Care Planning Act of 2015

Policy issues facing not-for-profit community-based hospice programs, including: Care Planning Act S.1549 Medicare Advantage hospice carve-in Face-to-face-recertification requirement

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Policy issues facing not-for-profit community-based hospice programs, including: Care Planning Act S.1549 Medicare Advantage hospice carve-in Face-to-face-recertification requirement

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

"H.R. 263, Adult Day Center Enhancement Act," all sections; and "S. 1549, The Care Planning Act of 2015," all sections.

Client expense: $50,765 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

P.L. 111-375 National Alzheimer's Project Act, All sections H.R. 9/S. 1137, the Innovation Act H.R. 1559/S. 857, the Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act of 2015 H.R. 1468, the Global Brain Health Act of 2015 H.R. 2624/S. 1488, the Part D Beneficiary Appeals Fairness Act H.R. 3090/S. 3113, the Alzheimer's Caregiver Support Act H.R. 3091, the Missing Alzheimer's Disease Patient Alert Program Reauthorization Act H.R. 3092, the Alzheimer's Disease Semipostal Stamp Act H.R. 3099/S. 1719, the RAISE Family Caregivers Act H.R. 3119/S. 2748, the Palliative Care and Hospice Education and Training Act H.R. 3243/S. 1362, the PACE Innovation Act H.R. 3660/S. 3126, the Preventive Health Savings Act H.R. 4708/S.2759, the Credit for Caring Act of 2016 H.R. 4919/S. 2614, Kevin and Avonte's Law of 2016 H.R. 5196/S. 879, the Americans Giving Care to Elders (AGE) Act of 2015 H.R. 5347, the Social Security Disability Fairness Act H.R. 5681/S. 3137, the Alzheimer's Beneficiary and Caregiver Support Act H. Res. 237/S. Res. 74, a resolution declaring that achieving the primary goal of the National Plan to Address Alzheimer's Disease of the Department of Health and Human Services to prevent and effectively treat Alzheimer's disease by 2025 is an urgent national priority S. 192, the Older Americans Act Reauthorization Act of 2015 S. 1549, the Care Planning Act of 2015 S. 2010, the Expedited Disability Insurance Payments for Terminally Ill Individuals Act S. 2961, the Compassionate Care Act S. 3130, the Independence at Home Act of 2016 S. 3270, the Elder Abuse Prevention and Prosecution Act

Client expense: $245,500 · 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), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

P.L. 111-375 National Alzheimer's Project Act, All sections H.R. 9/S. 1137, the Innovation Act H.R. 1559/S. 857, the Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act of 2015 H.R. 1468, the Global Brain Health Act of 2015 H.R. 2624/S. 1488, the Part D Beneficiary Appeals Fairness Act H.R. 3090/S. 3113, the Alzheimer's Caregiver Support Act H.R. 3091, the Missing Alzheimer's Disease Patient Alert Program Reauthorization Act H.R. 3092, the Alzheimer's Disease Semipostal Stamp Act H.R. 3099/S. 1719, the RAISE Family Caregivers Act H.R. 3119/S. 2748, the Palliative Care and Hospice Education and Training Act H.R. 3243/S. 1362, the PACE Innovation Act H.R. 3660/S. 3126, the Preventive Health Savings Act H.R. 4708/S.2759, the Credit for Caring Act of 2016 H.R. 4919/S. 2614, Kevin and Avonte's Law of 2016 H.R. 5196/S. 879, the Americans Giving Care to Elders (AGE) Act of 2015 H.R. 5347, the Social Security Disability Fairness Act H.R. 5681/S. 3137, the Alzheimer's Beneficiary and Caregiver Support Act H. Res. 237/S. Res. 74, a resolution declaring that achieving the primary goal of the National Plan to Address Alzheimer's Disease of the Department of Health and Human Services to prevent and effectively treat Alzheimer's disease by 2025 is an urgent national priority S. 192, the Older Americans Act Reauthorization Act of 2015 S. 1549, the Care Planning Act of 2015 S. 2010, the Expedited Disability Insurance Payments for Terminally Ill Individuals Act S. 2961, the Compassionate Care Act S. 3130, the Independence at Home Act of 2016 S. 3270, the Elder Abuse Prevention and Prosecution Act

Client expense: $245,500 · 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), Natl Institutes of Health (NIH), SENATE, Veterans Affairs, Dept of (VA)

H.R.290-Creating Access to Rehabilitation for Every Senior (CARES) Act of 2015 H.R.1190-Protecting Seniors Access to Medicare Act of 2015 H.R.1571-Improving Access to Medicare Coverage Act of 2015 H.R.2298-Medicare Patient Safety and Drug Abuse Prevention Act H.R.2646-Helping Families in Mental Health Crisis Act of 2015 H.R.2799-Furthering Access to Stroke Telemedicine (FAST) Act H.R.2948-Medicare Telehealth Parity Act of 2015 H.R.3081-TELEmedicine for MEDicare (TELE-MED) Act of 2015 H.R.3288-Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R.3291-Medicare Crosswalk Hospital Code Development Act of 2015 H.R.3292-Medicare IME Pool Act of 2015 H.R.3762-Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 H.R.3770-End Surprise Billing Act of 2015 H.R.4059-Medicare Choices Empowerment and Protection Act H.R.4435-Comprehensive Behavioral Health Reform and Recovery Act of 2016 H.R.5273-Helping Hospitals Improve Patient Care H.R.5284-World's Greatest Healthcare Plan Act of 2016 H.R.5547-Health Care Price Transparency Promotion Act of 2016 S.141-Protecting Seniors Access to Medicare Act of 2015 S.599-Improving Access to Emergency Psychiatric Care Act S.843-Improving Access to Medicare Coverage Act of 2015 S.1465-Furthering Access to Stroke Telemedicine (FAST) Act S.1549-Care Planning Act of 2015 S.1648-Rural Emergency Acute Care Hospital (REACH) Act S.1778-TELEmedicine for MEDicare (TELE-MED) Act of 2015 S.1913-Stopping Medication Abuse and Protecting Seniors Act of 2015 S.2297-Medicare Choices Empowerment and Protection Act S.2525-Expand Excellence in Mental Health Act S.2680-Mental Health Reform Act of 2016 S.2985-World's Greatest Healthcare Plan Act of 2016 P.L.114-10-Medicare Access and CHIP Reauthorization Act of 2015

