Electronic Health Fairness Act of 2015

H.R. 34, 21st Century Cures Act (Upton) - Medicare Advantage and Medicaid issues H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 5659, ESRD Choice Act (Smith) - option for ESRD patients to enroll in MA plans H.R. 5942, Dialysis PATIENTS Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 6265, Medigap Reforms (McDermott) S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD S. 3504, Chronic Care Act (Hatch-Wyden-Isakson-Warner) - chronic care reforms, Medicare Advantage provisions Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.

Client expense: $1,330,000 · Firm income: Not reported

Government targets: 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), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office

H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015. S. 624: Removing Barriers to Colorectal Cancer Screening Act of 2015. Support H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Opposition to proposed Part B demo (81 FR 13229). MACRA Implementation (81 FR 28161). Support for H.R.5122 - To prohibit further action on the proposed rule regarding testing of Medicare Part B prescription drug models. Opposition to H.R.5088 - PIMA of 2016. Sec. 4001, electronic health fairness provision H.R.34 - 21st Century Cures Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1453 & S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015. H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Sec. 4001 and Sec. 4011 in H.R.34 - 21st Century Cures Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1453- The ASC Quality and Access Act S.2071 The ASC Quality and Access Act Electronic Medical records/Meaningful use S.1347- The Electronic Health Fairness Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1220 / S. 624 - Removing Barriers to Colorectal Cancer Screening Act S. 1347 / HR 887 -- The Electronic Health Fairness Act; A bill exempting patient encounters that occur in Ambulatory Surgery Centers when calculating attainment of the Medicare Electronic Health Record Meaningful Use requirements. Further Flexibility in HIT Reporting and Advancing Interoperability Act (FLEX-IT 2 Act) (H.R. 3309)

Client expense: Not reported · Firm income: $28,500

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1453/S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015 H.R. 1220/S. 624 - Removing Barriers to Colorectal Cancer Screening Act of 2015 H.R. 887/S. 1347 - Electronic Health Fairness Act of 2015 H.R. 1314 - Bipartisan Budget Act of 2015 H.R. 5273 - Helping Hospitals Improve Patient Care Act of 2016 H.R. 2299 - To amend title XVIII of the Social Security Act to provide for site-of-service price transparency under the Medicare program H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 Reform of Medicare payments to ASCs Reform of Medicare regulations dealing with ASCs

Client expense: $201,900 · Firm income: Not reported

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

H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 5659, ESRD Choice Act (Smith) - option for ESRD patients to enroll in MA plans H.R. 5942, Dialysis PATIENTS Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD H.R. 6265, Medigap Reforms (McDermott) S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

Client expense: $1,710,000 · 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), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office

H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015. S. 624: Removing Barriers to Colorectal Cancer Screening Act of 2015. Support H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Opposition to proposed Part B demo (81 FR 13229). MACRA Implementation (81 FR 28161). EHR Provision in HR 5273 -Helping Hospitals Improve Patient Care Act of 2016. Support for H.R.5122 - To prohibit further action on the proposed rule regarding testing of Medicare part B prescription drug models.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1453 & S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015. H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Section 203 of HR 5273 - Helping Hospitals Improve Patient Care Act of 2016.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1453- The ASC Quality and Access Act S.2071 The ASC Quality and Access Act Electronic Medical records/Meaningful use S.1347- The Electronic Health Fairness Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Lobbied in support of S. 1347, Electronic Health Record Improvement Act, legislation that would exempt patient encounters performed in an ASC from being counted toward a physician's meaningful use requirement.

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

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

HR 1220 / S. 624 - Removing Barriers to Colorectal Cancer Screening Act S. 1347 / HR 887 -- The Electronic Health Fairness Act; A bill exempting patient encounters that occur in Ambulatory Surgery Centers when calculating attainment of the Medicare Electronic Health Record Meaningful Use requirements. Urge CMS to adopt a reporting policy that would allow a 90-day continuous period for participants in the MU program in 2016, as was the policy for 2015. (HR 3309)

