345-FC) - Provisions related to line extension drug definition, effective date and other issues S. 31: Medicare Prescription Drug Price Negotiation Act of 2015 - Provisions related to Secretary negotiation authority in Part D program S. 141: Protecting Seniors' Access to Medicare Act of 2015 - Provisions related to Independent Payment Advisory Board (IPAB) repeal S. 275: Medicare Home Infusion Site of Care Act of 2015 - Provisions related to Medicare coverage S. 480: National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 - Provisions related to the reauthorization of the national controlled substance monitoring program S. 648: Medicare Formulary Improvement Act of 2015 - Provisions related to codification of six protected classes in Part D program S. 1083: Medicare Drug Savings Act of 2015 - Provisions related to drug rebates in Medicare Part D S. 1253: Patient Access to Disposable Medical Technology Act of 2015 - Provisions related to capitated payments for disposable medical technology S. 1396: Value-Based Insurance Design Seniors Copayment Reduction Act of 2015 - Provisions related to changes to the Medicare Advantage Program S. 1884: Medicare Prescription Drug Savings and Choice Act of 2015 - Provisions related to the Medicare Operated Prescription Drug Plan Option S. 1913: Stopping Medication Abuse and Protecting Seniors Act of 2015 - Provisions related to programs to prevent prescription drug abuse under the Medicare program S. 2023: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures S. 2409: Medicare and Medicaid Improvements and Adjustments Act of 2015 - Provisions related to outpatient reimbursement rates S. 2646: Veterans Choice Improvement Act of 2016 - Provisions related to TRICARE drug pricing H.R. 22: FAST Act - Medicare related offsets to the biopharmaceutical industry H.R. 1190: Protecting Seniors Access to Medicare Act of 2015 - Provisions related to IPAB repeal H.R. 2005: Medicare Drug Savings Act of 2015 - Provisions related to changes to Part D rebates H.R. 2298: Medicare Patient Safety and Drug Abuse Prevention Act - Provisions related to the design of a Part D Lock-in program H.R. 3513: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures H.R. 4273: Medicare and Medicaid Improvements and Adjustments Act of 2015 - Provisions related to outpatient reimbursement rates Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability; Proposed rules [CMS-2390-P] - Provisions related to Medicaid Proposed Medicare hospital outpatient prospective payment system (OPPS) rule for 2016 (CMS-1633-P) Proposed Medicare physician fee schedule (MPFS) rule for 2016 (CMS-1631-P) Hospital Improvements for Payment Act (discussion draft) - Provisions related to Medicare Parts A and B reform Department of Health and Human Services (HHS) delivery system reform issues and regulatory barriers to innovation Medicare Part B Average Sales Price (ASP) policy issues Medicare Part D rebates policy issues Drug cost and pricing policy issues Transparency policy issues Medication adherence policy issues Alternative payment models policy issues Value-based arrangements policy issues Coding and reimbursement policy issues including for biologics Center for Medicare and Medicaid Innovation (CMMI) transparency policy issues Chronic Care Working Group - Medicare policy affecting drugs

Client expense: $5,950,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, U.S. Trade Representative (USTR), Vice President of the U.S.

Policies to enhance patient access to medicines in Medicaid; Policies to enhance patient access to medicines in Medicare; H.R. 3061 & S. 31, Medicare Prescription Drug Price Negotiation Act of 2015; H.R. 1102 & S. 117, Medicare Prescription Drug Price Negotiation Act; H.R. 2005 & S. 1083, Medicare Drug Savings Act; H.R. 3261 & S. 1884, Medicare Prescription Drug Savings and Choice Act of 2015; Medicare payment proposals;

Client expense: $2,570,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), 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), Veterans Affairs, Dept of (VA)

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in P.L. 114-10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 and S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Medicare diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015.

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

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

Policies to enhance patient access to medicines in Medicaid; Policies to enhance patient access to medicines in Medicare; H.R. 3061 & S. 31, Medicare Prescription Drug Price Negotiation Act of 2015; H.R. 1102 & S. 117, Medicare Prescription Drug Price Negotiation Act; H.R. 2005 & S. 1083, Medicare Drug Savings Act; H.R. 3261 & S. 1884, Medicare Prescription Drug Savings and Choice Act of 2015; Medicare payment proposals;

Client expense: $2,630,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), 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), Veterans Affairs, Dept of (VA)

