Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 3292 Medicare IME Pool Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter; S. 2484 CONNECT for Health Act; MACRA payment models & reimbursement policies; Hospital Inpatient Payment Systems; Acute Care Hospitals and the Long Term Care Hospital PPS; policy changes to FY 2017 Rates-CMS-1655-P proposed rule; Home infusion payment issues

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

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter. Advancing Care for Exceptional Kids Act of 2015 (H.R. 546. S. 298).

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

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

Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016

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

Ongoing implementation of payment and regulatory issues for the Medicare Advantage program. Issues relating to the Medicare Part D prescription drug program, various CMS demonstration programs and of P.L. 111-148 (Patient Protection and Affordable Care Act). Issues relating to Medigap insurance, and H.R. 2, The Medicare Access and CHIP Re authorization Act of 2015. Issues relating to H.R. 2579 - Securing Care for Seniors Act of 2015. Issues related to the introduction of S. 2104, A bill to amend title XVIII of the Social Security Act to provide relief to Medicare Advantage plans with a significant number of dually eligible or low-income subsidy beneficiaries and to prevent the termination of two star plans.

Client expense: $1,040,000 · Firm income: Not reported

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter. Advancing Care for Exceptional Kids Act of 2015 (H.R. 546. S. 298).

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

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 3292 Medicare IME Pool Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter; S. 2484 CONNECT for Health Act; MACRA payment models & reimbursement policies; Hospital Inpatient Payment Systems; Acute Care Hospitals and the Long Term Care Hospital PPS; policy changes to FY 2017 Rates-CMS-1655-P proposed rule

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

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

H.R. 1427/S. 804 Medicare CGM Access Act H.R. 3081/ S. 1778 TELEmedicine for MEDicare (TELE-MED) Act H.R. 1190/S. 141 Protecting Seniors' Access to Medicare Act H.R. 2446 To amend title XIX of the Social Security Act to require the use of electronic visit verification for personal care services furnished under the Medicaid program, and for other purposes. H.R. 3821 Medicaid Directory of Caregivers Act S.2104 Preserving Medicare Advantage for all Medicare Beneficiaries Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

S.2511 Improving Health Information Technology Act H.R. 6 21st Century Cures Act H.R 5447/S. 3060 Small Business Health Care Relief Act of 2016 S. 2744 Genetic Research Privacy Protection Act H.R. 5273 Helping Hospitals Improve Patient Care Act S. 2713 Advancing Precision Medicine Act S. 1878 The Advancing Hope Act S. 1767 Combination Products Innovation Act S. 1077 Advancing Breakthrough Medical Devices for Patients Act S. 2512 Adding Zika Virus to the FDA Priority Review voucher Program Act S. 1101 Medical Electronic Data Technology Enhancement for Consumers Health Act S. 1597 Patient Focused Impact Assessment Act S. 2055 Medical Countermeasures Innovation Act S. 2873 Expanding Capacity for Health Outcomes (ECHO) Act H.R. 3081/ S. 1778 TELEmedicine for MEDicare (TELE-MED) Act H.R. 4442/S. 2484 CONNECT for Health Act H.R. 1192 National Diabetes Clinical Care Commission Act S. 620, H.R. 1189 Preserving Employee Wellness Programs Act H.R. 4878 Better Care, Lower Cost Act H.R. 5273 Helping Hospitals Improve Patient Care Act H.R. 4774 Training Tomorrows Doctors Today Act S. 2671, H.R.4732 Advancing Medical Resident Training in Community Hospitals Act S. 314, H.R. 592 Pharmacy and Medically and Underserved Areas Enhancement Act H.R.1314 Bipartisan Budget Act H.R. 1190/S. 141 Protecting Seniors' Access to Medicare Act H.R. 160/S. 149 Protect Medical Innovation Act H.R. 4732/ S. 2671 Advancing Medical Resident Training in Community Hospitals Act H.R. 2061, Equitable Access to Care and Health (EACH) Act H.R. 2446 To amend title XIX of the Social Security Act to require the use of electronic visit verification for personal care services furnished under the Medicaid program, and for other purposes. H.R. 2603/S. 1475 Saving Lives, Saving Costs Act H.R. 2646 Helping Families in Mental Health Crisis Act H.R. 2704/H.R. 4212/S.704 Community Based Independence for Seniors Act H.R. 2878/S. 1461 To provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2015. H.R.2911/S. 1697 Small Business Healthcare Relief Act H.R. 3539 Reinvigorating Antibiotic and Diagnostic Innovation (READI) Act H.R. 3660 Preventive Health Savings Act H.R. 3716 Ensuring Terminated Providers are Removed from Medicaid and CHIP Act H.R. 3762 Restoring Americans Healthcare Freedom Reconciliation Act H.R. 3821 Medicaid Directory of Caregivers Act H.R. 5380 Telehealth Parity Act S. 139 Ensuring Access to Clinical Trials Act S. 2023 Prescription Drug Affordability Act S. 2030 Advancing Targeted Therapies for Rare Diseases Act S. 2045 Middle Class Health Benefits Tax Repeal Act S. 2075 American Worker Health Care Tax Relief Act S. 2153 Provider Payment Sunshine Act S. 2187 FDA Regulatory Efficiency Act S. 754 Cyber security Information Sharing Act (CISA) S.2104 Preserving Medicare Advantage for all Medicare Beneficiaries Act