Client expense: Not reported · Firm income: $28,500

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1453 & S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015. H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Section 203 of HR 5273 - Helping Hospitals Improve Patient Care Act of 2016.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 546, ACE Kids Act (Barton) - Medicaid Childrens Care Coordination Program H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.R. 5273, Helping Hospitals Improve Patient Care Act (Tiberi) - MA issues, site-neutral payments H.R. 5506, Dialysis PATIENT Demonstration Act (Young) - demonstration program for Medicare beneficiaries with ESRD Draft Bill on Option for ESRD Patients to Enroll in MA Plans (Ways and Means Committee) H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 298, ACE Kids Act (Grassley) - Medicaid Childrens Care Coordination Program S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services S. 2864, RxCAP Act (Wyden) - Medicare Part D cost-sharing S. 3090, Dialysis PATIENT Demonstration Act (Heller) - demonstration program for Medicare beneficiaries with ESRD Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List.

Client expense: $1,710,000 · Firm income: Not reported

Government targets: 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), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office

H.R. 1453/S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015 H.R. 1220/S. 624 - Removing Barriers to Colorectal Cancer Screening Act of 2015 H.R. 887/S. 1347 - Electronic Health Fairness Act of 2015 H.R. 1314 - Bipartisan Budget Act of 2015 H.R. 2299 - To amend title XVIII of the Social Security Act to provide for site-of-service price transparency under the Medicare program H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 Reform of Medicare payments to ASCs Reform of Medicare regulations dealing with ASCs

Client expense: $202,438 · Firm income: Not reported

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

HR 1453- The ASC Quality and Access Act S.2071 The ASC Quality and Access Act Electronic Medical records/Meaningful use S.1347- The Electronic Health Fairness Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015. S. 624: Removing Barriers to Colorectal Cancer Screening Act of 2015. Support H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Education and advocacy regarding proposed colonoscopy cuts in CY 2016 Proposed Rule for Medicare Physician Fee Schedule. Opposition to proposed Part B demo (81 FR 13229). MACRA Implementation (81 FR 28161). EHR Provision in HR 5273 -Helping Hospitals Improve Patient Care Act of 2016.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015. S. 624: Removing Barriers to Colorectal Cancer Screening Act of 2015. Support H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Education and advocacy regarding proposed colonoscopy cuts in CY 2016 Proposed Rule for Medicare Physician Fee Schedule. S.2425, Patient Access and Medicare Protection Act. Opposition to proposed Part B demo (81 FR 13229)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1453 & S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015. H.R.887 & S.1347 - Electronic Health Fairness Act of 2015.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1220 / S. 624 - Removing Barriers to Colorectal Cancer Screening Act S. 1347 / HR 887 -- The Electronic Health Fairness Act; A bill exempting patient encounters that occur in Ambulatory Surgery Centers when calculating attainment of the Medicare Electronic Health Record Meaningful Use requirements. Urge CMS to adopt a reporting policy that would allow a 90-day continuous period for participants in the MU program in 2016, as was the policy for 2015. (no specific bill) Request for stakeholder input and Centers for Medicare and Medicaid Services transparency related to implementation of the Medicare Access and CHIP Reauthorization Act. (no specific bill)

Client expense: Not reported · Firm income: $28,500

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Affordable Care Act - Chronic Care Innovations; Small Group Expansion; Payment reform; 2017 Notice of Benefit and Payment Parameters (NBPP); ACA Regulations; Co-ops; Implementation; Cyber Security; Open enrollment; Market Stability; Department of Labor Conflict of Interest Rule; Grace Periods; Special Enrollment Periods; (SEPs) Other Health Care Issues - Mental Health Parity; Opioid Education Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) this bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1624 Introduced March 25, 2015 by Brett Guthrie (R-KY) To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. HR 3463 Aligning Children's Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) to amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes as introduced. S. 1347 Electronic Health Fairness Act of 2015 Introduced May 14, 2015 by John Isakson (R-GA) bill to amend title XVII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, and for other purposes. S. 2484 the Clinical Opportunities for Novel and Necessary Effective Technologies (CONNECT) for Health Act Introduced February, 2, 2016 by Brian Schatz (D-HI) a bill to amend titels XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program through the use of telehealth and remote patient monitoring services, and for other purposes. S. 2511 Introduced February 8, 2016 by Lamar Alexander (R-TN) Improving Health Information Technology Act A bill to improve Federal requirements relating to the development and use of electronic health record technology. S. 1945 Introduced August 5, 2015 by Bill Cassidy (R-LA) Mental Health Reform Act of 2016 A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes. S. 2713 Introduced March 17, 2016 by Lamar Alexander (R-TN) Advancing Precision Medicine Act of 2016 A bill to provide for the implementation of a Precision Medicine Initiative.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1453/S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015 H.R. 1220/S. 624 - Removing Barriers to Colorectal Cancer Screening Act of 2015 H.R. 887/S. 1347 - Electronic Health Fairness Act of 2015 H.R. 2299 - To amend title XVIII of the Social Security Act to provide for site-of-service price transparency under the Medicare program H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 Reform of Medicare payments to ASCs Reform of Medicare regulations dealing with ASCs