Client expense: $462,139 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.6-21st Century Cures Act H.R.33-Protecting Volunteer Firefighters and Emergency Responders Act H.R.34-21st Century Cures Act H.R.290-Creating Access to Rehabilitation for Every Senior (CARES) Act of 2015 H.R.293-To amend title XI of the Social Security Act to exempt from manufacturer transparency reporting certain transfers used for educational purposes, and for other purposes. H.R.398-Trafficking Awareness Training for Health Care Act H.R.639-Improving Regulatory Transparency for New Medical Therapies Act H.R.647-Access to Life-Saving Trauma Care for All Americans Act H.R.648-Trauma Systems and Regionalization of Emergency Care Reauthorization Act H.R.836-Health Care Safety Net Enhancement Act H.R.953-Comprehensive Addiction and Recovery Act of 2015 H.R.1190-Protecting Seniors Access to Medicare Act of 2015 H.R.1571-Improving Access to Medicare Coverage Act of 2015 H.R.1641-Jason Simcakoski Memorial Opioid Safety Act H.R.1725-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 H.R.1818-Veteran Emergency Medical Technician Support Act of 2015 H.R.1821-Opioid Overdose Reduction Act of 2015 H.R.1854-Comprehensive Justice and Mental Health Act of 2015 H.R.1877-Mental Health First Aid Act of 2015 H.R.2050-Middle Class Health Benefits Tax Repeal Act of 2015 H.R.2298-Medicare Patient Safety and Drug Abuse Prevention Act H.R.2366-Field EMS Modernization and Innovation Act H.R.2463-Dispose Responsibly of your Pills (DROP) Act of 2015 H.R.2536-Recovery Enhancement for Addiction Treatment (TREAT) Act H.R.2603-Saving Lives, Saving Costs Act H.R.2646-Helping Families in Mental Health Crisis Act of 2015 H.R.2799-Furthering Access to Stroke Telemedicine (FAST) Act H.R.2805-Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015 H.R.2850-Stop Overdose Stat Act of 2015 H.R.2872-Opioid Addiction Treatment Modernization Act H.R.2948-Medicare Telehealth Parity Act of 2015 H.R.3014-Medical Controlled Substances Transportation Act of 2015 H.R.3081-TELEmedicine for MEDicare (TELE-MED) Act of 2015 H.R.3250-DXM Abuse Prevention Act of 2015 H.R.3299-Strengthening Public Health Emergency Response Act H.R.3537-Synthetic Drug Control Act of 2015 H.R.3677-Opioid Abuse Prevention and Treatment Act of 2015 H.R.3680-Co-Prescribing to Reduce Overdose Act of 2015 H.R.3681-Improving Access to Emergency Psychiatric Care Act H.R.3682-Reducing Employer Burdens, Unleashing Innovation, and Labor Development Act of 2015 H.R.3691-Improving Treatment for Pregnant and Postpartum Women Act of 2015 H.R.3762-Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 H.R.3770-End Surprise Billing Act of 2015 H.R.3865-Cradle Act H.R.4059-Medicare Choices Empowerment and Protection Act H.R.4063-Promoting Responsible Opioid Management and Incorporating Scientific Expertise Act H.R.4150-Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act H.R.4365-Protecting Patient Access to Emergency Medications Act of 2016 H.R.4435-Comprehensive Behavioral Health Reform and Recovery Act of 2016 H.R.4447-Opioid and Heroin Epidemic Emergency Supplemental Appropriations Act H.R.4499-Promoting Responsible Opioid Prescribing Act of 2016 H.R.4599-Reducing Unused Medications Act of 2016 H.R.4641-To provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes. H.R.4697-Prevevent Drug Addiction Act of 2016 H.R.4771-Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2016 H.R.4732-Advancing Medical Resident Training in Community Hospitals Act of 2016 H.R.5243-Zika Response Appropriations Act H.R.5273-Helping Hospitals Improve Patient Care H.R.5284-World's Greatest Healthcare Plan Act of 2016 H.R.5547-Health Care Price Transparency Promotion Act of 2016 H.Res.877-Encouraging each State to enact legislation that increases the likelihood of survival after sudden cardiac arrest in our Nation's schools. S.141-Protecting Seniors Access to Medicare Act of 2015 S.425-Homeless Veterans' Reintegration Programs Reauthorization Act of 2015 S.453-Veteran Emergency Medical Technician Support Act of 2015 S.480-National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 S.524-Comprehensive Addiction and Recovery Act of 2015 S.599-Improving Access to Emergency Psychiatric Care Act S.636-Increasing the Safety of Prescription Drug Use Act of 2015 S.707-Opioid Overdose Reduction Act of 2015 S.711-Mental Health First Act of 2015 S.763-Trauma Systems and Regionalization of Emergency Care Reauthorization Act S.884-Health Care Safety Net Enhancement Act S.843-Improving Access to Medicare Coverage Act of 2015 S.954-FDA Accountability for Public Safety Act S.993-Comprehensive Justice and Mental Health Act of 2015 S.1134-Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015 S.1392-Safer Prescribing of Controlled Substances Act S.1410-Treatment and Recovery Investment Act S.1431-Prescription Drug Abuse Prevention and Treatment Act of 2015 S.1446-SOAR to Health and Wellness Act of 2015 S.1450-Department of Veterans Affairs Emergency Medical Staffing Recruitment and Retention Act S.1452-Veterans Emergency Health Safety Net Expansion Act of 2015 S.1455-Recovery Enhancement for Addiction Treatment Act S.1465-Furthering Access to Stroke Telemedicine (FAST) Act S.1475-Saving Lives, Saving Costs Act S.1549-Care Planning Act of 2015 S.1648-Rural Emergency Acute Care Hospital (REACH) Act S.1654-Overdose Prevention Act S.1693-To amend title 38, United States Code, to expand eligibility for reimbursement for emergency medical treatment to certain veterans that were unable to receive care from the Department of Veterans Affairs in the 24-month period preceding the furnishing of such emergency treatment, and for other purposes. S.1778-TELEmedicine for MEDicare (TELE-MED) Act of 2015 S.1893-Mental Health Awareness and Improvement Act of 2015 S.1913-Stopping Medication Abuse and Protecting Seniors Act of 2015 S.1945-Mental Health Reform Act of 2015 S.2002-Mental Health and Safe Communities Act of 2015 S.2045-Middle Class Health Benefits Tax Repeal Act of 2015 S.2256-Co-Prescribing Saves Lives Act of 2015 S.2297-Medicare Choices Empowerment and Protection Act S.2525-Expand Excellence in Mental Health Act S.2562-Heroin and Prescription Drug Abuse Prevention and Reduction Act S.2567-Preventing Overprescribing for Pain Act of 2016 S.2578-Reducing Unused Medications Act of 2016 S.2597-Medicare Mental Health Access Act S.2671-Advancing Medical Resident Training in Community Hospitals Act of 2016 S.2680-Mental Health Reform Act of 2016 S.2687-Plan of Safe Care Improvement Act S.2932-Protecting Patient Access to Emergency Medications Act of 2016 S.2985-World's Greatest Healthcare Plan Act of 2016 S. 3407, Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths (MISSION ZERO) Act P.L.114-10-Medicare Access and CHIP Reauthorization Act of 2015 P.L.114-324-Justice for All Reauthorization Act

Client expense: $462,139 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Oppose home health and hospice payment cuts and co-pays. Legislative and regulatory proposals affecting home care and hospice. Fostering Independence Through Technology Act (to be re-filed). S. 578/H.R. 1342, Home Health Care Planning Improvement Act. H.R. 5926/S. 3040, Labor/Health and Human Services/Education Appropriations, FY2017, provisions relating to Lifespan Respite Program, caregiver, and falls prevention matters. Recognition and payment for telehealth services under Medicare and Medicaid. Face to Face Physician Encounter Requirement. Medicare Home Health Rebasing Relief and Reassessment Act (to be re-filed). H.R. 2066, Telehealth Enhancement Act of 2015. H.R. 2948, Medicare Telehealth Parity Act. Home health rural add on payment. H.R. 1202, Medicare Patient Access to Hospice Act of 2015. S. 2389, Preserve Access to Medicare Rural Home Health Services Act of 2015. Value Based Purchasing and Bundling. S. 1650, Home Health Documentation and Program Improvement Act of 2015. Medicare reimbursement of advance care planning services. Appropriations for Family Caregiver Support Programs. H.R. 2208, Hospice Commitment to Accurate and Relevant Encounters Act. S. 1549, Care Planning Act of 2015. H.R. 1202/S. 1354, Medicare Patient Access to Hospice Act of 2015. H.R. 3298, Medicare Post-Acute Value-Based Purchasing Act of 2015. Chronic Care Management Proposals. Case Mix "Creep" Payment cuts Home Health Access Protection Act (draft legislation). S. 2368, Audit and Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015. Medicare Advantage hospice proposals. S. 2416, VERIFI Act. H.R. 2446, to amend the Social Security Act to require the use of electronic visit verification for Medicaid personal care services. H.R. 3119, Palliative Care and Hospice Education and Training Act. S. 2364, Medicare Home Health Flexibility Act of 2015. VA Home Care Services. Home Health Prior Authorization and Pre-Claim review. H.R. 4994 (Public Law 113-185), Improving Medicare Post-Acute Care Transformation (IMPACT) Act. H.R. 4111, Rural Healthcare Connectivity Act. H.R. 2646, Helping Families in Mental Health Crisis Act. H.R. 5799/S. 2786, Rural Access to Hospice Care Act. H.R. 6226, Pre-Claim Undermines Senior's Health (PUSH) Act. S. 2484, CONNECT for Health Care. H.R. 34, 21st Century Cures Act.