Advocated for fairness in Medicare Advantage Stars Quality measurements. S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015, all provisions relating to Medicare Advantage Star Ratings. Opposed cuts to Medicare Advantage and Part D rates. Advocated for a system that incorporates more chronic codes under the risk adjustment methodology. Advocated for the transparency in the methodology surrounding the calculation of the Fee-for-Service error rate in Medicare Advantage Risk Adjustment Data-Validation. H.R. 546 and S. 298, ACE Kids Act, all provisions regarding care of children with complex medical needs. H.R. 2646, Helping Families in Mental Health Crisis Act, all provisions relating to Medicaid and Medicare. S. 2680, Mental Health Reform Act, all provisions relating to Medicaid and Medicare. Advocated for Medicaid Managed Care in an effort to reform the Medicaid program.

Client expense: $280,000 · Firm income: Not reported

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

Advocated for fairness in Medicare Advantage Stars Quality measurements; S.2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015, all provisions relating to Medicare Advantage Star Ratings; advocated for a system that incorporates more chronic codes under the risk adjustment methodology; advocated for the transparency in the methodology surrounding the calculation of the Fee-for-Service error rate in Medicare Advantage Risk Adjustment Data-Validation; H.R.2646, Helping Families in Mental Health Crisis Act, all provisions relating to Medicaid and Medicare; S.2680, Mental Health Reform Act, all provisions relating to Medicaid and Medicare; general implementation of PL 114-10 Medicare Access and CHIP Reauthorization Act of 2015, and Education and issues related to Medicaid program reforms.

Client expense: Not reported · Firm income: $90,000

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

Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016

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

Advocated for fairness in Medicare Advantage Stars Quality measurements. S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015, all provisions relating to Medicare Advantage Star Ratings. Opposed cuts to Medicare Advantage and Part D rates. Advocated for a system that incorporates more chronic codes under the risk adjustment methodology. Advocated for the transparency in the methodology surrounding the calculation of the Fee-for-Service error rate in Medicare Advantage Risk Adjustment Data-Validation. Advocated for fairness in Medicare Advantage rates when high number of beneficiaries opt-out of Medicare Part B.

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

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

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

Issues related to Medicare Advantage payment policy including S.2104, the Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015, Medicare Advantage Stars Quality measurements and risk adjustment within the Medicare Advantage CY 2017 Call Letter and Rate Notice.