Client expense: $182,027 · Firm income: Not reported

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

H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3716, Ensuring Access to Quality Medicaid Providers Act (Bucshon) - oversight of terminated Medicaid providers H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap H.R. 4442, CONNECT for Health Act (Black-Welch) - telehealth, remote patient monitoring services H.R. 4589, Excellence in Medicare Act (MacArthur) - MA payment cap H.Con.Res. 125, Budget Resolution (Price) - Medicare, Medicaid issues S. 524, Comprehensive Addiction and Recovery Act (Whitehouse) - Medicare Part D lock-in programs S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 1913, Stopping Medication Abuse and Protecting Seniors Act (Toomey) - Medicare Part D lock-in programs S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2484, CONNECT for Health Act (Schatz-Wicker) - telehealth, remote patient monitoring services Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, , enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); CMS's proposed Part B drug demonstration program; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value-based insurance design (VBID) demonstration; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; new payment system for physicians under MACRA, including implications for MA and Part D plans; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including CMS' proposed substantial revisions to the managed care regulations, new mental health parity rules, the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.

Client expense: $2,210,000 · Firm income: Not reported

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

H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015. S. 624: Removing Barriers to Colorectal Cancer Screening Act of 2015. Support H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Education and advocacy regarding proposed colonoscopy cuts in CY 2016 Proposed Rule for Medicare Physician Fee Schedule. S.2425, Patient Access and Medicare Protection Act. Opposition to proposed Part B demo (81 FR 13229)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1453 & S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015. H.R.887 & S.1347 - Electronic Health Fairness Act of 2015.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Affordable Care Act Issues - Chronic Care Innovations; Small Group Expansion; Payment reform; 2017 Notice of Benefit and Payment Parameters (NBPP); ACA Regulations; Co-ops; Implementation; Cyber Security; Open Enrollment; Market Stability; Department of Labor Conflict of Interest Rule; Grace Periods; Special Enrollment Periods (SEPs) Other Health Care Issues - Mental Health Parity; Opioid Education Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) This bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1624 Introduced March 25, 2015 by Brett Guthrie (R-KY) To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. HR 2646 Helping Families in Mental Health Crisis Act of 2015 Introduced May 4, 2015 by Tim Murphy (R-PA) To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes HR 3463 Aligning Childrens Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) To amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes. as introduced. S. 1347 Electronic Health Fairness Act of 2015 Introduced May 14, 2015 by John Isakson (R-GA) bill to amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, and for other purposes. S. 2484 the Clinical Opportunities for Novel and Necessary Effective Technologies (CONNECT) for Health Act Introduced February 2, 2016 by Brian Schatz (D-HI) A bill to amend titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program through the use of telehealth and remote patient monitoring services, and for other purposes. S. 2511 Introduced February 8, 2016 by Lamar Alexander (R-TN) Improving Health Information Technology Act A bill to improve Federal requirements relating to the development and use of electronic health records technology S. 1945 Introduced August 5, 2015 by Bill Cassidy (R-LA) Mental Health Reform Act of 2016 A bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes. S. 2713 Introduced March 17, 2016 by Lamar Alexander (R-TN) Advancing Precision Medicine Act of 2016 A bill to provide for the implementation of a Precision Medicine Initiative.