Client expense: $100,000 · Firm income: Not reported

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

The Care Planning Act (S. 1549), Home Health Documentation and Program Improvement Act (S. 1650), PCHETA (H.R. 3119/S.2748), Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298), Home Health Planning and Improvement Act (S. 578/H.R. 1342)

Client expense: $15,562 · Firm income: Not reported

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

The Home Health Care Planning Improvement Act of 2015 (H.R. 1342, S. 578) The Care Planning Act (S. 1549), Palliative Care Hospice Education and Training Act (H.R. 3119, S.2748), Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298), Pre-Claims Undermine Seniors' Health Act (H.R. 6226), Home Health Documentation and Program Improvement Act (S. 15650)

Client expense: $15,562 · Firm income: Not reported

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

DEA nurse agent issues; EHR and meaningful use specific to a long term care setting; Improve Access to Medicare Coverage Act S. 843/H.R. 1571; S. 1549, the Care Planning Act.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for H.R. 298, the Put a Registered Nurse in the Nursing Home Act Opposition to S. 30, the Forty Hours is Full Time Act Support for H.R. 1247, the Improving Veterans Access to Care Act Support for H.R. 1209, Improving Access to Maternity Care Act Support for H.R. 2083/S. 1132, the Registered Nurse Safe Staffing Act Opposition to H.R. 36, the Pain Capable Unborn Child Protection Act Support for S. 1549, the Care Planning Act Support S. 1893, the Mental Health Awareness and Improvement Act of 2015 Support for H.R., the Nurse and Health Care Worker Protection Act of 2015 Support for S. 2279, the Veterans Health Care Staffing Improvement Act Support for H.R. 2536, S. 2645 Recovery Enhancement for Addiction Treatment Act of 2015 Support for H.R. 2646, The Helping Families in Mental Crisis Act Support for S. 524, Comprehensive Addiction and Recovery Act of 2016 (Public Law No. 114-198) Support for H.R. 6, the 21st Century Cures Act

Client expense: $430,200 · Firm income: Not reported

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

Urged Congress to protect the Medicaid Coverage expansion in discussions relative to Repeal of the Affordable Care Act. The Helping Hospitals Improve Patient Care Act (H.R. 5273) - Expressed support to enable vulnerable and underserved populations access to quality care. Expressed support for S.3129/H.R. 5613, which would provide the extension of the enforcement moratorium on "direct supervision" requirements for outpatient therapeutic services in critical access and small rural hospitals under Medicare. Common Sense Savings Act of 2016 (H.R. 4725) - Urged Congress to not cut critical funding for Medicaid, CHIP, and the Public and Prevention Fund. The Care Planning Act of 2015 (S. 1549)- Expressed support of bipartisan legislation that would help ensure that Medicare patients facing serious or life-threatening illness have access to care planning and coordination of services to ensure patients receive the care they want and need. Comments to the Senate Finance Committee's Chronic Care working group.

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

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

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

Hospice Medicare Advantage "carve-in"; S. 1549, Care Planning Act of 2015; S. 2786/H.R. 5799, Rural Access to Hospice Act of 2016; H.R. 1202, Medicare Patient Access to Hospice Act of 2015; H.R. 2208, Hospice CARE Act; H.R. 3037, Hospice Care Access Improvement Act of 2015; H.R. 3119, Palliative Care and Hospice Education and Training Act; H.R. 5555, Personalize Our Care Act 2.0; Notice of election/notice of termination/revocation; Medicare Choices Model

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to the prevention and treatment of lung disease. HR 1190 Protecting Seniors Access to Medicare Act of 2015; S. 1549 Care Planning Act of 2015;H.R. 670,the Special Needs Trust Fairness and Medicaid Improvement Act; Issues related to the Affordable Care Act; Issues related to Part B; Issues related to state Medicaid waivers; Issues related to lung cancer screening; Issues related to asthma; Issues related to tobacco cessation; Issues related to durable medical equipment; Issues related to the President's Budget; Issues related to the Budget Control Act;

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Natl Institutes of Health (NIH), Navy, Dept of, Office of Management & Budget (OMB), SENATE, Treasury, Dept of, U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), White House Office

Policy issues facing not-for-profit community-based hospice programs, including: Care Planning Act S.1549 Medicare Advantage hospice carve-in Face-to-face-recertification requirement

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Policy issues facing not-for-profit community-based hospice programs, including: Care Planning Act S.1549 Medicare Advantage hospice carve-in Face-to-face-recertification requirement

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocate for reimbursement for advance care planning, complex care management, and portability of advance directives (Care Planning Act, S. 1549).

Client expense: Not reported · Firm income: $15,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocate for reimbursement for advance care planning, complex care management, and portability of advance directives (Care Planning Act, S. 1549).