Client expense: Not reported · Firm income: $90,000

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

Issues related to Medicare Advantage Stars Quality measurements and risk adjustment and Medicare Advantage payment policy, including S.2104, the Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; H.R.2582 Seniors' Health Care Plan Protection Act of 2015; H.R.2506 Seniors' Health Care Plan Protection Act of 2015; H.R.2579 Securing Care for Seniors Act of 2015; and issues related to plan contracting arrangements with Medicare and Medicaid.

Client expense: Not reported · Firm income: $90,000

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

Issues related to Medicare Advantage payment policy including S.2104, the Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015, Medicare Advantage Stars Quality measurements and risk adjustment within the Medicare Advantage CY 2017 Call Letter and Rate Notice.

Client expense: Not reported · Firm income: $90,000

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 3292 Medicare IME Pool Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; MedPAC Nomination; Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter; S. 2484 CONNECT for Health Act

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

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter

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

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

Advocated for fairness in Medicare Advantage Stars Quality measurements. S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015, all provisions relating to Medicare Advantage Star Ratings. Opposed cuts to Medicare Advantage and Part D rates. Advocated for a system that incorporates more chronic codes under the risk adjustment methodology. Advocated for the transparency in the methodology surrounding the calculation of the Fee-for-Service error rate in Medicare Advantage Risk Adjustment Data-Validation. Advocated for fairness in Medicare Advantage rates when high number of beneficiaries opt-out of Medicare Part B.

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

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

Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Ongoing implementation of payment and regulatory issues for the Medicare Advantage program. Issues relating to the Medicare Part D prescription drug program, various CMS demonstration programs and of P.L. 111-148 (Patient Protection and Affordable Care Act). Issues relating to Medigap insurance, and H.R. 2, The Medicare Access and CHIP Re authorization Act of 2015. Issues relating to H.R. 2579 - Securing Care for Seniors Act of 2015. Issues related to the introduction of S. 2104, A bill to amend title XVIII of the Social Security Act to provide relief to Medicare Advantage plans with a significant number of dually eligible or low-income subsidy beneficiaries and to prevent the termination of two star plans.

Client expense: $1,010,000 · Firm income: Not reported

H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments 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) - rulemaking 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 S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

Advocated for fairness is Medicare Advantage Stars Quality measurements. H.R. 2582, the Seniors Health Care Plan Protection Act. S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015. Opposed cuts to Medicare Advantage and Part D rates. H.R. 1343/S. 688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. H.R. 928/S. 193, to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act. H.R. 2029, Consolidated Appropriations Act, 2016, provisions to delay the annual fee on health insurance providers enacted in the Affordable Care Act by one year (2017). Advocated for a system that incorporates more chronic codes under the risk adjustment methodology. Advocated for transparency in the methodology surrounding the calculation of the Fee-for-Service error rate in Medicare Advantage Risk Adjustment Data-Validation. H.R. 2646, Helping Families in Mental Health Crisis Act of 2015. S. 1945, Mental Health Reform Act of 2015. Medicare and Medicaid plan contracting issues.

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

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

Issues related to Medicare Advantage Stars Quality measurements and risk adjustment and Medicare Advantage payment policy, including S.2104, the Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; H.R.2582 Seniors' Health Care Plan Protection Act of 2015; H.R.2506 Seniors' Health Care Plan Protection Act of 2015; H.R.2579 Securing Care for Seniors Act of 2015; and issues related to plan contracting arrangements with Medicare and Medicaid.

Client expense: Not reported · Firm income: $90,000

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

Ongoing implementation of payment and regulatory issues for the Medicare Advantage program, including H.R. 2570 and H.R. 2582. Issues relating to the Medicare Part D prescription drug program, various CMS demonstration programs and of P.L. 111-148 (Patient Protection and Affordable Care Act). Issues relating to Medigap insurance, and H.R. 2, The Medicare Access and CHIP Re authorization Act of 2015. Issues relating to H.R. 1600, the Patient's Access to Treatments Act of 2015. Issues relating to H.R. 2298, Medicare Patient Safety and Drug Abuse Prevention Act, and H.R. 2579 - Securing Care for Seniors Act of 2015. Issues related to the introduction of S. 2104, A bill to amend title XVIII of the Social Security Act to provide relief to Medicare Advantage plans with a significant number of dually eligible or low-income subsidy beneficiaries and to prevent the termination of two star plans.

Client expense: $1,550,000 · Firm income: Not reported

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 3292 Medicare IME Pool Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015; MedPAC Nomination

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

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

S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; HR 4275, Medicare Advantage Quality Payment Relief Act of 2015

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

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

Medicare Advantage/CMS-Hierarchical Condition Category Risk Assessment (CMS-HCC RA) payment model; Medicare and Medicaid dual eligible integration; Performance evaluation/quality oversight; SES (socio-economic status) issues related to SNP payment rates and quality measures; SNP (Special Needs Plans) reauthorization and permanency; Social determinants of health research/Medicare Advantage Star Ratings program; S.2104, A bill to amend title XVIII of the Social Security Act to provide relief to Medicare Advantage plans with a significant number of dually eligible or low-income subsidy beneficiaries and to prevent the termination of two star plans

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1190, Protecting Seniors' Access to Medicare Act of 2015 H.R. 1314, the Bipartisan Budget Act of 2015 H.R. 1427/S. 804 Medicare CGM Access Act H.R. 1624/S. 1099, the Protecting Affordable Coverage for Employees Act (PACE Act). H.R. 1686, the Preventing Diabetes in Medicare Act H.R. 1726/S. 1345, the Access to Quality Diabetes Education Act H.R. 2029, Consolidated Appropriations Act, 2016 H.R. 2050/S. 2045, the Middle Class Health Benefits Tax Repeal Act of 2015 H.R. 2061, the Equitable Access to Care and Health (EACH) Act H.R. 209/S. 139, the Ensuring Access to Clinical Trials Act H.R. 2102/S. 1131, the Medicare Diabetes Prevention Act H.R. 2205, the Data Security Act of 2015 H.R. 2404/S.1509, The Treat and Reduce Obesity Act H.R. 2446, To amend title XIX of the Social Security Act to require the use of electronic visit verification for personal care services furnished under the Medicaid program, and for other purposes. H.R. 2646, the Helping Families in Mental Health Crisis Act H.R. 2878/ S. 1461, to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2015. H.R. 2911/S. 1697, the Small Business Healthcare Relief Act H.R. 292/S. 2260, the Long-Term Studies of Comprehensive Outcomes and Returns for the Economy Act (Long-Term SCORE Act) H.R. 3081/S.1778 - TELEmedicine for MEDicare (TELE-MED) Act H.R. 3539, the Reinvigorating Antibiotic and Diagnostic Innovation (READI) Act H.R. 3660, the Preventive Health Savings Act H.R. 3716, the Ensuring Terminated Providers are Removed from Medicaid and CHIP Act H.R. 3762, the Restoring Americans Healthcare Freedom Reconciliation Act H.R. 3821, the Medicaid Directory of Caregivers Act H.R. 4155/S. 2343, the Telehealth Innovation and Improvement Act H.R. 4227/S.2392, the Medicare Advantage Bill of Rights Act H.R. 592/S. 314, Pharmacy and Medically Underserved Areas Enhancement Act H.R. 6, 21st Century Cures Act S. 139, Ensuring Access to Clinical Trials Act of 2015 S. 1945, Mental Health Reform Act of 2015 S. 2023, the Prescription Drug Affordability Act S. 2030, the Advancing Targeted Therapies for Rare Diseases Act S. 2104, A bill to amend title XVIII of the Social Security Act to provide relief to Medicare Advantage plans with a significant number of dually eligible or low-income subsidy beneficiaries and to prevent the termination of two star plans. S. 2141, TRUST IT Act S. 2153, the Provider Payment Sunshine Act, S. 2187, the FDA Regulatory Efficiency Act S. 2425, the Patient Access and Medicare Protection Act S. 754, the Cybersecurity Information Sharing Act (CISA)

H.R. 6, 21st Century Cures Act (Upton) - timing of certain Medicare Part D payments 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) - rulemaking 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 S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act (Carper-Enzi) - reducing fraud S. 1396, Value-Based Insurance Design Seniors Copayment Reduction Act (Thune-Stabenow) - VBID demonstration S. 1549, Care Planning Act (Warner) - advanced illness care coordination for Medicare beneficiaries S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act (Portman-Casey) - preventing certain MA plan terminations, MA demonstration program Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, encounter data and other data-related issues, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); in-home health risk assessments; Medicare Medical Loss Ratio issues; implementation of sequestration under the Medicare Advantage and Part D programs; implications of the health insurer fee for MA and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); Medication Therapy Management Program requirements; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; implementation of the Affordable Care Act (ACA) changes to the Part D coverage gap; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation. *Add MACPAC to Agency List

Advocated for fairness is Medicare Advantage Stars Quality measurements. H.R. 2582, the Seniors Health Care Plan Protection Act. Opposed cuts to Medicare Advantage and Part D rates. H.R. 1343/S. 688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. H.R. 546/S. 298, ACE Kids Act of 2015. H.R. 928/S. 193, to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act. Advocated for a system that incorporates more chronic codes under the risk adjustment methodology. H.R. 6, 21st Century Cures Act, advocated against using MA or Part D offsets. Advocated for transparency in the methodology surrounding the calculation of the Fee-for-Service error rate in Medicare Advantage Risk Adjustment Data-Validation. S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015. H.R. 2646, Helping Families in Mental Health Crisis Act of 2015. S. 1945, Mental Health Reform Act of 2015.

Client expense: $510,000 · Firm income: Not reported

Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Use of psychotropic drugs in Medicaid Medicaid DOC Act S.2104

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

"State of Medicaid" Congressional briefing and related advocacy and policy documents; 50th Anniversary of Medicaid; Actuarial soundness; Appropriate payment, including risk adjustment, for D-SNPs and MMPs; Appropriate quality measurement for D-SNPs and MMPs; Capped Medicaid Funding Proposals; Changes to Medicare/Medicaid programs as part of entitlement reform and deficit reduction efforts; Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles; Fraud, waste, and abuse issues for Medicare and Medicaid; H.R. ___, Medicaid Directory of Caregivers Act; H.R. 2582, Seniors' Health Care Plan Protection Act of 2015; H.R. 2646, Helping Families in Mental Health Crisis Act of 2015; H.R. 546 and S. 298, The Advancing Care for Exceptional (ACE) Kids Act of 2015; H.R. 700, Stabilize Medicaid and CHIP Coverage Act; High cost specialty medications; Impact of significant budget cuts in Medicaid; Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs; Marketing rule consistency across Medicaid and the Exchange; Medicaid and Medicare reform discussions with MACPAC and MedPAC; Medicaid eligibility and enrollment issues; Medicaid health plans serving as qualified health plans in the Exchange; Medicaid managed care best practices; Medicaid managed care external quality review standards; Medicaid managed care regulations; Medicaid quality measurement and improvement; Medical loss ratio for Medicaid managed care plans; Mental Health Issues and Legislation; Network adequacy; Protecting Medicaid from reductions made during budget reconciliation; Provider Directories; Psychotropic medication use among foster care children; Regulatory and systematic impact of Medicaid continuous coverage; Risk adjustment; S. 2104, Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; S. 428, Stabilize Medicaid and CHIP Coverage Act; SNP reauthorization; SNP sustainability and improvements to MMPs

Issues related to Medicare Advantage Stars Quality measurements and risk adjustment and Medicare Advantage payment policy, including S.2104, the Preserving Medicare Advantage for all Medicare Beneficiaries Act of 2015; H.R.2582 Seniors' Health Care Plan Protection Act of 2015; H.R.2506 Seniors' Health Care Plan Protection Act of 2015; H.R.2579 Securing Care for Seniors Act of 2015

Client expense: Not reported · Firm income: $90,000

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