Client expense: $1,940,000 · Firm income: Not reported

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

HR 1453- The ASC Quality and Access Act S.2071 The ASC Quality and Access Act Electronic Medical records/Meaningful use S.1347- The Electronic Health Fairness Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Affordable Care Act; Small Group Expansion; Payment reform; 2017 Notice of Benefit and Payment Parameters; ACA Regulations; Co-ops; Risk Stabilization programs; Open Enrollment; Market Stability; Site-neutral payments HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) This bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1624 Introduced March 25, 2015 by Brett Guthrie (R-KY) To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. HR 2646 Helping Families in Mental Health Crisis Act of 2015 Introduced May 4, 2015 by Tim Murphy (R-PA) To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes. HR 3463 Aligning Childrens Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) To amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes. as introduced. S. 1099 Introduced April 27, 2015 by Tim Scott (R-SC) A bill to amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1347 Electronic Health Fairness Act of 2015 Introduced May 14, 2015 by John Isakson (R-GA) bill to amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, and for other purposes.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1220 / S. 624 - Removing Barriers to Colorectal Cancer Screening Act HR 3940 - A bill authorizing a blanket Medicare Electronic Health Record Meaningful Use hardship exemption for the 2015 reporting period. S. 1347 / HR 887 -- The Electronic Health Fairness Act; A bill exempting patient encounters that occur in Ambulatory Surgery Centers when calculating attainment of the Medicare Electronic Health Record Meaningful Use requirements.

Client expense: Not reported · Firm income: $28,500

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 588, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA enrollment opportunities H.R. 818, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 1021, Protecting the Integrity of Medicare Act (Brady) - reducing fraud H.R. 1314, Bipartisan Budget Act - Medicare Part B premium and deductible, Medicare sequestration cuts H.R. 2488, Medicare Beneficiary Preservation of Choice Act (Rothfus-Schrader) - MA open enrollment period H.R. 2505, Increasing Access to Data in Medicare Advantage Act (Kelly) - annual reporting of MA enrollment data H.R. 2506, Preventing Unnecessary Plan Terminations Act (Buchanan) - preventing certain MA plan terminations H.R. 2507, Increasing Regulatory Fairness Act (Brady) - schedule for MA rates H.R. 2570, Strengthening Medicare Advantage through Innovation and Transparency for Seniors Act (Black) - Value-Based Insurance Design demonstration H.R. 2579, Securing Care for Seniors Act (Black) - MA risk adjustment model H.R. 2581, Preservation of Access for Seniors in Medicare Advantage Act (Brady) - Value-Based Insurance Design demonstration and MA open enrollment period H.R. 2582, Seniors Health Care Plan Protection Act (Buchanan) - preventing certain MA plan terminations, MA risk adjustment model H.R. 3696, Protecting Medicare Beneficiaries Act (Titus) - Medicare Part B premiums and deductibles H.R. 3718, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Roskam-Carney) - reducing fraud H.R. 3831, Securing Fairness in Regulatory Timing Act (Brady) - revised schedule for MA payment rates H.R. 4275, Medicare Advantage Quality Payment Relief Act (Kelly) - calculation of MA benchmark cap S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1347, Electronic Health Fairness Act - preventing certain MA plan terminations, annual reporting of MA enrollment data S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program S. 2148, Protecting Medicare Beneficiaries Act (Wyden) - Medicare Part B premiums and deductibles S. 2349, Medicare Advantage Coverage Transparency Act (Heller) - MA enrollment data S. 2351, Securing Fairness in Regulatory Timing Act (Isakson) - revised schedule for MA payment rates Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; Center for Medicare and Medicaid Innovation demonstrations for MA and PDP plans; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