Client expense: Not reported · Firm income: $15,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation and policies relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Section 2706 of the ACA regarding provider non-discrimination Policies affecting nurse practitioner education and workforce Definition of essential health benefits and provider network adequacy Health information technology and electronic health records Telehealth provisions of draft medical innovation legislation Mental health services and violence prevention Lead contamination of drinking water H.R. 6/H.R. 34 - 21st Century Cures Act H.R. 30 - Save American Workers Act H.R. 248/S. 305 - American Job Protection Act H.R. 512 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 596 - To repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010 H.R. 609/S. 287 - Safe Food Act H.R. 879 - Ax the Tax on Middle Class Americans' Health Plans Act H.R. 897 - Zika Vector Control Act H.R. 931 - Helping Effective Antibiotics Last (HEAL) Act H.R. 932/S. 497 - Healthy Families Act H.R. 933/S. 486 - Head Start on Vaccinations Act H.R. 1151 - USPSTF Transparency and Accountability Act of 2015 H.R 1189/S. 620 - Preserving Employee Wellness Programs Act H.R. 1209/S. 628 - Improving Access to Maternity Care Act H.R. 1372 - Home Visiting Extension Act H.R. 1462/S. 799 - Protecting Our Infants Act H.R 1517 - Stop Selling and Marketing to Our Kids E-Cigarettes (SMOKE) Act H.R. 1552 - Preservation of Antibiotics for Medical Treatment Act H.R. 1599 - Safe and Accurate Food Labeling Act H.R 1624 - Protecting Affordable Coverage for Employees (PACE) Act H.R. 2017/S. 2217 - Common Sense Nutrition Disclosure Act H.R. 2300/S. 2519 - Empowering Patients First Act of 2015 H.R. 2646 - Helping Families in Mental Health Crisis Act H.R. 2653 - American Health Care Reform Act H.R. 2690 - Including Families in Mental Health Recovery Act H.R. 2713 - Title VIII Nursing Workforce Reauthorization Act H.R. 2948 - Medicare Telehealth Parity Act H.R. 3081/S. 1778 - Telemedicine for Medicare (TELE-MED) Act H.R. 3299 - Strengthening Public Health Emergency Response Act of 2015 H.R. 3379 - Airplane Kits Act H.R. 3463 - Aligning Childrens Dental Coverage Act H.R. 3495 - Women's Public Health and Safety Act H.R. 3660 - Preventive Health Savings Act H.R. 3659 - Exchange Inclusion for a Healthy America Act H.R. 3762 - Restoring Americans Healthcare Freedom Reconciliation Act H.R. 3865/S. 2542 - Cradle Act H.R. 4276 - Behavioral Health Coverage Transparency Act H.R. 4400/S. 2512 - Adding Zika Virus to the FDA Priority Review Voucher Program Act H.R. 4479 - Families of Flint Act H.R. 4723 - Protecting Taxpayers by Recovering Improper Obamacare Subsidy Overpayments Act H.R. 4724 - Reducing Duplicative and Ineffective Federal Funding Act H.R. 4771 - Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2016 H.R. 5001/S. 2822 - Flexibility in Health IT Reporting (Flex-IT) Act H.R. 5003 - Improving Child Nutrition and Education Act of 2016 H.R. 5065/S. 3299 - Bottles and Breastfeeding Equipment Screening (BABES) Act H.R. 5284 - Worlds Greatest Healthcare Plan Act of 2016 H.R. 5456/S. 3065 - Family First Prevention Services Act S. 30 - Forty Hours Is Full Time Act S. 142/H.R. 1375/H.R. 3242 - Child Nicotine Poisoning Prevention Act S. 185 - Promise for Antibiotics and Therapeutics for Health (PATH) Act S. 203 - American Liberty Restoration Act S. 339 - ObamaCare Repeal Act S. 481 - Improving Regulatory Transparency for New Medical Therapies Act S. 522 - Protecting & Retaining Our Children's Health Insurance Program (PRO-CHIP) Act S. 612 - Water Infrastructure Improvements for the Nation Act S. 621 - Prevention of Antibiotic Resistance Act S. 673 - Winding Down Obamacare Act S. 674 - 21st Century Womens Health Act S. 764 - National Bioengineered Food Disclosure Standard S. 971 - Medicare Independence at Home Medical Practice Demonstration Improvement Act S. 993/H.R. 1854 - Comprehensive Justice and Mental Health Act S. 1014 - Personal Care Products Safety Act S. 1016 - Preserving Freedom and Choice in Health Care Act S. 1456 - Rural ACO Improvement Act S. 1549 - Care Planning Act S. 1793 - Promoting Physical Activity for Americans Act S. 1893 - Mental Health Awareness and Improvement Act S. 1945 - Mental Health Reform Act S. 2002/H.R. 3722 - Mental Health and Safe Communities Act S. 2045/H.R. 2050 - Middle Class Health Benefits Tax Repeal Act S. 2075 - American Worker Health Care Tax Relief Act S. 2100 - Tobacco to 21 Act S. 2153 - Provider Payment Sunshine Act S. 2173/H.R. 3712 - Improving Access to Mental Health Act S. 2218/H.R. 1218 - Personal Health Investment (PHIT) Act S. 2259 - ACO Assignment Improvement Act S. 2261 - Rural ACO Provider Equity Act S. 2343/H.R. 4155 - Telehealth Innovation and Improvement Act S. 2380 - Public Health Emergency Response and Accountability Act S. 2408/H.R. 4266 - Nurse and Health Care Worker Protection Act S. 2484 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act S. 2525/H.R. 4567 - Expand Excellence in Mental Health Act of 2016 S. 2609 - An original bill to amend the Agricultural Marketing Act of 1946 to require the Secretary of Agriculture to establish a national voluntary labeling standard for bioengineered foods S. 2680 - Mental Health Reform Act of 2016 S. 2687 - Plan of Safe Care Improvement Act S. 2821 - Testing, Removal, and Updated Evaluations of Lead Everywhere in America for Dramatic Enhancements that Restore Safety to Homes, Infrastructure, and Pipes (True LEADership) Act of 2016 S. 2848/H.R. 5303 - Water Resources Development Act of 2016 S. 2873/H.R. 5395 - Expanding Capacity for Health Outcomes (ECHO) Act S. 3136 - Improving Child Nutrition Integrity and Access Act of 2016 S. 3190 - Strengthening Our Rural Health Workforce Act of 2016 S. 3239 - Research to Accelerate Cures and Equity (RACE) for Children Act S. 3245 - Nursing Workforce Reauthorization Act of 2016 S. 3504 - Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Contacts in support of repealing the Patient Protection and Affordable Care Act, Public Law 111-148, because repeal would 1) eliminate the excise tax on high cost employer-sponsored health coverage which would discourage businesses from offering plans less likely to deny lifesaving medical treatment, 2) eliminate the Independent Payment Advisory Boards duty to make recommendations to limit growth in private, nongovernmental spending on health to below the rate of medical inflation, 3) eliminate the authority of the Department of Health and Human Services to implement those recommendations by imposing "quality and efficiency" measures on health care providers, limiting the circumstances in which treatments can be given to their patients, and 4) eliminate the requirement that state health insurance exchanges administrators exclude from their exchanges insurance plans offered by any insurers the administrators believe allow their policyholders inside or outside the exchange to spend what the administrators consider an "excessive or unjustified" amount on their own health care, thereby restricting the medical treatment. Contacts in response to inquiries regarding implementation of certain elements of The Patient Protection and Affordable Care Act, Public Law 111-148, related to the denial of life-saving medical treatments. Contacts regarding S. 1549, the Care Planning Act of 2015 because 1) it fails to contain proper safeguards against dissuading patients to reject life-saving treatment they would otherwise want both to cut costs, and also due to a pervasive quality of life ethic 2) it authorizes health care providers to deny life-preserving treatment against the express will of a patient or surrogate invalidating several state protective laws and 3) advance planning documents that may have been filled out in other states are to be implemented removing state power over informed consent requirements surrounding choosing life-saving measures, food and fluids. Contacts in the U.S. Senate in support of S.2297, the Medicare Choices Empowerment and Protection Act, which would give Medicare beneficiaries and others online access to a website with state-specific model advance directives that choose life-saving treatment, food and fluids equally with those that reject them. Contacts in the U.S. House in support of H.R. 4059, the Medicare Choices Empowerment and Protection Act, which would give Medicare beneficiaries and others online access to a website with state-specific model advance directives that choose life-saving treatment, food and fluids equally with those that reject them. Contacts regarding advance care planning legislation (not introduced) 1) ensure the legislation provides for adequate oversight regarding the creation of advance planning materials, websites, etc. in order to protect against the materials being crafted in a way that persuades patients to reject treatment they might otherwise choose, 2) ensure that there are not Federally funded unmonitored practitioner consultations could lead to patients forgoing treatment they would otherwise have wanted, 3) ensure that there are not adverse changes to the Assisted Suicide Funding and Restriction Act 4) include oversight for grant approval for physician orders for lifesustaining treatment and 5) protect the right of states to ensure informed consent in choosing and rejecting treatment. Contacts regarding legislation (not introduced) regarding the Patient Protection and Affordable Care Act, Public Law 111-148, provision related to the excise tax on employer-paid health insurance premiums above a governmentally imposed limit that does not allow for medical inflation because the excess benefits tax will have its intended result of effectively imposing a price control on health insurance premiums. Contacts in the U.S. House in support of H.R. 3251 which would prohibit the coverage of advance care planning services under the Medicare Program because unmonitored advance care planning services can in practice be used to nudge patients to agree to forego life-saving treatment and even assisted feeding through the use of unbalanced, distorted, and even inaccurate information. Contacts regarding H.R. 3119, the "Palliative Care and Hospice Education and Training Act" as to whether provisions of the Assisted Suicide Funding Restriction Act would be revoked. Contacts regarding legislation (not introduced) regarding potential legislation related to strengthening Federal policy against physician assisted suicide. Contacts regarding legislation (not introduced) regarding potential legislation related to the actions of the D.C. council pertaining to the "Death with Dignity Act" (B21-0038) and associated violations of the Assisted Suicide Funding Restriction Act of 1997, Pub. L. No. 105-12. National Right to Life opposes the "Death with Dignity Act" and favors congressional nullification thereof. Contacts in the U.S. House regarding potential CMS action in regards to the advance care planning services that have been added to the list of services in the Physician Fee Schedule payment rule.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation and regulations affecting health plans. S.1549, Care Planning Act of 2015; issues related to palliative care. Affordable Care Act (P.L.111-148).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues concerning reimbursement for Medicare hospice services. Issue regarding hospice and the Notice of Election (NOE) process. Issues related to access to the Medicare hospice benefit and Medicare Advantage plans. S. 1549, The Care Planning Act, H.R. 5555 Personalize Your Care Act 2.0 and issues related to care planning. S. 2786 / H.R. 5799, Rural Access to Hospice Act of 2016.

Client expense: Not reported · Firm income: $43,749

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Many aspects of the Affordable Care Act promote changes that are consistent with the mission of the Marshfield Clinic: Extends health insurance to the uninsured Calls for Value Based Purchasing for all providers Calls for the establishment of Accountable Care Organizations The following are key elements of the health policy agenda of the Marshfield Clinic Health System: Medicare Access and CHIP Reauthorization Act With passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress has put to rest the constant threat of massive cuts to Medicare physician fees. Going forward Medicare physician payments will transition to an incentive-based system based on value and accountability. Starting in 2019, Medicare physician payment will be based on the Merit-Based Incentive Payment System (MIPS). Physicians who perform well on quality, value and IT metrics will be rewarded with higher pay rates and those who perform poorly will face penalties. Participants in Alternative Payment Systems (APMs) such as accountable care organizations that assume financial risk will receive 5% bonuses between 2019 and 2024. Because the language of the statute is not specific, the Centers for Medicare and Medicaid Services (CMS) is developing metrics that will be used to determine the bonus payments and penalties that will start in 2019 in a public rulemaking currently underway. The proposed metrics simplify and consolidate the existing measurements employed under the Meaningful Use Incentive Program, the Physician Reporting System (PQRS), and the Value-Based Modifier (VBM) to streamline the reporting burden for physician practices. MIPS will then pay physicians based on four weighted performance categories: Quality (50% of total score in year 1), Advancing Care Information (25% of total score in year 1); Clinical Practice Improvement Activities (15% of total score in year 1): Resource Use (10% of total score in year 1, but growing to 30% in subsequent years). Having a source of credible data as the foundation of CMS metrics is critical both to fair payment and maintaining access to medical services in rural areas. CMS will be refining the metrics perpetually throughout the lifespan of this program. Challenges to fair reimbursement persist under the current Medicare fee schedule, which remains the foundation of the reimbursement system, particularly in regard to the valuation of primary care and the geographic adjustment of physician wages. These challenges must be addressed. Adequate funding for CMS to implement and maintain this new system is critical to patient care, provider education and acceptance of the new program and its long term success. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs and full implementation of the Affordable Care Act and MACRA. MCHS also supported MACRA provisions that extended funding for the Childrens Health Insurance Program and provided $7.2 billion to community health centers over the next 2 years, postponed cuts in payments to hospitals that treat large numbers of low-income patients; and extended provisions that funded geographic adjustment of the physician work, therapy services and payments for rural hospitals. Accountable Care Organizations Marshfield Clinic has benefitted substantially from its 9 + years of experience with CMS in the development and implementation of the Physician Group Practice Demonstration, and the Medicare Shared Savings Program. The mission of the Clinic and the objectives of the PGP and MSSP programs are closely paralleled in that it is our mission and objective to make compassionate care more affordable, improve outcomes and enrich the care experience of our patients. It is in our organizational self-interest that these programs succeed, so we have committed substantial resources and energy to the understanding and improvement of the programs. By both objective and subjective criteria Marshfield Clinic has performed successfully. In a recent letter to CMS we focused on the CMS program objective of encouraging ACOs to transition into full risk arrangements. In the proposed regulations codifying the terms and definitions of the Medicare and CHIP Reauthorization Act of 2015, (MACRA) we find that we must become a risk-bearing MSSP ACO before 2017 to become a qualified Alternative Payment Model (APM). This is a primary strategic objective for MCHS. As Dr. Patrick Conway testified before the Energy and Commerce Health subcommittee on March 17th We (CMS) want to help (organizations) make the transition to become APMs. We believe that it is in our own and our patients best interests that we take whatever steps are necessary to move into risk-bearing arrangements, and we have requested support from CMS to make this necessary transition. Graduate Medical Education - MCHS is concerned about having a sufficient supply of primary care physicians to meet the demands of an expanding and aging population. This is doubly true for patients and health systems in rural settings. Currently only about 10% of physicians practice in rural areas while 25% of the population resides there. While 36% allopathic residents and 50% osteopathic residents who are trained in a rural residency end up practicing in a rural area, only 4% of the residency training actually occurs in rural areas. Currently there are more US medical students graduating from medical school than there are GME slots. An increase in GME primary care training positions is essential to maintaining high-quality, accessible, and cost efficient care. Teaching hospitals in rural locations provide an environment for residents to learn and faculty to serve as educators, providers and researchers. These roles advance the broad mission of preparing each generation of physicians, provide critical patient care and specialized services, often to the disadvantaged, facilitate the discovery of new therapies and treatments, and enable residents to acclimate to the rural setting. As new payment and delivery models emphasize primary care to improve patient outcomes and reduce costs, and as more care shifts to outpatient settings, teaching faculty and residency programs must increase access to ambulatory residency rotations to serve Americans who live in areas with an under-supply of primary care physicians including Psychiatry. The purpose and value of residency training in clinical settings and the financial support needed to sustain physician education will only increase as the U.S. population lives longer with more complex health conditions. To ensure GME can meet the future needs of the newly insured and aging population, Congress must commit to the consistent GME funding and lift Medicares limit on funded residency positions. We support the Teaching Health Center funding in MACRA for Community Health Centers but request you extend funding beyond 2017. The Medicare Advantage Benchmark Cap - ACA SEC. 3201. (b) (4) The Medicare Advantage program provides a full risk, capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. The Medicare Advantage Benchmark Cap - ACA SEC. 3201. (b) (4) By authorizing Quality Incentive Payments for MA plans with star ratings of 4 stars and above, Congress made a significant policy change towards value-based purchasing in the MA program. If a plan is eligible for a Quality Incentive Payment, it receives it in the form of a 5 percent increase to its benchmark. However, Congress also authorized a new methodology for calculating benchmarks, and mandated that benchmarks under the new methodology cannot be greater than what they would have been under the old benchmark methodology. This is the benchmark cap. The benchmark cap reduces or even eliminates Quality Incentive Payments. The policy issue is that the cap weakens the incentive for plans to attain higher star ratings and undermines the shift towards paying for performance in the MA program. We do not think that Congress intended to take away with one provision (the cap) the significant policy change towards paying for value that it enacted in the ACA. This change will have a significant negative impact on Medicare Advantage beneficiaries. Medicare Advantage benchmark cap legislation was introduced in December. MCHS supports H.R. 4275, the Medicare Advantage Quality Payment Relief Act of 2015, introduced by Reps. Mike Kelly (R-PA), Ron Kind (D-WI), Brett Guthrie (R-KY) and Mike Doyle (D-PA) that would remove the quality incentive payments from the calculation of the benchmark cap. Geographic Adjustment of Physician Payments - Recent findings by the Institute of Medicine and the Medicare Payment Advisory Commission have demonstrated significant shortcomings in the data utilized to geographically adjust physician payments. The IOM and MedPAC studies have confirmed that the data sources currently relied upon for geographic adjustment bear no correlation to physician earnings. CMS officials have admitted that the proxies utilized for the purpose of geographic adjustment have never been validated, and there never has been a new data source utilized in the twenty years since the fee schedule was implemented. MedPAC data show that the geographic adjustment reference occupations predict earnings of rural physicians to be 25-30% less than physicians in metropolitan areas. MedPAC data show that earnings of primary care physicians in rural areas are, in fact, 13% higher than physicians in metropolitan areas. Since there is no statistical basis of support for disparities in payment we strongly recommend that Congress require CMS to correct this inequity immediately. Having a source of credible data and a sustainable payment mechanism is critical to maintaining access to primary care services in rural areas for patients who reside in those areas. Telemedicine in Medicare Changes to Medicare law and regulation are needed to improve equity in access for Medicare beneficiaries to services delivered via TeleHealth. Medicare beneficiaries should be allowed to receive services in telemedicine sites located in urban areas. The necessary changes would remove restrictions on originating sites by removing the rural requirement and the list of originating sites and allowing any certified Medicare facility to provide the services; current requirements that physician must bill for services from the originating site should be removed; restrictions on eligible practitioners should be removed to allow all Medicare approved practitioners to provide telemedicine services; and there should be no restrictions on which Medicare services may be provided through telemedicine. We recommend that the Medicare requirement for non-MSA geographic location of the patient be expanded to allow all Medicare certified organizations as originating sites regardless of rural or metropolitan statistical area designation. In addition, MCHS supports the CONNECT for Health Act (S. 2484) and (H.R. 4442) that contains a provision which would permit Medicare Advantage plans to use telehealth or remote patient monitoring technologies to provide basic Medicare benefits, without the restrictions that limit originating sites, geographic locations, store-and-forward technologies, and types of health care provider. We believe that telehealth is a different way of delivering an already covered service, and that Medicare should treat remote access technologies as an alternative modality or complementary means of providing clinical services, and not a service itself. In other words, telehealth should not be seen as simply a supplement or complement to face-to-face encounters. Patients increasingly expect their health plans to provide the access to services and convenience that remote technologies facilitate. These technologies can increase communication between providers and patients, enhance care coordination, and help physicians and patients work together to treat illness and maintaining health. Oral Health Coverage for the Medically Compromised and at Risk Populations There is sufficient data that demonstrates oral health impacts the systemic health of the patient and in doing can reduce the cost of care. Linkages that encourage patient compliance, patient education, provider education, and bi-directional referral and surveillance should be incented and compensated. Shared savings demonstrations should be developed for health systems and co-pay incentives developed for patients engaging in and complying with such inter-disciplinary care. Part B Drug Payment Model CMS proposed a new Medicare Part B Drug Payment Model in the Federal Register on March 11, 2016. This model proposes to test alternative payment methodologies for separately payable Part B drugs to determine whether alternative drug payment designs will lead to a reduction in Medicare expenditures while preserving or enhancing quality of care. MCHS supports CMS efforts to address the rising cost of Medicare Part B drugs, but has concerns about the proposed demonstration of a new Average Sales Price (ASP) payment methodology. Specifically we believe that CMS should utilize its rule making authority to de-link physician payment entirely from the drugs they prescribe for patients. MCHS believes that the major responsibility for unsustainable drug spending remains with pharmaceutical manufacturers. The rising costs of drugs and biologics is a system-wide concern. A major contributing factor to those costs is the price set by manufacturers. The fact that there are no regulations on pricing of new anticancer drugs is disturbing. Pharmaceutical companies have the freedom to price their drug liberally at whatever price they deem appropriate, on the basis of what they presume the market will bear. The fact that the largest purchaser of drugs, the US Government, via Medicare and VA, is obligated to purchase the drug at that price and is barred by law from negotiating price, is illogical, disturbing, and unfortunate for public beneficiaries throughout the country. We believe manufacturers should be transparent about their research and development, marketing, advertising and other costs in getting a drug to market and setting prices that reasonably reflect the true costs. MCHS encourages CMS to work further with stakeholders to address the pricing side of the ledger with the expectation that this will enable it to move beyond shortsighted modifications in the Average Sales Price (ASP)-based payment methodology. To be very explicit we are not recommending that this proposal be withdrawn, but we do believe it is a long way from perfect policy. We believe that some necessary preconditions should be met before this program is implemented. The first of which must be to de-link physician payment entirely from the drugs they prescribe for patients. In addition, we believe manufacturers should be transparent about their research and development, marketing, advertising and other costs in getting a drug to market and setting prices that reasonably reflect the true costs. Advance Care Planning MCHS supports S. 1549 Care Planning Act of 2015, introduced by Senators Mark Warner, Johnny Isakson and Tammy Baldwin which Amends titles XVIII of Medicare) of the Social Security Act (SSAct) to cover advanced illness planning and coordination services furnished to an eligible individual with progressive illness, including Alzheimer's disease, by a hospice or other provider through an interdisciplinary team.

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

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

S. 1549 - Care Planning Act S. 2748/H.R. 3119-the Palliative Care and Hospice Education and Training Act H.R. 3913-Lifespan Respite Care Reauthorization Act S. 2614-Kevin and Avonte's Law of 2016

Client expense: $29,500 · Firm income: Not reported

Government targets: Administration on Aging, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, White House Office

S. 3504 - Creating High Quality Results and Outcome Necessary to Improve Chronic Care Act of 2016 - Issues related to palliative care, telemedicine and other issues related to better serving Medicare beneficiaries. H.R. 5327 - Continuing Appropriations and Military Construction, VA and Related Agencies Appropriations Act of 2017 and Zika Response and Preparedness Act. Issues regarding the funding of opioid related programs. S. 1549 - The Care Planning Act - supporting advances in End-of-Life Care throughout the nation. H.R. 5555 "Personalize Your Care Act 2.0" - focused on improving end of life and palliative care in America. Work surrounding the consumer experience across the private and public insurance spectrum. Focus on elements of the Senate Finance Committee's work related to chronic care coverage in the Medicare program, with an emphasis on end of life and palliative care data provisions. Issues related to Health Reform Law implementation with a specific focus on the regulations to govern insurance cover in and outside of the Exchanges. Potential upcoming regulations applying to insurers in the Affordable Care Act. Issues regarding strengthening, advancing and improving patient and provider options for palliative and end of life care in Medicare, Medicaid and private insurance. Both legislative and regulatory work. Regulatory issues regarding coverage, payment and plan design issues related to Medicare ACA-related regulations promulgated by the Department of Health and Human Services and CMS regarding program integrity within the Exchanges with regard to product design. Issues related to participation and coverage in state based market places. Issues related to the treatment of the 3 Rs in the current ACA-environment.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 3504 - Creating High Quality Results and Outcome Necessary to Improve Chronic Care Act of 2016 - Issues related to palliative care, telemedicine and other issues related to better serving Medicare beneficiaries. S. 1549 - The Care Planning Act - supporting advances in End-of-Life Care throughout the nation. H.R. 5555 "Personalize Your Care Act 2.0" - focused on improving end of life and palliative care in America. Focus on elements of the Senate Finance Committee's work related to chronic care coverage in the Medicare program, with an emphasis on end of life and palliative care data provisions. Issues regarding strengthening, advancing and improving patient and provider options for palliative and end of life care in Medicare, Medicaid and private insurance. Both legislative and regulatory work. Regulatory issues regarding coverage, payment and plan design issues related to Medicare Parts C and D. ACA-related regulations promulgated by the Department of Health and Human Services and CMS regarding program integrity within the Exchanges with regard to product design. Issues related to participation and coverage in state based market places. Issues related to the treatment of the 3 Rs in the current ACA-environment.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

P.L. 114-255 - 21st Century Cures Act - Issues focused on preventing opioid abuse. H.R. 5327 Continuing Resolution for Appropriations and Military Construction, VA and Related Agencies Act of 2017 and Zika Response and Preparedness Act - issues related to opioid issues, policies focused on antibiotic resistance and other public health related policies. S. 1549 - The Care Planning Act - supporting advances in End-of-Life Care throughout the nation. S. 524 - The Comprehensive Addiction and Recovery Act - supporting efforts to fight opioid abuse in the United States. Work focused on the inclusion of "lock in" programs in the Medicare program to prevent and protect seniors from opioid addiction. S.185 - The Promise for Antibiotics and Therapeutics for Health (PATH) Act - Focused on ensuring that the Food and Drug Administration has the necessary to tools to ensure that medically needed antibiotics are made available to the public. S. 2153 - Provider Payment Sunshine Act - policies supporting the inclusion of all prescribers to the Open Payments program. H.R. 5054 - Agriculture Appropriations Bill for FY 2017 - Issues related to FDA treatment of antibiotics and compounding of certain pharmaceuticals. Legislative and regulatory issues surrounding unique device identifiers (UDI) being addressed by CMS, FDA and ONC. Exploring new policies to improve end of life care in America.

Client expense: Not reported · Firm income: $25,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

P.L. 114-255 - 21st Century Cures Act - Issues focused on preventing opioid abuse. H.R. 5327 Continuing Resolution for Appropriations and Military Construction, VA and Related Agencies Act of 2017 and Zika Response and Preparedness Act - issues related to opioid issues, policies focused on antibiotic resistance and other public health related policies. S. 1549 - The Care Planning Act - supporting advances in End-of-Life Care throughout the nation. S. 524 - The Comprehensive Addiction and Recovery Act - supporting efforts to fight opioid abuse in the United States. Work focused on the inclusion of "lock in" programs in the Medicare program to prevent and protect seniors from opioid addiction. S. 2153 - Provider Payment Sunshine Act - policies supporting the inclusion of all prescribers to the Open Payments program. Legislative and regulatory issues surrounding unique device identifiers (UDI) being addressed by CMS, FDA and ONC. Exploring new policies to improve end of life care in America. Issues related to ending prescription drug abuse and diversion in Medicare and Medicaid. Supporting policies to maintain the integrity of laws regarding compounding of certain medications.