Responded to inquiry regarding in-home supportive services programs. (no bill #) S. 1549, Care Planning Act - Discussed the bill and urged cosponsorship. Discussed structural changes to Medicaid. (no bill #) Discussed health care quality and measurement. (no bill #) Discussed changes to the Medicare benefit design, such as copays, premiums and deductibles. (no bill #) Discussed Personalize Your Care Act and provided feedback. (no bill #) Discussed Money Follows the Person Rebalancing Demonstration. (no bill #) Made inquiry regarding DC Medicaid HCBS waiver. (no bill #) S. 1085, Military and Veteran Caregiver Services Improvement Act - Discussed bill. H.R. 4878, Better Care Lower Cost Act - Discussed bill. Discussed spousal impoverishment in Medicaid. (no bill #) H.R. 4059, S.2297, Medicare Choices Empowerment and Protection Act - Provided feedback on bill. H.R. 3298, Medicare Post-Acute Care Value-Based Purchasing Act - Discussed feedback and next steps. (no bill #) Inquired regarding final rule on discharge planning. (no bill #) H.R.1571, Improving Access to Medicare Coverage Act - Discussed bill. Discussed retroactive eligibility for Medicaid HCBS (no bill #) Discussed observations status issues. (no bill #) S.578, Home Health Planning Improvement Act - Discussed bill and urged cosponsorship. Discussed the Medicare Part D prescription drug benefit program and changes needed to lower prescription drug costs and related agency proposed rule changes. (no bill #) H.R.2005, S.1083 - Discussed legislation 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. 2624, S.1488, Part D Beneficiary Appeals Fairness Act- Discussed bill that would allow seniors to appeal the placement of their medications on a Medicare Part D specialty tier. Discussed Medicare Part D fraud and abuse legislation including lock-in provisions for high risk enrollees. (no bill #) Discussed legislation to require the addition of unique device identifier (UDI) of medical devices in health insurance claim forms. Discussed the Medicare Part B prescription drug demonstration proposal from the Centers for Medicare and Medicaid Services. H.R.1220, S.624, Removing Barriers to Colorectal Cancer Screening Act - Discussed bill. Discussed Medicare site of service payment policy. (no bill #) H.R. 4442,S.2484,CONNECT Act - Sent letter of endorsement. Discussed Medicare coverage and reimbursement of cataract surgery. Labor, Health and Human Services,FY2017 - Lobbied in support of increased funding for CMS' state survey and certification program. (no bill #)

Client expense: $1,830,000 · 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), Commerce, Dept of (DOC), Congressional Budget Office (CBO), Equal Employment Opportunity Commission (EEOC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), White House Office

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in P.L. 114-10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 and S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Continuous Glucose Monitoring (CGM); Medicare diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015; Physician Quality and Reporting System (PQRS)

Client expense: $910,000 · Firm income: Not reported

Medicare Privatization. (No bill.) Proposals to transform traditional Medicare to a private insurance carrier program. Medicare Benefit Redesign. (No bill.) Proposals 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 Eligibility Age. (No bill.) Proposals to raise the eligibility age for Medicare from 65 to 67. Medicare Drug Savings. S. 1083, H.R. 2005, the Medicare Drug Savings Act: proposals to extend the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by Medicare-Medicaid eligible beneficiaries (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Prescription Drug Price Negotiation. H.R. 3061, S. 31, the Medicare Prescription Drug Price Negotiation Act of 2015: proposals to authorize the Secretary of the Department of Health and Human Services to negotiate discounts, rebates, and other price concessions to lower the cost paid by Medicare to pharmaceutical manufacturers. Medicare Prescription Drug Price Negotiation. H.R. 4207, Medicare Fair Drug Pricing Act of 2015: proposal to allow the Secretary of HHS to negotiate prices with manufacturers where little or no competition exists for drugs. Medicare Prescription Drug Plan Option. H.R. 3261, S. 1884, the Medicare Prescription Drug Savings and Choice Act of 2015: proposals to create one or more Medicare-administered drug plans with uniform premiums, providing seniors with the opportunity to purchase drugs directly through the Medicare program; requires the federal government to use its purchasing power to negotiate lower prices on prescription drugs for beneficiaries who enroll in the Medicare-administered plan. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Observation Status. S. 843, H.R. 1571, Improving Access to Medicare Coverage Act of 2015: proposal 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, 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. Patent Reform. S. 1137, Patent Act; H.R. 9, Innovation Act: proposal to carve brand-named pharmaceutical manufacturers out of an expedited United States Patent and Trademark Office (USPTO) review process that allows generic companies to bypass costly litigation when challenging drug patents. Expanding Drug Monopolies. H.R. 6, 21st Century Cures Act: proposal to extend orphan drug market exclusivity for existing drugs to new indications. Reducing Prescription Drug Costs. S. 2023, H.R. 3513, Prescription Drug Affordability Act: proposals to allow Medicare to negotiate drug prices, to allow Medicare and Medicaid to receive additional rebates from brand and generic drugs, and to allow for the re-importation of drugs from Canada. Chronic Care Coordination. (No bill.) Proposals to facilitate the delivery of high-quality care for people with Medicare living with multiple chronic conditions. Medicare Vision, Dental and Hearing Coverage. H.R. 3308, Seniors Have Eyes, Ears and Teeth Act: proposal to provide Medicare coverage for vision, hearing and dental services. Medicare Hearing Coverage. H.R. 1653, the Medicare Hearing Aid Coverage Act of 2015: proposal to provide Medicare coverage for the cost of hearing aids and examinations. Medicare Dental Coverage. S. 570, H.R. 1055, the Comprehensive Dental Reform Act: proposal to extend comprehensive dental coverage to all Medicare, Medicaid, and VA beneficiaries. Medicare Part B Premium and Deductible Increase. S. 2148, Protecting Medicare Beneficiaries Act of 2015; H.R. 3696, Medicare Premium Fairness Act of 2015 and P.L. 114-74: proposals to prevent steep increases in Medicare Part B premiums and deductibles in 2016. Medicare Care Planning. S. 1549, the Care Planning Act of 2015: proposals to create a Medicare benefit for care planning, the coordination of services, to fill gaps in quality measurement in the advanced illness field, and to include advanced care planning information in the Medicare & You handbook. Medicare Private Plan Notification Improvements. (No bill.) Proposals to improve the annual notification Medicare private plans promulgate to Parts C and D enrollees pertaining to plan changes that will raise enrollee costs or limit access to products and services. Medicare Part B Payment Reforms. (No bill.) Proposals to change the way Medicare pays doctors for administering drugs to eliminate incentives to prescribe drugs based on their expense instead of clinical need. Medicare Advantage Payment Reforms. (No bill.) Proposals to eliminate discrepancies in how much Medicare pays for services for similarly situated individuals in traditional Medicare and in Medicare Advantage plans.

Client expense: $200,000 · 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), Labor, Dept of (DOL), 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.

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. S. 1083, Medicare Drug Savings Act, entire bill 8. Medicare Part B Premiums and Deductibles for 2016 9. Expansion of Medicare benefits to include hearing, vision, and dental benefits 10.H.R. 3696, Medicare Premium Fairness Act of 2015, entire bill 11. S. 2148, Medicare Beneficiaries Act of 2015, entire bill

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

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

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in P.L. 114-10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 and S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Continuous Glucose Monitoring (CGM); Medicare diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015; Physician Quality and Reporting System (PQRS)

Client expense: $620,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), SENATE

P.L. 111-148 Patient Protection and Affordable Care Act: Employer responsibility requirements premium and cost sharing subsidies, treatment of excepted benefits P.L. 111-152 Health Care and Education Reconciliation Act of 2010: Employer responsibility requirements premium and cost sharing subsidies, treatment of excepted benefits H.R. 3999 FMLA 2014, FMLA Enhancement Act of 2014 H.R. 1786/S.928 James Zadroga 9/11 Health and Compensation Reauthorization Act: coverage, funding H.R.2050/S. 2045 Middle Class Health Benefits Tax Repeal Act of 2015: Provisions repealing the tax on high cost health care plans H.R.30/ S. 30 Save American Workers Act of 2015: Change of hours threshold from 30 to 40 for required offer of health coverage by employer S.1083/ H.R. 2005 Medicare Drug Savings Act of 2015: Provisions that would apply the Medicaid drug rebate to drugs for Medicare LIS beneficiaries H.R.2712 Commonsense Reporting and Verification Act of 2015: Provisions reducing employers' requirements to report compliance with the ACA employer responsibility requirement H.R. 879 Ax the Tax on Middle Class Americans' Health Plans Act S. 2075: American Worker Health Care Tax Relief Act of 2015 OSHA enforcement policies and programs H.R. 1314: Provisions preventing large increases in the Medicare Part B Health Insurance Premium Tax H.R. 2090: Excise Tax (Code 49801 Repeal) ACA: Implementation OSHA Injury tracking rule

Client expense: $740,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), Election Assistance Commission (EAC), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Deposit Insurance Corporation (FDIC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

P.L. 111-148 Patient Protection and Affordable Care Act: Employer responsibility requirements, treatment of excepted benefits P.L. 111-152 Health Care and Education Reconciliation Act of 2010: Employer responsibility requirements, treatment of excepted benefits H.R. 3999 FMLA 2014, FMLA Enhancement Act of 2014; comp time, overtime H.R. 1786/S.928 James Zadroga 9/11 Health and Compensation Reauthorization Act: coverage, funding H.R.2050/S. 2045 Middle Class Health Benefits Tax Repeal Act of 2015: Provisions repealing the tax on high cost health care plans H.R.30/ S. 30 Save American Workers Act of 2015: Change of hours threshold from 30 to 40 for required offer of health coverage by employer S.568 Trade Adjustment Assistance Act of 2015: Provisions related to extension of the Health Coverage Tax Credit S.1005 A bill to amend the Internal Revenue Code of 1986 to extend and modify the credit for health insurance costs of certain eligible individuals, and for other purposes: Provisions related to extension of the Health Coverage Tax Credit S.1083/ H.R. 2005 Medicare Drug Savings Act of 2015: Provisions that would apply the Medicaid drug rebate to drugs for Medicare LIS beneficiaries H.R.2712 Commonsense Reporting and Verification Act of 2015: Provisions reducing employers' requirements to report compliance with the ACA employer responsibility requirement H.R.1974 HEAL for Immigrant Women and Families Act of 2015: Provisions expanding Medicaid and ACA premium subsidy eligibility for immigrants S. 1817/S. 1818/S. 708/S. 1607: Regulatory Reform legislation Medicare: premiums ACA Excise tax on high-cost health plans, meeting prep call, implementation H.R. 879 Ax the Tax on Middle Class Americans' Health Plans Act S. 2075: American Worker Health Care Tax Relief Act of 2015 Medicare part B premium and deductible; provisions preventing high premium and deductible increases for beneficiaries OSHA enforcement policies and programs

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

Government targets: Bureau of Labor Statistics (BLS), Defense, Dept of (DOD), Election Assistance Commission (EAC), Energy, Dept of, Environmental Protection Agency (EPA), Executive Office of the President (EOP), Federal Reserve System, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Occupational Safety & Health Administration (OSHA), Office of Personnel Management (OPM), Office of the Vice President of the United States, President of the U.S., SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR), Vice President of the U.S., White House Office

P.L. 111-148 Patient Protection and Affordable Care Act: Employer responsibility requirements, treatment of excepted benefits P.L. 111-152 Health Care and Education Reconciliation Act of 2010: Employer responsibility requirements, treatment of excepted benefits Repeal of the Affordable Care Act excise tax on high cost plans; provisions repealing the excise tax on employer-based high cost health plans, H.R. 3999 FMLA 2014 Prescription drug prices H.R. 2712 Common Sense Reporting Act OSHA's Infections Disease Rulemaking Regulatory: safety and health H.R. 1786/S.928 James Zadroga 9/11 Health and Compensation Reauthorization Act: coverage, funding H.R.2050 Middle Class Health Benefits Tax Repeal Act of 2015: Provisions repealing the tax on high cost health care plans H.R.30/ S. 30 Save American Workers Act of 2015: Change of hours threshold from 30 to 40 for required offer of health coverage by employer S.Con.Res.11 An original concurrent resolution setting forth the congressional budget for the United States Government for fiscal year 2016 and setting forth the appropriate budgetary levels for fiscal years 2017 through 2025: Amendments that would allow for a change in the definition of full time employee for the purposes of the ACA and exempting educational employers from the employer mandate S.568 Trade Adjustment Assistance Act of 2015: Provisions related to extension of the Health Coverage Tax Credit S.1005 A bill to amend the Internal Revenue Code of 1986 to extend and modify the credit for health insurance costs of certain eligible individuals, and for other purposes: Provisions related to extension of the Health Coverage Tax Credit S.1083/ H.R. 2005 Medicare Drug Savings Act of 2015: Provisions that would apply the Medicaid drug rebate to drugs for Medicare LIS beneficiaries H.R.2712 Commonsense Reporting and Verification Act of 2015: Provisions reducing employers' requirements to report compliance with the ACA employer responsibility requirement H.R.1974 HEAL for Immigrant Women and Families Act of 2015: Provisions expanding Medicaid and ACA premium subsidy eligibility for immigrants H.R.1571 Improving Access to Medicare Coverage Act of 2015: Provisions defining inpatient stay for Medicare reimbursement H.R.1650 Medicare Patient Empowerment Act of 2015: Provisions allowing physicians to charge Medicare beneficiaries fees that exceed Medicare's reimbursement for services

Client expense: $920,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Vice President of the United States, Pension Benefit Guaranty Corporation (PBGC), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

P.L. 111-148 Patient Protection and Affordable Care Act: Employer responsibility requirements, treatment of excepted benefits P.L. 111-152 Health Care and Education Reconciliation Act of 2010: Employer responsibility requirements, treatment of excepted benefits H.R. 3999 FMLA 2014, FMLA Enhancement Act of 2014; comp time, overtime H.R. 1786/S.928 James Zadroga 9/11 Health and Compensation Reauthorization Act: coverage, funding H.R.2050/S. 2045 Middle Class Health Benefits Tax Repeal Act of 2015: Provisions repealing the tax on high cost health care plans H.R.30/ S. 30 Save American Workers Act of 2015: Change of hours threshold from 30 to 40 for required offer of health coverage by employer S.568 Trade Adjustment Assistance Act of 2015: Provisions related to extension of the Health Coverage Tax Credit S.1005 A bill to amend the Internal Revenue Code of 1986 to extend and modify the credit for health insurance costs of certain eligible individuals, and for other purposes: Provisions related to extension of the Health Coverage Tax Credit S.1083/ H.R. 2005 Medicare Drug Savings Act of 2015: Provisions that would apply the Medicaid drug rebate to drugs for Medicare LIS beneficiaries H.R.2712 Commonsense Reporting and Verification Act of 2015: Provisions reducing employers' requirements to report compliance with the ACA employer responsibility requirement H.R.1974 HEAL for Immigrant Women and Families Act of 2015: Provisions expanding Medicaid and ACA premium subsidy eligibility for immigrants S. 1817/S. 1818/S. 708/S. 1607: Regulatory Reform legislation Medicare: premiums ACA Excise tax on high-cost health plans, meeting prep call, implementation H.R. 879 Ax the Tax on Middle Class Americans' Health Plans Act S. 2075: American Worker Health Care Tax Relief Act of 2015 Medicare part B premium and deductible; provisions preventing high premium and deductible increases for beneficiaries OSHA enforcement policies and programs

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

Government targets: Bureau of Labor Statistics (BLS), Defense, Dept of (DOD), Election Assistance Commission (EAC), Energy, Dept of, Environmental Protection Agency (EPA), Executive Office of the President (EOP), Federal Reserve System, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Occupational Safety & Health Administration (OSHA), Office of Personnel Management (OPM), Office of the Vice President of the United States, President of the U.S., SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR), Vice President of the U.S., White House Office

P.L. 111-148 Patient Protection and Affordable Care Act: Employer responsibility requirements premium and cost sharing subsidies, treatment of excepted benefits P.L. 111-152 Health Care and Education Reconciliation Act of 2010: Employer responsibility requirements premium and cost sharing subsidies, treatment of excepted benefits H.R. 3999 FMLA 2014, FMLA Enhancement Act of 2014 H.R. 1786/S.928 James Zadroga 9/11 Health and Compensation Reauthorization Act: coverage, funding H.R.2050/S. 2045 Middle Class Health Benefits Tax Repeal Act of 2015: Provisions repealing the tax on high cost health care plans H.R.30/ S. 30 Save American Workers Act of 2015: Change of hours threshold from 30 to 40 for required offer of health coverage by employer S.1083/ H.R. 2005 Medicare Drug Savings Act of 2015: Provisions that would apply the Medicaid drug rebate to drugs for Medicare LIS beneficiaries H.R.2712 Commonsense Reporting and Verification Act of 2015: Provisions reducing employers' requirements to report compliance with the ACA employer responsibility requirement H.R. 879 Ax the Tax on Middle Class Americans' Health Plans Act S. 2075: American Worker Health Care Tax Relief Act of 2015 OSHA enforcement policies and programs H.R. 1314: Provisions preventing large increases in the Medicare Part B Health Insurance Premium Tax H.R. 2090: Excise Tax (Code 49801 Repeal) ACA: Implementation OSHA Injury tracking rule

Client expense: $740,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), Election Assistance Commission (EAC), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Deposit Insurance Corporation (FDIC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

1. Patient Protection and Affordable Health Care Act, implementation of provisions regarding Medicare Part D coverage gap assistance, preventive care services, and dual eligible Medicare and Medicare beneficiaries 2. Proposals to create a premium support or voucher program under Medicare 3. Proposals to "means test" Medicare premiums and benefits 4. Proposals to change federal and state Medicaid cost sharing 5. Proposals to raise the Medicare eligibility age 6. Proposals regarding prescription drug costs for low income Medicare beneficiaries 7. S. 1083, Medicare Drug Savings Act, entire bill 8. Medicare Part B Premiums and Deductibles for 2016 9. Expansion of Medicare benefits to include hearing, vision, and dental benefits 10.H.R. 3696, Medicare Premium Fairness Act of 2015, entire bill 11. S. 2148, Medicare Beneficiaries Act of 2015, entire bill 12. H.R. 1314, Bipartisan Budget Act of 2015, provisions relating to Medicare premiums and deductibles

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, U.S. Postal Service (USPS)

S. 31: Medicare Prescription Drug Price Negotiation Act of 2015 - Provisions related to Secretary negotiation authority in Part D program S. 141: Protecting Seniors' Access to Medicare Act of 2015 - Provisions related to Independent Payment Advisory Board (IPAB) repeal S. 275: Medicare Home Infusion Site of Care Act of 2015 - Provisions related to Medicare coverage S. 480: National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 - Provisions related to the reauthorization of the national controlled substance monitoring program S. 648: Medicare Formulary Improvement Act - Provisions related to codification of six protected classes in Part D program S. 1083: Medicare Drug Savings Act of 2015 - Provisions related to drug rebates in Medicare Part D S. 1253: Patient Access to Disposable Medical Technology Act of 2015 - Provisions related to capitated payments for disposable medical technology S. 1396: Value-Based Insurance Design Seniors Copayment Reduction Act of 2015 - Provisions related to changes to the Medicare Advantage Program S. 1884: Medicare Prescription Drug Savings and Choice Act of 2015 - Provisions related to the Medicare Operated Prescription Drug Plan Option S. 1913: Stopping Medication Abuse and Protecting Seniors Act of 2015 - Provisions related to programs to prevent prescription drug abuse under the Medicare program S. 2023: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures H.R. 22: FAST Act - Medicare related offsets to the biopharmaceutical industry H.R. 1190: Protecting Seniors Access to Medicare Act of 2015 - Provisions related to IPAB repeal H.R. 2005: Medicare Drug Savings Act of 2015 - Provisions relating to changes to Part D rebates H.R. 2298: Medicare Patient Safety and Drug Abuse Prevention Act - Provisions related to the design of a Part D Lock-in program H.R. 3513: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures H.R. 3819: Surface Transportation Extension Act of 2015 - Medicare related offsets to the biopharmaceutical industry H.R. __, S. __: Medicare and Medicaid Improvements and Adjustments Act of 2015 - Provisions related to Hospital Outpatient Department (HOPD) reimbursement rates Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability; Proposed Rules [CMS-2390-P] - Provisions related to Medicaid Medicaid Program; Covered Outpatient Drugs; Proposed Rule [CMS-2345-F] - Provisions related to calculating Average Manufacturer Price (AMP) Proposed Medicare hospital outpatient prospective payment system (OPPS) rule for 2016 (CMS-1633-P) Proposed Medicare physician fee schedule (MPFS) rule for 2016 (CMS-1631-P) Hospital Improvements for Payment Act (discussion draft) - Provisions related to Medicare Parts A and B reform Department of Health and Human Services (HHS) delivery system reform issues and regulatory barriers to innovation Medicare Part B Average Sales Price (ASP) policy issues Medicare Part D rebates policy issues Drug cost and pricing policy issues Transparency policy issues Medication adherence policy issues Alternative payment models policy issues Chronic Care Working Group - Medicare policy affecting drugs HR. 512 - the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms Act of 2014

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

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

P.L. 111-148 Patient Protection and Affordable Care Act: Employer responsibility requirements premium and cost sharing subsidies, treatment of excepted benefits P.L. 111-152 Health Care and Education Reconciliation Act of 2010: Employer responsibility requirements premium and cost sharing subsidies, treatment of excepted benefits H.R. 3999 FMLA 2014, FMLA Enhancement Act of 2014 H.R. 1786/S.928 James Zadroga 9/11 Health and Compensation Reauthorization Act: coverage, funding H.R.2050/S. 2045 Middle Class Health Benefits Tax Repeal Act of 2015: Provisions repealing the tax on high cost health care plans H.R.30/ S. 30 Save American Workers Act of 2015: Change of hours threshold from 30 to 40 for required offer of health coverage by employer S.1083/ H.R. 2005 Medicare Drug Savings Act of 2015: Provisions that would apply the Medicaid drug rebate to drugs for Medicare LIS beneficiaries H.R.2712 Commonsense Reporting and Verification Act of 2015: Provisions reducing employers' requirements to report compliance with the ACA employer responsibility requirement H.R. 879 Ax the Tax on Middle Class Americans' Health Plans Act S. 2075: American Worker Health Care Tax Relief Act of 2015 OSHA enforcement policies and programs H.R. 1314: Provisions preventing large increases in the Medicare Part B Health Insurance Premium Tax H.R. 2090: Excise Tax (Code 49801 Repeal) ACA: Implementation OSHA Injury tracking rule

Client expense: $740,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), Election Assistance Commission (EAC), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Deposit Insurance Corporation (FDIC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Labor Relations Board (NLRB), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), Office of the Vice President of the United States, SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

H.R. 2005, S. 1083, Medicare Drugs Savings Act, Discussed legislation 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. 919, S.522, Childrens's Health Insurance Program - Discussed Children's Health Insurance Program (CHIP) extension. Discussed Medicare coverage of hearing aids. (no bill) Discussed changes to the Medicare benefit design, such as copays, premiums, and deductibles.(no bill) Discussed Medicare health information technology, data transparency, and Qualifying Entities. (no bill) Discussed health care quality and measurement. (no bill) H.R. 2029,H.J.Res.75, H.J.Res.78, Labor, HHS, Education and Related Agencies Appropriations, FY2016 - Lobbied to protect vital health and social services programs, and to prevent repeal of certain financial and healthcare legislation. Discussed structural changes to Medicaid. (no bill) S. 1549, Care Planning Act, Discussed the bill which provides for advanced illness care coordination services. Discussed family caregiver assessment in Medicaid home and community-based services with CMS and guidance to states on the issue.(no bill) Discussed Medicare telemedicine policy. Discussed Medicare Part B premiums and deductibles in 2016. 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 number). Discussed legislation (no bill) 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. 2624, S. 1488, Discussed the Part D Beneficiary Appeals Fairness Act, a bill that would allow seniors to appeal the placement of their medications on a Medicare Part D specialty tier. Discussed Medicare Part D fraud and abuse legislation including lock-in provisions for high risk enrollees (no bill). Wrote to CMS in support of the second initiative of Washington State's proposed 1115 waiver. (no bill) S. 1719, Discussed family caregiving, home and community-based services, Money Follows the Person Rebalancing Demonstration, and Balancing Incentives Payments Program. (no bill) Signed onto letter to CMS to request a revision in Medicaid policy to eliminate coverage gaps in home and community-based services in accord with a recent federal court ruling (CMS). (no bill) PL 114-42, Called into NOTICE Act CMS town hall meeting. Discussed Medicaid personal care services in Oregon and California with GAO. (no bill) Discussed Spurring and Environment for Telehealth Innovation Act of 2015. (no bill) Discussed Medicaid managed long-term services and supports in states with GAO. (no bill) Provided feedback on draft Medicare Choices Empowerment and Protection Act (H.R. 4059, S. 2297) and Compassionate Care Act (no bill). H.R. 3298, Provided feedback on Medicare Post-Acute Care Value-Based Purchasing Act. H.R. 2029, Omnibus Appropriations Bill, Talked with Hill staff about possible Medicare Advantage provisions.

Client expense: $1,880,000 · 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), Commerce, Dept of (DOC), Congressional Budget Office (CBO), Consumer Financial Protection Bureau (CFPB), Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), White House Office

S. 31: Medicare Prescription Drug Price Negotiation Act of 2015 - Provisions related to Secretary negotiation authority in Part D program S. 141: Protecting Seniors' Access to Medicare Act of 2015 - Provisions related to Independent Payment Advisory Board (IPAB) repeal S. 275: Medicare Home Infusion Site of Care Act of 2015 - Provisions related to Medicare coverage S. 480: National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 - Provisions related to the reauthorization of the national controlled substance monitoring program S. 648: Medicare Formulary Improvement Act - Provisions related to codification of six protected classes in Part D program S. 1083: Medicare Drug Savings Act of 2015 - Provisions related to drug rebates in Medicare Part D S. 1253: Patient Access to Disposable Medical Technology Act of 2015 - Provisions related to capitated payments for disposable medical technology S. 1396: Value-Based Insurance Design Seniors Copayment Reduction Act of 2015 - Provisions related to changes to the Medicare Advantage Program S. 1884: Medicare Prescription Drug Savings and Choice Act of 2015 - Provisions related to the Medicare Operated Prescription Drug Plan Option S. 1913: Stopping Medication Abuse and Protecting Seniors Act of 2015 - Provisions related to programs to prevent prescription drug abuse under the Medicare program S. 2023: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures S. 2409: Medicare and Medicaid Improvements and Adjustments Act of 2015 - Provisions related to outpatient reimbursement rates H.R. 22: FAST Act - Medicare related offsets to the biopharmaceutical industry H.R. 1190: Protecting Seniors Access to Medicare Act of 2015 - Provisions related to IPAB repeal H.R. 2005: Medicare Drug Savings Act of 2015 - Provisions related to changes to Part D rebates H.R. 2298: Medicare Patient Safety and Drug Abuse Prevention Act - Provisions related to the design of a Part D Lock-in program H.R. 3513: Prescription Drug Affordability Act of 2015 - Provisions related to Secretary negotiation authority in Part D program, Medicare and Medicaid rebates, resolution of government enforcement actions, and reporting of certain drug manufacturer expenditures H.R. 3819: Surface Transportation Extension Act of 2015 - Medicare related offsets to the biopharmaceutical industry H.R. 4273: Medicare and Medicaid Improvements and Adjustments Act of 2015 - Provisions related to outpatient reimbursement rates Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability; Proposed rules [CMS-2390-P] - Provisions related to Medicaid Medicaid Program; Covered Outpatient Drugs; Proposed rule [CMS-2345-F] - Provisions related to calculating Average Manufacturer Price (AMP) Proposed Medicare hospital outpatient prospective payment system (OPPS) rule for 2016 (CMS-1633-P) Proposed Medicare physician fee schedule (MPFS) rule for 2016 (CMS-1631-P) Hospital Improvements for Payment Act (discussion draft) - Provisions related to Medicare Parts A and B reform Department of Health and Human Services (HHS) delivery system reform issues and regulatory barriers to innovation Medicare Part B Average Sales Price (ASP) policy issues Medicare Part D rebates policy issues Drug cost and pricing policy issues Transparency policy issues Medication adherence policy issues Alternative payment models policy issues Chronic Care Working Group - Medicare policy affecting drugs

Client expense: $3,820,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Congressional Budget Office (CBO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, U.S. Trade Representative (USTR)

Policies to enhance patient access to medicines in Medicaid; Policies to enhance patient access to medicines in Medicare; H.R. 2298, Medicare Patient Safety and Drug Abuse Prevention Act; H.R. 2914, Promoting Integrity in Medicare Act; H.R. 1190 & S. 141, Protecting Seniors' Access to Medicare Act of 2015; H.R. 2925, Strengthening Medicare Anti-Fraud Measures Act; H.R. 3061 & S. 31, Medicare Prescription Drug Price Negotiation Act of 2015; H.R. 1102 & S. 117, Medicare Prescription Drug Price Negotiation Act; H.R. 2005 & S. 1083, Medicare Drug Savings Act; H. R. 3742, Access to Marketplace Insurance Act; Medicare payment proposals;

Client expense: $1,180,000 · Firm income: Not reported

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

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in P.L. 114-10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 and S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Continuous Glucose Monitoring (CGM); Medicare diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015; Physician Quality and Reporting System (PQRS)

Client expense: Not reported · Firm income: Not reported

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in P.L. 114-10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 and S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Medicare diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015.

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

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

Medicare Privatization. (No bill.) Proposals to transform traditional Medicare to a private insurance carrier program. Medicare Benefit Redesign. (No bill.) Proposals 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. 1083, H.R. 2005, the Medicare Drug Savings Act: proposals to extend the application of Medicaid drug rebates to prescription drugs paid for by Medicare and used by Medicare-Medicaid eligible beneficiaries (dual-eligibles), and by people receiving the Medicare Part D Low-Income Subsidy. Medicare Prescription Drug Price Negotiation. H.R. 3061, S. 31, the Medicare Prescription Drug Price Negotiation Act of 2015: proposals to authorize the Secretary of the Department of Health and Human Services to negotiate discounts, rebates, and other price concessions to lower the cost paid by Medicare to pharmaceutical manufacturers. Medicare Prescription Drug Price Negotiation. H.R. 4207, Medicare Fair Drug Pricing Act of 2015: proposal to allow the Secretary of HHS to negotiate prices with manufacturers where little or no competition exists for drugs. Medicare Prescription Drug Plan Option. H.R. 3261, S. 1884, the Medicare Prescription Drug Savings and Choice Act of 2015: proposals to create one or more Medicare-administered drug plans with uniform premiums, providing seniors with the opportunity to purchase drugs directly through the Medicare program; requires the federal government to use its purchasing power to negotiate lower prices on prescription drugs for beneficiaries who enroll in the Medicare-administered plan. Medicare Home Health Benefits. (No bill.) Proposals pertaining to copayments for beneficiaries receiving the Medicare home health benefit. Medicare Observation Status. S. 843, H.R. 1571, Improving Access to Medicare Coverage Act of 2015: proposal 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, 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. Patent Reform. S. 1137, Patent Act; H.R. 9, Innovation Act: proposal to carve brand-named pharmaceutical manufacturers out of an expedited United States Patent and Trademark Office (USPTO) review process that allows generic companies to bypass costly litigation when challenging drug patents. Expanding Drug Monopolies. H.R. 6, 21st Century Cures Act: proposal to extend orphan drug market exclusivity for existing drugs to new indications. Reducing Prescription Drug Costs. S. 2023, H.R. 3513, Prescription Drug Affordability Act: proposals to allow Medicare to negotiate drug prices, to allow Medicare and Medicaid to receive additional rebates from brand and generic drugs, and to allow for the re-importation of drugs from Canada. Chronic Care Coordination. (No bill.) Proposals to facilitate the delivery of high-quality care for people with Medicare living with multiple chronic conditions. Medicare Vision, Dental and Hearing Coverage. H.R. 3308, Seniors Have Eyes, Ears and Teeth Act: proposal to provide Medicare coverage for vision, hearing and dental services. Medicare Hearing Coverage. H.R. 1653, the Medicare Hearing Aid Coverage Act of 2015: proposal to provide Medicare coverage for the cost of hearing aids and examinations. Medicare Dental Coverage. S. 570, H.R. 1055, the Comprehensive Dental Reform Act: proposal to extend comprehensive dental coverage to all Medicare, Medicaid, and VA beneficiaries. Medicare Part B Premium and Deductible Increase. S. 2148, Protecting Medicare Beneficiaries Act of 2015; H.R. 3696, Medicare Premium Fairness Act of 2015 and P.L. 114-74: proposals to prevent steep increases in Medicare Part B premiums and deductibles in 2016. Medicare Care Planning. S. 1549, the Care Planning Act of 2015: proposals to create a Medicare benefit for care planning, the coordination of services, to fill gaps in quality measurement in the advanced illness field, and to include advanced care planning information in the Medicare & You handbook. Medicare Private Plan Notification Improvements. (No bill.) Proposals to improve the annual notification Medicare private plans promulgate to Parts C and D enrollees pertaining to plan changes that will raise enrollee costs or limit access to products and services.

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), Labor, Dept of (DOL), 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.

Issues related to Medicare Part D, Special Diabetes Program, CHIP, and childhood obesity in H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); H.R. 2102 / S.1131 Medicare Diabetes Prevention Act; H.R. 2404 and S. 1509 Treat and Reduce Obesity Act; Issues related to medical nutrition therapy services to such beneficiaries with pre-diabetes or with risk factors for developing type 2 diabetes H.R. 1686 Medical Nutrition Therapy 2015; issues related to patient diabetes education in H.R. 1726 Access to Quality Diabetes Education Act of 2015; Continuous Glucose Monitoring (CGM); Medicare diabetes screening generally; H.R. 1021 Protecting the Integrity of Medicare Act (PIMA) of 2015; H.R.2005 and S. 1083 Medicare Drug Savings Act of 2015; Physician Quality and Reporting System (PQRS)

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, U.S. Trade Representative (USTR)

Discussed the 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. 2005, S. 1083, Medicare Drugs Savings Act, Discussed legislation 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. House and Senate H.R. 2624, S.1488, Discussed the Part D Beneficiary Appeals Fairness Act, a bill that would allow seniors to appeal the placement of their medications on a Medicare Part D specialty tier. Discussed Medicare Part D fraud and abuse legislation including lock-in provisions for high risk enrollees. (no bill) Discussed legislation 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. (no bill) Discussed pending U.S.Trade agreement negotiations on the Trans Pacific Partnership and their potential impact on prescription drug access and affordabillity.(no bill) H.R.919, S.522, Childrens's Health Insurance Program - Discussed Children's Health Insurance Program (CHIP) extension. Discussed Medicare coverage of hearing aids. (no bill) H.R. 1571, S.843, Improving Access to Medicare Coverage Act - Discussed the bill and urged movement of the bill. H.R.1470, SGR Repeal and Medicare Provider Payment Modernization Act of 2015 - Advocated for greater beneficiary protections. H.R.605, S.275, Home Infusion Site of Care Act - Sent letter of endorsement. H.R. 818, S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME)Act - Sent letter of endorsement. H.R. 876, S.1349, Notice of Observation Treatment and Implication for Care Eligibility (NOTICE)Act - Sent letter of endorsement. Discussed changes to the Medicare benefit design, such as copays, premiums, and deductibles.(no bill) Discussed Medicare health information technology, data transparency, and Qualifying Entities. (no bill) Discussed health care quality and measurement. (no bill) H.R. 3020, S. 1695, S.2132, H.Con.Res.27, S.Con.Res.11, Labor, HHS, Education and Related Agencies Appropriations, FY2016 - Lobbied to protect vital health and social services programs, and to prevent repeal of certain financial and healthcare legislation. Discussed structural changes to Medicaid. (no bill) S. 1549, Care Planning Act, Discussed the bill which provides for advanced illness care coordination services. Met with Senate Finance Committee to discuss recommendations on chronic care, including independence at home expansion and family caregiving support. Discussed family caregiver assessment in Medicaid home and community-based services with CMS (no bill). Attended LTSS financing colloquium with HHS ASPE. (no bill) H.R. 1202, Discussed Medicare Patient Access to Hospice Act. Discussed nursing home care, staffing data, value-based purchasing for SNFs and nursing home quality measures. Attended HHS event on 50th anniversary of Medicare and Medicaid. (no bill) Shared comments on Medicaid and managed care and long-term care facility requirements proposed regulations. Discussed GAO report on Medicaid personal care services. H.R. 3220, S. 1871, Endorsed Medicare Smartcard legislation. H.R. 2948, Endorsed Telehealth Parity Act. Discussed Medicare telemedicine policy. Discussed Medicare Part B premiums and deductibles in 2016. 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 number). Discussed legislation (no bill) 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. 2624, S. 1488, Discussed the Part D Beneficiary Appeals Fairness Act, a bill that would allow seniors to appeal the placement of their medications on a Medicare Part D specialty tier. Discussed Medicare Part D fraud and abuse legislation including lock-in provisions for high risk enrollees (no bill). H.R.1220, S.624, Discussed the removing barriers to Colorectal Cancer Screening Act. Discussed legislation with staff regarding PRIME ACT-HR 818 Preventing and reducing improper Medicare expenditures act.

Client expense: $1,930,000 · 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), Congressional Budget Office (CBO), Consumer Financial Protection Bureau (CFPB), Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), Federal Transit Administration (FTA), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Social Security Administration (SSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), White House Office