Client expense: $1,850,000 · Firm income: Not reported

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

H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015. S. 624: Removing Barriers to Colorectal Cancer Screening Act of 2015. Support H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Education and advocacy regarding proposed colonoscopy cuts in CY 2016 Proposed Rule for Medicare Physician Fee Schedule. S.2425, Patient Access and Medicare Protection Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1453 - Ambulatory Surgical Center Quality and Access Act of 2015. H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Section 3121, Medicare Site-of-Service Price Transparency in H.R.6 - 21st Century Cures Act. S.2425, Patient Access and Medicare Protection Act. H.R.2029 - Consolidated Appropriations Act, 2016.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Affordable Care Act - Chronic Care Innovations; Small Group Expansion; Payment reform; CBPP; 2017 Notice of Benefit and Payment Parameters; ACA Regulations; Co-ops; Innovations for Healthier Americans Act; Implementation; Cyber Security; Open enrollment; Market Stability; Agency Health Research Quality (AHRQ) Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM HR 6 21st Century Cures Act Introduced May 19, 2015 by Fred Upton (R-MI) This bill amends the Public Health Service Act to reauthorize the National Institutes of Health (NIH) through FY2018. The NIH Innovation Fund is established to fund a strategic plan, early stage investigators, and high-risk, high-reward research. The NIH may require scientific data to be shared if the research is fully funded by the NIH. The NIH and the Food and Drug Administration (FDA) must implement a system that allows further research on clinical trial data. The Centers for Disease Control and Prevention must expand surveillance of neurological diseases. The Council for 21st Century Cures is established to accelerate the discovery, development, and delivery of innovative cures, treatments, and preventative measures. The Department of Health and Human Services monitor the use of antibacterial and antifungal drugs and resistance to these drugs. HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) this bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1624 Introduced March 25, 2015 by Brett Guthrie (R-KY) To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. HR 2646 Helping Families in Mental Health Crisis Act of 2015 Introduced May 4, 2015 by Tim Murphy (R-PA) To make available needed psychiatric, psychological, and supportive services for individuals with mental ilness and families in mental health crisis, and for other purposes. HR 3463 Aligning Children's Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) to amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes as introduced. S. 1099 Introduced April 27, 2015 by Tim Scott (R-SC) A bill to amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1347 Electronic Health Fairness Act of 2015 Introduced May 14, 2015 by John Isakson (R-GA) bill to amend title XVII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, and for other purposes.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to Medicare cancer payment policy. Bipartisan Budget Act of 2015 (P.L. 114-74); provisions related to outpatient department reimbursements. Issues related to Electronic Health Record interoperability. Issues related to ICD-10 implementation. Medicare IME Pool Act of 2015 (H.R. 3292); issues related to the reimbursement of graduate medical students. Electronic Health Fairness Act of 2015 (S. 1347); provisions related to meaningful use. Issues related to federal debt held by physicians and Medicare reimbursements.

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

Government targets: Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, SENATE

Affordable Care Act - -Chronic Care Innovations; Small Group Expansion; Payment reform; CBPP; 2017 Notice of Benefit and Payment Parameters; ACA Regulations; Co-ops; Innovations for Healthier Americans Act; Implementation; Cyber Security; Open Enrollment; Market Stability; Agency Health Research Quality (AHRQ) Federal Employee Health Benefit Program (FEHBP) regarding proposals to allow additional types of carriers including regional PPOs to be included in the coverage options offered by OPM HR 6 21st Century Cures Act Introduced May 19, 2015 by Fred Upton (R-MI) This bill amends the Public Health Service Act to reauthorize the National Institutes of Health (NIH) through FY2018. The NIH Innovation Fund is established to fund a strategic plan, early stage investigators, and high-risk, high-reward research. The NIH may require scientific data to be shared if the research is fully funded by the NIH. The NIH and the Food and Drug Administration (FDA) must implement a system that allows further research on clinical trial data. The Centers for Disease Control and Prevention must expand surveillance of neurological diseases. The Council for 21st Century Cures is established to accelerate the discovery, development, and delivery of innovative cures, treatments, and preventive measures. The Department of Health and Human Services must monitor the use of antibacterial and antifungal drugs and resistance to these drugs. . HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) This bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1314 Spectrum Pipeline Act of 2015 Introduced March 4, 2015 by Patrick Meehan (R-PA) To amend the Internal Revenue Code of 1986 to provide for a right to an administrative appeal relating to adverse determinations of tax-exempt status of certain organizations. HR 1624 Introduced March 25, 2015 by Brett Guthrie (R-KY) To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. HR 2646 Helping Families in Mental Health Crisis Act of 2015 Introduced May 4, 2015 by Tim Murphy (R-PA) To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes. HR 3463 Aligning Childrens Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) To amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes. as introduced. S. 1099 Introduced April 27, 2015 by Tim Scott (R-SC) A bill to amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1347 Electronic Health Fairness Act of 2015 Introduced May 14, 2015 by John Isakson (R-GA) bill to amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, and for other purposes.