Client expense: Not reported · Firm income: $25,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Radiation oncology reimbursement. Radiation oncology treatment safety. In office ancillary service exception for Stark laws. H.R.3940, To amend title XVIII of the Social Security Act to authorize a blanket meaningful use significant hardship exception for the 2015 reporting period due to the delay in timely publication of the Stage 2 meaningful use rule. S.1549, To amend title XVIII of the Social Security Act to provide for advanced illness care coordination services for Medicare beneficiaries, and for other purposes. H.R. 6, 21st Century Cures Act.

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

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

S.2425-Patient Access and Medicare Protection Act (PAMPA) implementation. Support for legislation to ensure patient safety and preserve the integrity of the Medicare program by ending abuses of the physician self-referral law for radiation therapy services; Protecting Integrity in Medicare Act (H.R. 5088) Support for structural changes that lead to delivering high-quality care for patients while increasing efficiencies and promoting Medicare sustainability; oppose radiation oncology benefit managers. Support for ensuring radiation oncologists participation in the Medicare electronic health record incentive program. Support for reforming the way Medicare pays for radiation oncology services by tying payments to quality and value. Implementation of H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 Support the elimination of abuse to the Medicare program by closing the in-office ancillary services exception to the Stark Law for radiation oncology services. S. 1549, To amend title XVIII of the Social Security Act to provide for advanced illness care coordination services for Medicare beneficiaries, and for other purposes. Helping Hospitals Improve Patient Care (H.R. 5273) H.R. 5721 Local Coverage Determination Clarification Act of 2016

Client expense: $169,918 · 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), Natl Institutes of Health (NIH), Nuclear Regulatory Commission (NRC), Office of Management & Budget (OMB), SENATE

Medicare hospice and advanced care planning issues The Care Planning Act: S 1549 The Hospice Commitment to Accurate and Relevant Encounters Act - Hospice CARE: H.R. 2208

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

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

P.L. 111-375 National Alzheimer's Project Act, All sections H.R. 9/S. 1137, the Innovation Act H.R. 1559/S. 857, the Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act of 2015 H.R. 1468, the Global Brain Health Act of 2015 H.R. 2624/S. 1488, the Part D Beneficiary Appeals Fairness Act H.R. 3090/S. 3113, the Alzheimer's Caregiver Support Act H.R. 3091, the Missing Alzheimer's Disease Patient Alert Program Reauthorization Act H.R. 3092, the Alzheimer's Disease Semipostal Stamp Act H.R. 3099/S. 1719, the RAISE Family Caregivers Act H.R. 3119/S. 2748, the Palliative Care and Hospice Education and Training Act H.R. 3243/S. 1362, the PACE Innovation Act H.R. 3660/S. 3126, the Preventive Health Savings Act H.R. 4708/S.2759, the Credit for Caring Act of 2016 H.R. 4919/S. 2614, Kevin and Avonte's Law of 2016 H.R. 5196/S. 879, the Americans Giving Care to Elders (AGE) Act of 2015 H.R. 5347, the Social Security Disability Fairness Act H.R. 5681/S. 3137, the Alzheimer's Beneficiary and Caregiver Support Act H. Res. 237/S. Res. 74, a resolution declaring that achieving the primary goal of the National Plan to Address Alzheimer's Disease of the Department of Health and Human Services to prevent and effectively treat Alzheimer's disease by 2025 is an urgent national priority S. 192, the Older Americans Act Reauthorization Act of 2015 S. 1549, the Care Planning Act of 2015 S. 2010, the Expedited Disability Insurance Payments for Terminally Ill Individuals Act S. 2961, the Compassionate Care Act S. 3130, the Independence at Home Act of 2016 S. 3270, the Elder Abuse Prevention and Prosecution Act

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

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

The Home Health Care Planning Improvement Act of 2015 (H.R. 1342, S. 578) The Care Planning Act (S. 1549), Palliative Care Hospice Education and Training Act (H.R. 3119, S.2748), Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298), Pre-Claims Undermine Seniors' Health Act (H.R. 6226)

Client expense: $15,603 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Care Planning Act (S. 1549), Home Health Documentation and Program Improvement Act (S. 1650), PCHETA (H.R. 3119/S.2748), Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298)

Client expense: $15,603 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for H.R. 298, the Put a Registered Nurse in the Nursing Home Act Opposition to S. 30, the Forty Hours is Full Time Act Support for H.R. 1247, the Improving Veterans Access to Care Act Support for H.R. 1209, Improving Access to Maternity Care Act Support for H.R. 2083/S. 1132, the Registered Nurse Safe Staffing Act Opposition to H.R. 36, the Pain Capable Unborn Child Protection Act Support for S. 1549, the Care Planning Act Support S. 1893, the Mental Health Awareness and Improvement Act of 2015 Support for H.R., the Nurse and Health Care Worker Protection Act of 2015 Support for S. 2279, the Veterans Health Care Staffing Improvement Act Support for H.R. 2536, S. 2645 Recovery Enhancement for Addiction Treatment Act of 2015 H.R. 2646, The Helping Families in Mental Crisis Act S. 524, Comprehensive Addiction and Recovery Act of 2016 (Public Law No. 114-198)

Client expense: $478,462 · 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

Oppose home health and hospice payment cuts and co-pays. Legislative and regulatory proposals affecting home care and hospice. Fostering Independence Through Technology Act (to be re-filed). S. 578/H.R. 1342, Home Health Care Planning Improvement Act. H.R. 5926/S. 3040, Labor/Health and Human Services/Education Appropriations, FY2017, provisions relating to Lifespan Respite Program, caregiver, and falls prevention matters. Recognition and payment for telehealth services under Medicare and Medicaid. Face to Face Physician Encounter Requirement. Medicare Home Health Rebasing Relief and Reassessment Act (to be re-filed). H.R. 2066, Telehealth Enhancement Act of 2015. H.R. 2948, Medicare Telehealth Parity Act. Home health rural add on payment. H.R. 1202, Medicare Patient Access to Hospice Act of 2015. S. 2389, Preserve Access to Medicare Rural Home Health Services Act of 2015. Value Based Purchasing and Bundling. S. 1650, Home Health Documentation and Program Improvement Act of 2015. Medicare reimbursement of advance care planning services. Appropriations for Family Caregiver Support Programs. H.R. 2208, Hospice Commitment to Accurate and Relevant Encounters Act. S. 1549, Care Planning Act of 2015. H.R. 1202/S. 1354, Medicare Patient Access to Hospice Act of 2015. H.R. 3298, Medicare Post-Acute Value-Based Purchasing Act of 2015. Chronic Care Management Proposals. Case Mix "Creep" Payment cuts Home Health Access Protection Act (draft legislation). S. 2368, Audit and Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015. Medicare Advantage hospice proposals. S. 2416, VERIFI Act. H.R. 2446, to amend the Social Security Act to require the use of electronic visit verification for Medicaid personal care services. H.R. 3119, Palliative Care and Hospice Education and Training Act. S. 2364, Medicare Home Health Flexibility Act of 2015. VA Home Care Services. Home Health Prior Authorization and Pre-Claim review. H.R. 4994 (Public Law 113-185), Improving Medicare Post-Acute Care Transformation (IMPACT) Act. H.R. 4111, Rural Healthcare Connectivity Act. H.R. 2646, Helping Families in Mental Health Crisis Act. H.R. 5799/S. 2786, Rural Access to Hospice Care Act. H.R. 6226, Pre-Claim Undermines Senior's Health (PUSH) Act. S. 2484, CONNECT for Health Care.

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

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

Issues related to the prevention and treatment of lung disease. HR 1190 Protecting Seniors Access to Medicare Act of 2015; S. 1549 Care Planning Act of 2015; Issues related to the Affordable Care Act; Issues related to Part B; Issues related to state Medicaid waivers; Issues related to lung cancer screening; Issues related to asthma; Issues related to tobacco cessation; Issues related to durable medical equipment; Issues related to the President's Budget; Issues related to the Budget Control Act;

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Natl Institutes of Health (NIH), Navy, Dept of, Office of Management & Budget (OMB), SENATE, Treasury, Dept of, U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), White House Office

S.2425-Patient Access and Medicare Protection Act (PAMPA) implementation. Support for legislation to ensure patient safety and preserve the integrity of the Medicare program by ending abuses of the physician self-referral law for radiation therapy services; Protecting Integrity in Medicare Act (H.R. 5088) Support for structural changes that lead to delivering high-quality care for patients while increasing efficiencies and promoting Medicare sustainability; oppose radiation oncology benefit managers. Support for ensuring radiation oncologists participation in the Medicare electronic health record incentive program. Support for reforming the way Medicare pays for radiation oncology services by tying payments to quality and value. Implementation of H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 Support the elimination of abuse to the Medicare program by closing the in-office ancillary services exception to the Stark Law for radiation oncology services. S. 1549, To amend title XVIII of the Social Security Act to provide for advanced illness care coordination services for Medicare beneficiaries, and for other purposes. Helping Hospitals Improve Patient Care (H.R. 5273) H.R. 5721 Local Coverage Determination Clarification Act of 2016

Client expense: $124,957 · 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), Natl Institutes of Health (NIH), Nuclear Regulatory Commission (NRC), Office of Management & Budget (OMB), 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

Hospice Medicare Advantage "carve-in"; S. 1549, Care Planning Act of 2015; S. 2786/H.R. 5799, Rural Access to Hospice Act of 2016; H.R. 1202, Medicare Patient Access to Hospice Act of 2015; H.R. 2208, Hospice CARE Act; H.R. 3037, Hospice Care Access Improvement Act of 2015; H.R. 3119, Palliative Care and Hospice Education and Training Act; H.R. 5555, Personalize Our Care Act 2.0; Notice of election/notice of termination/revocation; Medicare Choices Model

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation and policies relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Section 2706 of the ACA regarding provider non-discrimination Policies affecting nurse practitioner education and workforce Definition of essential health benefits and provider network adequacy Health information technology and electronic health records Telehealth provisions of draft medical innovation legislation Mental health services and violence prevention Lead contamination of drinking water H.R. 6 - 21st Century Cures Act H.R. 30 - Save American Workers Act H.R. 248/S. 305 - American Job Protection Act H.R. 512 - Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act H.R. 596 - To repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010 H.R. 609/S. 287 - Safe Food Act H.R. 879 - Ax the Tax on Middle Class Americans' Health Plans Act H.R. 897 - Zika Vector Control Act H.R. 931 - Helping Effective Antibiotics Last (HEAL) Act H.R. 932/S. 497 - Healthy Families Act H.R. 933/S. 486 - Head Start on Vaccinations Act H.R 1189/S. 620 - Preserving Employee Wellness Programs Act H.R. 1209/S. 628 - Improving Access to Maternity Care Act H.R. 1372 - Home Visiting Extension Act H.R. 1462/S. 799 - Protecting Our Infants Act H.R 1517 - Stop Selling and Marketing to Our Kids E-Cigarettes (SMOKE) Act H.R. 1552 - Preservation of Antibiotics for Medical Treatment Act H.R. 1599 - Safe and Accurate Food Labeling Act H.R 1624 - Protecting Affordable Coverage for Employees (PACE) Act H.R. 2017/S. 2217 - Common Sense Nutrition Disclosure Act H.R. 2300/S. 2519 - Empowering Patients First Act of 2015 H.R. 2646 - Helping Families in Mental Health Crisis Act H.R. 2653 - American Health Care Reform Act H.R. 2690 - Including Families in Mental Health Recovery Act H.R. 2713 - Title VIII Nursing Workforce Reauthorization Act H.R. 2948 - Medicare Telehealth Parity Act H.R. 3081/S. 1778 - Telemedicine for Medicare (TELE-MED) Act H.R. 3299 - Strengthening Public Health Emergency Response Act of 2015 H.R. 3379 - Airplane Kits Act H.R. 3463 - Aligning Childrens Dental Coverage Act H.R. 3495 - Women's Public Health and Safety Act H.R. 3660 - Preventive Health Savings Act H.R. 3659 - Exchange Inclusion for a Healthy America Act H.R. 3762 - Restoring Americans Healthcare Freedom Reconciliation Act H.R. 3865/S. 2542 - Cradle Act H.R. 4276 - Behavioral Health Coverage Transparency Act H.R. 4400/S. 2512 - Adding Zika Virus to the FDA Priority Review Voucher Program Act H.R. 4479 - Families of Flint Act H.R. 4723 - Protecting Taxpayers by Recovering Improper Obamacare Subsidy Overpayments Act H.R. 4724 - Reducing Duplicative and Ineffective Federal Funding Act H.R. 4771 - Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2016 H.R. 5001/S. 2822 - Flexibility in Health IT Reporting (Flex-IT) Act H.R. 5003 - Improving Child Nutrition and Education Act of 2016 H.R. 5284 - Worlds Greatest Healthcare Plan Act of 2016 H.R. 5456/S. 3065 - Family First Prevention Services Act S. 30 - Forty Hours Is Full Time Act S. 142/H.R. 1375/H.R. 3242 - Child Nicotine Poisoning Prevention Act S. 185 - Promise for Antibiotics and Therapeutics for Health (PATH) Act S. 203 - American Liberty Restoration Act S. 339 - ObamaCare Repeal Act S. 481 - Improving Regulatory Transparency for New Medical Therapies Act S. 522 - Protecting & Retaining Our Children's Health Insurance Program (PRO-CHIP) Act S. 621 - Prevention of Antibiotic Resistance Act S. 673 - Winding Down Obamacare Act S. 674 - 21st Century Womens Health Act S. 764 - National Bioengineered Food Disclosure Standard S. 971 - Medicare Independence at Home Medical Practice Demonstration Improvement Act S. 993/H.R. 1854 - Comprehensive Justice and Mental Health Act S. 1014 - Personal Care Products Safety Act S. 1016 - Preserving Freedom and Choice in Health Care Act S. 1456 - Rural ACO Improvement Act S. 1549 - Care Planning Act S. 1793 - Promoting Physical Activity for Americans Act S. 1893 - Mental Health Awareness and Improvement Act S. 1945 - Mental Health Reform Act S. 2002/H.R. 3722 - Mental Health and Safe Communities Act S. 2045/H.R. 2050 - Middle Class Health Benefits Tax Repeal Act S. 2075 - American Worker Health Care Tax Relief Act S. 2100 - Tobacco to 21 Act S. 2153 - Provider Payment Sunshine Act S. 2173/H.R. 3712 - Improving Access to Mental Health Act S. 2218/H.R. 1218 - Personal Health Investment (PHIT) Act S. 2259 - ACO Assignment Improvement Act S. 2261 - Rural ACO Provider Equity Act S. 2343/H.R. 4155 - Telehealth Innovation and Improvement Act S. 2380 - Public Health Emergency Response and Accountability Act S. 2408/H.R. 4266 - Nurse and Health Care Worker Protection Act S. 2484 - Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act S. 2525/H.R. 4567 - Expand Excellence in Mental Health Act of 2016 S. 2609 - An original bill to amend the Agricultural Marketing Act of 1946 to require the Secretary of Agriculture to establish a national voluntary labeling standard for bioengineered foods S. 2680 - Mental Health Reform Act of 2016 S. 2687 - Plan of Safe Care Improvement Act S. 2821 - Testing, Removal, and Updated Evaluations of Lead Everywhere in America for Dramatic Enhancements that Restore Safety to Homes, Infrastructure, and Pipes (True LEADership) Act of 2016 S. 2848/H.R. 5303 - Water Resources Development Act of 2016 S. 3190 - Strengthening Our Rural Health Workforce Act of 2016 S. 3239 - Research to Accelerate Cures and Equity (RACE) for Children Act S. 3245 - Nursing Workforce Reauthorization Act of 2016

Client expense: Not reported · Firm income: $23,450

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Issues concerning reimbursement for Medicare hospice services. Issues related to access to the Medicare hospice benefit and Medicare Advantage plans. S. 1549, The Care Planning Act, H.R. 5555 Personalize Your Care Act 2.0 and issues related to care planning. S. 2786 / H.R. 5799, Rural Access to Hospice Act of 2016.

Client expense: Not reported · Firm income: $43,749

Government targets: HOUSE OF REPRESENTATIVES, SENATE