Client expense: $2,240,000 · Firm income: Not reported

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

Lobbied in support of S. 1347, Electronic Health Record Improvement Act, legislation that would exempt patient encounters performed in an ASC from being counted toward a physician's meaningful use requirement.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1453/S. 2071 - Ambulatory Surgical Center Quality and Access Act of 2015 H.R. 1220/S. 624 - Removing Barriers to Colorectal Cancer Screening Act of 2015 H.R. 887/S. 1347 - Electronic Health Fairness Act of 2015 H.R. 2299 - To amend title XVIII of the Social Security Act to provide for site-of-service price transparency under the Medicare program H.R. 2570 - Strengthening Medicare Advantage through Innovation and Transparency for Seniors of 2015 Reform of Medicare payments to ASCs Reform of Medicare regulations dealing with ASCs

Client expense: $163,651 · Firm income: Not reported

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

Affordable Care Act; Small Group Expansion; Payment reform; 2017 Notice of Benefit and Payment Parameters; ACA Regulations; Co-ops; Risk Stabilization programs; Open Enrollment; Market Stability; Site-neutral payments HR 928 Introduced February 12, 2015 by Charles Boustany (R-LA) This bill repeals a provision of the Patient Protection and Affordable Care Act that imposes an annual fee on a health insurance provider based on its net premium income. HR 1624 Introduced March 25, 2015 by Brett Guthrie (R-KY) To amend title I of the Patient Protection and Affordable Care Act and title XXVII of the Public Health Service Act to revise the definition of small employer. HR 2646 Helping Families in Mental Health Crisis Act of 2015 Introduced May 4, 2015 by Tim Murphy (R-PA) To make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes. HR 3463 Aligning Childrens Dental Coverage Act Introduced September 9, 2015 by H. Griffith (R-VA) To amend title XXVII of the Public Health Service Act to clarify the treatment of pediatric dental coverage in the individual and group markets outside of Exchanges established under the Patient Protection and Affordable Care Act, and for other purposes. as introduced. S. 1099 Introduced April 27, 2015 by Tim Scott (R-SC) A bill to amend the Patient Protection and Affordable Care Act to provide States with flexibility in determining the size of employers in the small group market. S. 1347 Electronic Health Fairness Act of 2015 Introduced May 14, 2015 by John Isakson (R-GA) bill to amend title XVIII of the Social Security Act with respect to the treatment of patient encounters in ambulatory surgical centers in determining meaningful EHR use, and for other purposes.

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

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

Communicated support for S. 1347, the Electronic Health Fairness Act of 2015; communicated support for S. 1101, the MEDTECH Act; communicated support for on-time implementation of ICD-10; communicated support for S. 314, the Pharmacy and Medically Underserved Areas Enhancement Act; communicated support for S. 776, the Medication Therapy Management Empowerment Act of 2015

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

H.R.1453 - Ambulatory Surgical Center Quality and Access Act of 2015. H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Section 3121, Medicare Site-of-Service Price Transparency in H.R.6 - 21st Century Cures Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Prevent changes to in office ancillary services exception.H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015. S. 624: Removing Barriers to Colorectal Cancer Screening Act of 2015. Support H.R.887 & S.1347 - Electronic Health Fairness Act of 2015. Education and advocacy regarding proposed colonoscopy cuts in CY 2016 Proposed Rule for Medicare Physician Fee Schedule.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

issues related to in-office ancillary services exception; colonoscopy reimbursement cuts contained in Medicare Physician Fee Schedule Proposed Rule for 2016; S. 624/H.R. 1220, Removing Barriers to Colorectal Cancer Screening Act; S. 1079/H.R. 2035, SCREEN Act; S. 1347/H.R. 887, Electronic Health Fairness Act

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

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

Communicated support for S. 1347, the Electronic Health Fairness Act of 2015; communicated support for S. 1101, the MEDTECH Act; communicated support for on-time implementation of ICD-10; communicated support for S. 314, the Pharmacy and Medically Underserved Areas Enhancement Act; communicated support for S. 776, the Medication Therapy Management Empowerment Act of 2015

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

Government targets: SENATE

Prevent changes to in office ancillary services exception.H.R. 1220: Removing Barriers to Colorectal Cancer Screening Act of 2015. S. 624: Removing Barriers to Colorectal Cancer Screening Act of 2015. Support H.R.887 & S.1347 - Electronic Health Fairness Act of 2015

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE