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Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020
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Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 This bill indefinitely extends Medicare coverage of immunosuppressive drugs for kidney transplant recipients for individuals who do not have other coverage. Under current law, Medicare coverage is limited to 36 months following a transplant. Additionally, the Government Accountability Office must report on the bill's implementation, including any related program integrity issues.
These links require the bill number to appear in the filing's source-reported specific issue text. Client expenses and lobbying-firm income are separate disclosure fields.
Filing registrants (16)
Read twice and referred to the Committee on Finance.
Introduced in Senate
Bills with similar content found using semantic analysis.
Sources: Congress.gov
2022 · second_quarter · Medicare/Medicaid
Activities to address access and utilization of home dialysis, including H.R. 5426, the "Improving Access to Home Dialysis Act of 2021" to authorize Medicare reimbursement for staff-assisted home dialysis and for other purposes. Support for Protected Classes under Medicare Part D program. H.R. 1676, provide access to Medigap coverage for Medicare end-stage kidney disease patients under age 65. These Medicare beneficiaries do not have a guaranteed opportunity to purchase a Medigap policy. S. 1536, H.R. 3108, Medicare Medical Nutrition Therapy Act. Legislation would expand coverage of nutrition therapy services to additional diseases and conditions and expand the types of medical providers for such services. S. 2203, H.R. 5804, Medicare Diabetes Self-Management Training Act. Expands coverage of diabetes outpatient self-management training. S. 2173, H.R. 2807, PREVENT DIABETES Act. Requires Medicare to offer its Diabetes Prevention Program in a virtual or online format. Support for Kidney Health Evaluation (KED) for patients with diabetes. S. 1512 and H.R. 2903, "CONNECT for Health Act." Expands coverage of telehealth services under Medicare. S. 596 and H.R. 1577, the "Treat and Reduce Obesity Act," to expand the types of health professionals permitted to provide weight loss management and counseling services under Medicare Part B and to include coverage of weight loss management drugs under Medicare Part D. Support for COVID-19 patients (telehealth, home dialysis, copayment waivers, regulatory waivers). Participated in health community effort to urge HHS to expand Medicare coverage to include medically necessary dental treatments for solid organ transplant recipients and other vulnerable individuals. Submitted written comments on the Proposed Rule to implement the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 5534, S. 3353, 116th Congress) to provide Medicare Part B coverage of anti-rejection medications for kidney transplant recipients who lack private, group or other public health insurance coverage for these medications. Submitted comments on the Proposed Calendar Year 2023 Inpatient Prospective Payment System (IPPS) rule. Wrote individual Medicare Administrative Contractors (MACs) to request they align their policies to implement the routine and timely use of Cystatin C to assess kidney function.
Client expense: $100,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2022 · first_quarter · Medicare/Medicaid
Activities to address access and utilization of home dialysis, including H.R. 5426, the "Improving Access to Home Dialysis Act of 2021" to authorize Medicare reimbursement for staff-assisted home dialysis and for other purposes. Support for Protected Classes under Medicare Part D program. H.R. 1676, provide access to Medigap coverage for Medicare end-stage kidney disease patients under age 65. These Medicare beneficiaries do not have a guaranteed opportunity to purchase a Medigap policy. S. 1536, H.R. 3108, Medicare Medical Nutrition Therapy Act. Legislation would expand coverage of nutrition therapy services to additional diseases and conditions and expand the types of medical providers for such services. S. 2203, H.R. 5804, Medicare Diabetes Self-Management Training Act. Expands coverage of diabetes outpatient self-management training. S. 2173, H.R. 2807, PREVENT DIABETES Act. Requires Medicare to offer its Diabetes Prevention Program in a virtual or online format. S. 1512 and H.R. 2903, "CONNECT for Health Act." Expands coverage of telehealth services under Medicare. S. 596 and H.R. 1577, the "Treat and Reduce Obesity Act," to expand the types of health professionals permitted to provide weight loss management and counseling services under Medicare Part B and to include coverage of weight loss management drugs under Medicare Part D. Support for COVID-19 patients (telehealth, home dialysis, copayment waivers, regulatory waivers). Recommendations on the rulemaking process to implement the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 5534, S. 3353, 116th Congress) to provide Medicare Part B coverage of anti-rejection medications for kidney transplant recipients who lack private, group or other public health insurance coverage for these medications. Submitted comments on the Advanced Notice for Calendar Year 2023 for Medicare Advantage Capitation Rates and Medicare Part C and Part D Payment Policies.
2021 · fourth_quarter · Medicare/Medicaid
Activities to address access and utilization of home dialysis, including H.R. 5426, the "Improving Access to Home Dialysis Act of 2021" to authorize Medicare reimbursement for staff-assisted home dialysis and for other purposes. Support for Protected Classes under Medicare Part D program. H.R. 1676, provide access to Medigap coverage for Medicare end-stage kidney disease patients under age 65. These Medicare beneficiaries do not have a guaranteed opportunity to purchase a Medigap policy. S. 1536, H.R. 3108, Medicare Medical Nutrition Therapy Act. Legislation would expand coverage of nutrition therapy services to additional diseases and conditions and expand the types of medical providers for such services. S. 2203, H.R. 5804, Medicare Diabetes Self-Management Training Act. Expands coverage of diabetes outpatient self-management training. S. 2173, H.R. 2807, PREVENT DIABETES Act. Requires Medicare to offer its Diabetes Prevention Program in a virtual or online format. S. 1512 and H.R. 2903, "CONNECT for Health Act." Expands coverage of telehealth services under Medicare. S. 596 and H.R. 1577, the "Treat and Reduce Obesity Act," to expand the types of health professionals permitted to provide weight loss management and counseling services under Medicare Part B and to include coverage of weight loss management drugs under Medicare Part D. Support for COVID-19 patients (telehealth, home dialysis, copayment waivers, regulatory waivers). Request to expedite the rulemaking process following the 116th Congress enactment of the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 5534, S. 3353) to provide Medicare Part B coverage of anti-rejection medications for kidney transplant recipients who lack private, group or other public health insurance coverage for these medications.
2021 · first_quarter · Medicare/Medicaid
Issues related to Part B and Part D pricing; S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020.
Client expense: Not reported · Firm income: $40,000
Government targets: SENATE
2020 · third_quarter · Health Issues
Reimbursement for Pharmacist Services Related to COVID-19, Immunosuppression Bill H.R.5534/S.3353
Client expense: $20,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of
2020 · fourth_quarter · Medicare/Medicaid
| Republican |
| OK |
| James M. Inhofe | Republican | OK |
| Jeanne Shaheen | Democratic | NH |
| John Boozman | Republican | AR |
| John Cornyn | Republican | TX |
| Jon Tester | Democratic | MT |
| Joni Ernst | Republican | IA |
| Kirsten E. Gillibrand | Democratic | NY |
| Kyrsten Sinema | Independent | AZ |
| Marco Rubio | Republican | FL |
| Michael B. Enzi | Republican | WY |
| Mike Braun | Republican | IN |
| Patrick J. Toomey | Republican | PA |
| Richard J. Durbin | Democratic | IL |
| Rick Scott | Republican | FL |
| Sheldon Whitehouse | Democratic | RI |
| Shelley Moore Capito | Republican | WV |
| Sherrod Brown | Democratic | OH |
| Steve Daines | Republican | MT |
| Tina Smith | Democratic | MN |
| Todd Young | Republican | IN |
| Tom Cotton | Republican | AR |
Client expense: $150,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $120,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Office of Science & Technology Policy (OSTP), SENATE
H.R. 8254/S. 4574, Bringing Enhanced Treatments and Therapies to ESRD Recipients (BETTER) Kidney Care Act, all provisions CMS regulations pertaining to reimbursement rates for ESRD-related services CMS regulations pertaining to the Medicare Advantage program Protection of third party premium assistance for coverage under the Patient Protection and Affordable Care Act Issues related to chronic kidney disease (CKD) and prevention Issues related to home dialysis Issues related to access to kidney transplantation for ESRD patients H.R. 3912 / S.1676, Chronic Kidney Disease Improvement in Research and Treatment Act of 2019, all provisions ESRD Treatment Choices (ETC) Mandatory Demonstration Emergency response related to COVID-19 H.R. 5534/S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 H.R. 133, Consolidated Appropriations Act, 2021, dialysis and kidney care issues
Client expense: $1,100,000 · 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)
2020 · fourth_quarter · Health Issues
H.R. 8254/S. 4574, Bringing Enhanced Treatments and Therapies to ESRD Recipients (BETTER) Kidney Care Act, all provisions CMS regulations pertaining to reimbursement rates for ESRD-related services CMS regulations pertaining to the Medicare Advantage program Protection of third party premium assistance for coverage under the Patient Protection and Affordable Care Act Issues related to chronic kidney disease (CKD) and prevention Issues related to home dialysis Issues related to access to kidney transplantation for ESRD patients H.R. 3912/S.1676, Chronic Kidney Disease Improvement in Research and Treatment Act of 2019, all provisions ESRD Treatment Choices (ETC) Mandatory Demonstration Emergency response related to COVID-19 H.R. 5534/S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 H.R. 133, Consolidated Appropriations Act, 2021, dialysis and kidney care issues
Client expense: $1,100,000 · 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)
2020 · fourth_quarter · Health Issues
Support living donors through protected time off and no insurance discrimination through the "Living Donor Protection Act" (S. 511 and H.R. 1224) Provide lifetime immunosuppressive drug coverage for kidney transplant recipients "Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019" (S. 3353 and H.R. 5534) Expand access to home dialysis through reimbursement, other payments, and clarification of anti-kickback statutes Provide education regarding ASN's support for HHS proposed rule regarding organ procurement organization reform (42 CFR 486 or CMS-3380-P)
Client expense: $30,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE
2020 · fourth_quarter · Medicare/Medicaid
H.R. 8840, Medicare Sequester COVID Moratorium Act, all provisions H.R. 8702, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions S. 5007, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions H.R. 7154, Outpatient Therapy Modernization and Stabilization Act, all provisions H.R. 3107, Improving Seniors Timely Access to Care Act of 2019, all provisions S. 5044, Improving Seniors Timely Access to Care Act of 2020y, all provisions H.R. 8727, Telehealth Modernization Act, all provisions S. 4375, Telehealth Modernization Act, all provisions H.R. 7663, Protecting Access to Post-COVID-19 Telehealth Act of 2020, all provisions H.R. 7391, Protect Telehealth Access Act of 2020, all provisions H.R. 1301, Mental Health Telemedicine Expansion Act, all provisions H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019, all provisions H.R. 5201, Telemental Health Expansion Act of 2020, provisions relating to 1834(m) of the Social Security Act; geographic and originating sites H.R. 7233, Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, all provisions H.R. 5172, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions S. 3067, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions H.R. 3414, Opioid Workforce Act of 2019, all provisions H.R. 7791, Value in Health Care Act of 2020, provisions relating to qualifying APM physician thresholds H.R. 6837, Medicare Accelerated and Advance Payments Improvement Act of 2020, all provisions S. 3750, Medicare Accelerated and Advance Payments Improvement Act, all provisions H.R. 8505, To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes, all provisions H.R. 884, Medicare Mental Health Access Act, all provisions H.R. 945, Mental Health Access Improvement Act of 2019, all provisions H.R. 6744, Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2020, all provisions H.R. 4004, Social Determinants Accelerator Act of 2019, all provisions H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions S. 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, provisions related to PBM and prescription drug price transparency H.R. 19, Lower Costs, More Cures Act of 2019, provisions related to PBM and prescription drug price transparency H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2020, all provisions H.R. 6090, Physician Shortage GME Cap Flex Act of 2020, all provisions H.R. 6142, Black Maternal Health Momnibus Act of 2020, all provisions Medicare program: P.L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) implementation/Accountable Care Organizations/APM thresholds Medicare program: Patient Protection and Affordable Care Act (PPACA)/Prior authorization provider and patient burdens/patient electronic access to health information Medicare program: P.L. 113-93 Protecting Access to Medicare Act (PAMA)/Imaging appropriate use criteria/Radiation Oncology APM Medicare program: FY 2021 Inpatient Rehab Facility Prospective Payment System (IRF PPS)/scope of practice issues Medicare program: CY 2021 physician fee schedule/E&M services/Budget neutrality/Part B/Sequester Medicare program: Alternative payment models (APMs) Medicare program: Merit-based Incentive Payment System (MIPS)/cost/quality/interoperability/hardship exemption Medicare program: Regulatory relief/Advanced APMs, prior authorization, and utilization management Medicare program: Shared Savings Program Medicare program: Quality Payment Program/prior authorization/electronic funds transfer Medicare program: Surprise medical billing Medicare program: Medicare-For-All Medicare program: Electronic Health Records (EHR) Certification Medicare program: 21st Century Cures Act Medicare program: Quality payment program/physician burdens Medicare program: National Coverage determination/validated home blood pressure monitors Medicare program: Health IT/physician burden Medicare program: Drug pricing Medicare program: Most favored nation drug pricing Medicare program: Provider compliance/regulatory relief Medicare program: Provider Enrollment, Chain and Ownership (PECOS) enrollment/revalidation Medicare and Medicaid programs: 21st Century Cures Act/health data and privacy Medicaid program: CMS proposed regulation Medicaid Program Medicaid program: FMAP increases Medicaid program: Interoperability
Client expense: $3,870,000 · Firm income: Not reported
Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA), White House Office
2020 · fourth_quarter · Medicare/Medicaid
Issues related to Medicare reimbursement for Part D drugs; Issues related to CY2021 End Stage Renal Disease (ERSD) Prospective Payment System; Medigap insurance access for ESRD beneficiaries; H.R. 133, Consolidated Appropriations Act of 2021 H.R. 3436, Seniors' Chronic Care Management Improvements Act of 2019; H.R. 3912/S. 1676, Chronic Kidney Disease Improvement in Research and Treatment Act of 2019; CY2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescriptioon Drug Benefit Program, and Medicare Cost Plan Program rule; H.R. 5534/S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 H.R. 8177, Renal Anemia Innovation Support and Expansion (RAISE) Act; H.R. 8181, Jack Reynold's Memory MediGap Expansion; Coronavirus Aid Relief, and Economic Security (CARES) Act (P.L. 116-146).
Client expense: $310,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
2020 · fourth_quarter · Health Issues
Issues related to Medicare reimbursement for Part D drugs; Issues related to CY2021 End Stage Renal Disease (ERSD) Prospective Payment System; Medigap insurance access for ESRD beneficiaries; H.R. 133, Consolidated Appropriations Act of 2021 H.R. 3436, Seniors' Chronic Care Management Improvements Act of 2019; H.R. 3912/S. 1676, Chronic Kidney Disease Improvement in Research and Treatment Act of 2019; CY2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescriptioon Drug Benefit Program, and Medicare Cost Plan Program rule; H.R. 5534/S3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 H.R. 8177, Renal Anemia Innovation Support and Expansion (RAISE) Act; H.R. 8181, Jack Reynold's Memory MediGap Expansion; Coronavirus Aid Relief, and Economic Security (CARES) Act (P.L. 116-146).
Client expense: $310,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE
2020 · fourth_quarter · Medicare/Medicaid
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage H.R. 3925 - Reducing Barriers to Substance Use Treatment Act - Tonko - Opioids H.R. 3935 - Protecting Patients Transportation to Care Act - Carter - Medicaid coverage for transportation H.R. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud H.R. 4529 - Promoting Access to Broadband Act of 2019 - Maloney - Medicaid H.R. 4583 - Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Schneider - prescription drug affordability H.R. 4620 - More Help for Seniors Act of 2019 - Rose - expand eligibility for low-income subsidies under part D of the Medicare program H.R. 4621 - Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 - Blunt Rochester - best practices re social determinants of health H.R. 4629 - Star Rating for Biosimilars Act - Tonko - biosimilars H.R. 4632 - Better Transparency in Information for Medicare Beneficiaries Act of 2019 - Kind - provides consumers information regarding premiums under LIS benchmark plans H.R. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 4996 - Helping Medicaid Offer Maternity Services Act of 2020 - Kelly - extend Medicaid coverage post-partum H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized H.R. 5201 - Telemental Health Expansion Act of 2019 - Matsui - Medicare coverage of mental telehealth H.R. 5232 - Road to Recovery Act - Fitzpatrick - Medicaid and CHIP SUD treatment H.R. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program -Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - Increasing Hospital Capacity to Fight the Coronavirus Act of 2020 - Bishop - Medicare and Medicaid payments during COVID-19 emergency H.R. 6462 - Emergency Medicaid for Coronavirus Treatment Act - Gallego - Medicaid coverage H.R. 6511 - Ensuring Vaccination and Treatment Affordability Act - Pappas - COVID H.R. 6521 - To prohibit the Secretary of Health and Human Services from taking certain actions with respect to Medicaid supplemental payments reporting requirements, and for other purposes - Diaz Barragan - Medicaid, delays implementation of MFAR H.R. 6538 - Modernized Medicine Act - Kennedy - Medicaid, Telehealth H.R. 6539 - Coronavirus Medicaid Response Act - Lee - FMAP H.R. 6572 - To direct the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, to carry out a national campaign to increase awareness and knowledge of COVID-19. -Bilirakis - COVID H.R. 6583 - To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes. - Houlahan - COVID H.R. 6616 - Stronger Medicaid Response to the COVID-19 Pandemic Act -Cardenas - COVID H.R. 6640 - Medicare Advantage COVID Treatment Act - Mucarsel-Powell - COVID H.R. 6658 - Insular Area Medicaid Coronavirus Recovery Act - Sablan - FMAP H.R. 6727 - To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program - Schrier - COVID H.R. 6744 - Computer and Internet Equity Act - Davis - internet access for Lifeline program H.R. 6753 - Save Rural Hospitals Act of 2020 - Finkenauer - Medicare hospital payments H.R. 6792 - Improving Telehealth for Underserved Communities Act of 2020 - Smith - telehealth H.R. 6797 - CHIPPER Act - Wild - CHIP, COVID H.R. 6837 - Medicare Accelerated and Advance Payments Improvement Act of 2020 -Schneider - COVID H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act -Boyle - outpatient therapy services H.R. 7187 - HEALTH Act of 2020 -Thompson -Smith - telehealth H.R. 7292 - To amend title XVIII of the Social Security Act to provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. - Kaptur - advance payments H.R. 7338 - To amend title XVIII of the Social Security Act to permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program, and for other purposes. - Cheney - Telehealth H.R. 7391 - To amend title XVIII of the Social Security Act to remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program - Sherrill- Telehealth H.R. 7606 - MFAR Transparency Act - Williams - report on impact of MFAR to Congress H.R. 7627 - MORE Savings Act - Dean - Medicare access to opioid treatment and MAT H.R. 7663 - Protecting Access to Post-COVID-19 Telehealth Act of 2020 - Thompson - waive or modify application of Medicare requirements with respect to telehealth during PHE H.R. 7791 - Value in Health Care Act of 2020 - Welch - Medicare shared savings program and alternative payment arrangements H.R. 7877 - Lowering Drug Costs for Seniors Act of 2020 - Katko - Medicare Part D costs H.R. 7892 - Medicaid Expansion During Crisis Act - Coleman - extend eligibility period for Medicaid enrollment application H.R. 8177 - Renal Anemia Innovation Support and Expansion Act - OHalleran - Medicare prescription drug coverage for chronic kidney disease H.R. 8218 - Rural Ambulance Reimbursement Fairness Act - Gianforte - Medicare payment for rural ambulance services H.R. 8254 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Blumenauer - integrated care for Medicare beneficiaries with ESRD H.R. 8427 - To provide for certain reports on enrollment in the Lifeline program, and for other purposes - Luria - Lifeline program H.R. 8476 - TIKES Act -Blunt Rochester - telehealth coverage in Medicaid H.R. 8505 - To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule - Burgess - Medicare physician fee schedule H.R. 8525 - Expanded Genetic Screening Act of 2020 - Speier - Medicaid coverage of non-invasive prenatal genetic screening H.R. 8529 - Protecting Access to Affordable Medicines Act of 2020 - Butterfield - rebates under the Medicaid program for certain noninnovator multiple source drugs H.R. 8546 - Fair Drug Prices for Kids Act -Wild - Medicaid drug rebate program in CHIP H.R. 8558 - Comprehensive Breast Reconstruction Act of 2020 - Hastings - extends coverage of certain breast reconstructive services following mastectomy under the Medicare and Medicaid programs H.R. 8561 - Restoring Fairness to Medicaid Reimbursement Act of 2020 - Johnson - FMAP H.R. 8574 - PROTECT Long Term Care Facilities Act -Sherrill - long term care in COVID-19 H.R. 8586 - Medicaid Coverage for Addiction Recovery Expansion Act -Foster - Substance Use Disorder H.R. 8623 - SAVE for Seniors Act - Spanberger - Medicare coverage of COVID-19 vaccines H.R. 8624 - Protecting Access to Innovation During COVID-19 Act - Wenstrup - extension of pass-through status under the Medicare program H.R. 8702 - Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 -Bera - part B Medicare payments during COVID H.R. 8725 - HAPI Act - Soto - Medicaid Coverage of adult vaccines H.R. 8727 - Telehealth Modernization Act - Carter - Medicare telehealth payments H.R. 8755 - Expanded Telehealth Access Act -Sherrill - Medicare telehealth coverage H.R. 8756 - COVID Health Care Provider Assurance Act of 2020 - Riggleman - Medicare Part B payments during COVID-19 H.R. 8826 - The Resetting the Impact Act (TRIA) of 2020 - Sewell - amends the IMPACT Act of 2014 H.R. 8840 - Medicare Sequester COVID Moratorium Act - Schneider - extend temporary Medicare sequestration H.R. 8871 - COVID HCBS Relief Act of 2020 - Dingell - funding for state Medicaid programs HCBS H.R. 8934 - Community Integration Act of 2020 - Cartwright - Medicaid HCBS H.R. 8958 - Supporting Best Practices for Healthy Moms Act - Kelly - guidance for state Medicaid programs on maternal health H.R. 9002 - To amend title XIX of the Social Security Act to provide States an option to cover a children's program of all-inclusive coordinated care (ChiPACC) under Medicaid program - DeGette - Childrens health under Medicaid H.R. 9006 - To amend title XIX of the Social Security Act to provide for coverage under the Medicaid program under such title of routine patient costs associated with participation in certain clinical trials - Garcia - Medicaid coverage of clinical trials H.R. 9035 - Permanency for Audio-Only Telehealth Act - Smith - Audio only telehealth in Medicare S. 2846 - Protecting Patients Transportation to Care Act - Isakson - Medicaid coverage of transportation S. 2911 - Seniors Prescription Drug Relief Act of 2019 - Cassidy - Part D smoothing S. 3013 - Encouraging Innovative Benefit Design to Lower Costs for Seniors Act - Crapo - offer additional prescription drugs under Part D S. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program S. 3615 - Rural Community Hospital Demonstration Extension Act of 2020 - Murkowski - rural community hospital demonstration program S. 3665 - Save Rural Hospitals Act of 2020 - Alexander - Medicare hospital payments S. 3750 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Shaheen - COVID S. 3881 - CHIPPER Act - Casey - CHIP, COVID S. 3998 - HEALTH Act of 2020 - Hyde-Smith - telehealth S. 3999 - Mental and Behavioral Health Connectivity Act - King - Mental Health S. 4108 - A bill to amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns - Casey - FMAP S. 4151 - SOS: Sustaining Outpatient Services Act - Hoeven - Medicare OPPS coverage S. 4230 - Telehealth Expansion Act of 2020 - Wyden - Telehealth mental health services in Medicare S. 4274 - Legalizing Drug Discounts for Seniors Act of 2020 - Paul - exclude discounts for covered part D drugs from the anti-kickback prohibition S. 4295 - Public Health Emergency Pass-Through Payment Fairness Act of 2020 - Paul - access to drugs and devices under Medicare S. 4358 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Bennet - Medicaid coverage for vaccines and treatment for COVID-19 for uninsured without cost-sharing S. 4375 - Telehealth Modernization Act - Alexander - make permanent Medicare telehealth flexibilities S. 4423 - COVID-19 Hospice Respite Care Relief Act of 2020 - Brown - Medicare hospice care S. 4448- Fair Drug Prices for Kids Act - Warner - extend Medicaid drug rebate program to CHIP S. 4574 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Young - integrated care for Medicare beneficiaries with ESRD S. 4690 - Maternal Immunization Enhancement Act - Hassan - Medicaid and maternal health S. 4705 - Maternal Immunization Coverage Act - Cassidy - Medicaid coverage S. 4717 - Accelerating Kids Access to Care Act - Grassley - Medicaid enrollment S. 4742 - CLINICAL TREATMENT Act - Burr - Medicaid coverage S. 4825 - Ensuring Access to COVID-19 Vaccines for Seniors Act - Reed - Medicare coverage of COVID-19 vaccines S. 4840 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2020 -Roberts - audio-only risk adjustment in Medicare Advantage S. 4859 - Connected MOM Act - Cassidy - expanded coverage of remote physiologic devices and related services under Medicaid S. 4864 - HAPI Act - Brown - Medicaid coverage of adult vaccines S. 4944 - Equality in Medicare and Medicaid Treatment Act of 2020 - Booker - CMMI models for SDOH in Medicare/Medicaid S. 4949 - Supporting Best Practices for Healthy Moms Act - Toomey - guidance for state Medicaid programs on maternal health S. 4957 - COVID HCBS Relief Act of 2020 - Casey - funding for state Medicaid programs HCBS S. 5007 - Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 - Boozman - increase in Medicare part B payment S. 5044 - Bill to amend title XVIII of the SSA to establish requirement with respect to the use of prior authorization under the Medicare Advantage plans - Brown - Prior authorization S. 5077 - A bill to amend title XIX of the Social Security Act to adjust the limitations on Medicaid disproportionate share hospital payments - Cornyn - Medicaid DSH payments 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 risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; 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); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; issues related to health insurance tax for MA and Part D plans; implications of physician fee schedule on MA; 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); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's health plan models; 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) and the Bipartisan Budget Act of 2018 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's substantial revisions to the managed care regulations, 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; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Client expense: $2,400,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Council of Economic Advisers (CEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), 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), Office of the Vice President of the United States, SENATE, Treasury, Dept of, White House Office
2020 · fourth_quarter · Medicare/Medicaid
Issues relating to End Stage Renal Disease (ESRD) and Chronic Kidney Disease (CKD); S. 1676 / H.R. 3912, Chronic Kidney Disease Improvement in Research and Treatment Act of 2019; End-Stage Renal Disease (ESRD) payment reform and quality metrics; Medicare kidney disease education benefit; End Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model) Proposed Rule (84 FR 34478, 7/18/19); COVID emergency supplemental, CKD/ESRD issues; Continued monitoring of implementation of Public Law 116-123, Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020; Continued monitoring of implementation of Public Law 116-127, Families First Coronavirus Response Act; Continued monitoring of implementation of Public Law 116-136, CARES Act - proposals related to physician and provider relief; H.R. 6800, The Heroes Act (including Medicare Accelerated Payment program, increased FMAP payments, COBRA coverage, increased funding for HHS Provider Fund, changes to the Paycheck Protection Program, medical liability reform); Monitor Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program Final Rule; H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019; S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020; Extension of the Medicare Sequester
Client expense: Not reported · Firm income: $50,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · fourth_quarter · Health Issues
Ensuring access to health care coverage for kidney patients. H.R. 5534 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020
Client expense: Not reported · Firm income: $40,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Medicare Part A, B and D AMP Cap H.R 3 S.2543 - Prescription Drug Pricing Reduction Act of 2019 H.R. 1046/S.377 - Medicare Negotiation and Competitive Licensing Act of 2019 Innovative pharmaceuticals (including cell, gene and radioligand therapies), Biosimilars and Generics Drug Pricing Outcomes Based Contracts/value based arrangements Medicaid H.R.275 - Medicare Prescription Drug Price Negotiation Act of 2019 H.R.448 - Medicare Drug Price Negotiation Act H.R.19 - Lower Costs, More Cures Act of 2019 H.R.107 - To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs H.R.4455 - BIOSIM Act H.R.4619 - Pharmaceutical Rebates for Excessive Pricing Above Inflation Act HR. 3772 - The Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019 HR. 4597 - Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars Act of 2019 S.3466 - ACCESS for Biosimilars Act of 2020 HR. 6179 - Increasing Access to Biosimilars Act of 2020 HR. 4629 - Star Rating for Biosimilars Act S. 3129 - Lower Costs, More Cures Act of 2019 S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 S. 3457 - Preserving Patient Access to Home Infusion Act H.R.5741 - Strengthening Innovation in Medicare and Medicaid Act Department of Health and Human Services (HHS) drug policy issues and regulatory policy issues Transparency policy issues Center for Medicare and Medicaid Innovation (CMMI) policy issues ANPRM; Medicare Program; International Pricing Index Model for Medicare Part B Drugs (CMS-5528-ANPRM) Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection (RIN 0936-AA08) Proposed Rule; Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2021; Notice Requirement for Non-Federal Governmental Plans (CMS-9916-P) Reimbursement for cell therapy products S. 3353/H.R. 5534 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act Patient Cost-Sharing and Smoothing S. 4134 - Increasing Access to Biosimilars Act of 2020 S. 102 - Prescription Drug Price Relief Act of 2019 CMS Proposed Rule: Medicaid Program; Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based Purchasing (VBP) or Drugs Covered in Medicaid, Revising Medicaid Rebate and Third Party Liability (TPL) Requirements (CMS-2482-P) H.R. 8624 - Protecting Access to Innovation During COVID-19 Act H.R. 8702 - Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 S. 1895 - Lower Health Care Costs Act S. 4199 - Prescription Drug Pricing Reduction Act of 2020 S. 4274 - Legalizing Drug Discounts for Seniors Act of 2020 Anti-Kickback Statute policy issues Center for Medicare and Medicaid Innovation (CMMI) policy issues Medicaid rebates and waiver policy issues Medicare prescription drug payments cards and related issues ASP reporting policy issues Non-covered drugs policy issues Drug wastage rebates policy issues
Client expense: $660,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), Veterans Affairs, Dept of (VA), White House Office
2020 · fourth_quarter · Medicare/Medicaid
Centers for Medicare and Medicaid Innovation (CMMI) models including, Comprehensive ESRD care, ESRD Treatment Choices, and voluntary Kidney Care models, Improving policies on chronic kidney disease and transplantation, Improving end of life, hospice, and palliative care options for individuals with ESRD, Policies impacting Organ Procurement Organizations, COVID-19 policies and relief, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 5534/S.3353), Policies related to the implementation of ESRD coverage in Medicare Advantage, COVID-19 vaccine distribution.
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
2020 · fourth_quarter · Medicare/Medicaid
H.R. 8840, Medicare Sequester COVID Moratorium Act, all provisions H.R. 8702, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions S. 5007, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020, all provisions H.R. 7154, Outpatient Therapy Modernization and Stabilization Act, all provisions H.R. 3107, Improving Seniors Timely Access to Care Act of 2019, all provisions S. 5044, Improving Seniors Timely Access to Care Act of 2020y, all provisions H.R. 8727, Telehealth Modernization Act, all provisions S. 4375, Telehealth Modernization Act, all provisions H.R. 7663, Protecting Access to Post-COVID-19 Telehealth Act of 2020, all provisions H.R. 7391, Protect Telehealth Access Act of 2020, all provisions H.R. 1301, Mental Health Telemedicine Expansion Act, all provisions H.R. 3417, Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act of 2019, all provisions H.R. 5201, Telemental Health Expansion Act of 2020, provisions relating to 1834(m) of the Social Security Act; geographic and originating sites H.R. 7233, Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, all provisions H.R. 5172, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions S. 3067, Non-Opioids Prevent Addiction In the Nation (NOPAIN) Act, All provisions H.R. 3414, Opioid Workforce Act of 2019, all provisions H.R. 7791, Value in Health Care Act of 2020, provisions relating to qualifying APM physician thresholds H.R. 6837, Medicare Accelerated and Advance Payments Improvement Act of 2020, all provisions S. 3750, Medicare Accelerated and Advance Payments Improvement Act, all provisions H.R. 8505, To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes, all provisions H.R. 884, Medicare Mental Health Access Act, all provisions H.R. 945, Mental Health Access Improvement Act of 2019, all provisions H.R. 6744, Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2020, all provisions H.R. 4004, Social Determinants Accelerator Act of 2019, all provisions H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions S. 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, all provisions H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020, all provisions H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, provisions related to PBM and prescription drug price transparency H.R. 19, Lower Costs, More Cures Act of 2019, provisions related to PBM and prescription drug price transparency H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2020, all provisions H.R. 6090, Physician Shortage GME Cap Flex Act of 2020, all provisions H.R. 6142, Black Maternal Health Momnibus Act of 2020, all provisions Medicare program: P.L. 114-10 Medicare Access and CHIP Reauthorization Act (MACRA) implementation/Accountable Care Organizations/APM thresholds Medicare program: Patient Protection and Affordable Care Act (PPACA)/Prior authorization provider and patient burdens/patient electronic access to health information Medicare program: P.L. 113-93 Protecting Access to Medicare Act (PAMA)/Imaging appropriate use criteria/Radiation Oncology APM Medicare program: FY 2021 Inpatient Rehab Facility Prospective Payment System (IRF PPS)/scope of practice issues Medicare program: CY 2021 physician fee schedule/E&M services/Budget neutrality/Part B/Sequester Medicare program: Alternative payment models (APMs) Medicare program: Merit-based Incentive Payment System (MIPS)/cost/quality/interoperability/hardship exemption Medicare program: Regulatory relief/Advanced APMs, prior authorization, and utilization management Medicare program: Shared Savings Program Medicare program: Quality Payment Program/prior authorization/electronic funds transfer Medicare program: Surprise medical billing Medicare program: Medicare-For-All Medicare program: Electronic Health Records (EHR) Certification Medicare program: 21st Century Cures Act Medicare program: Quality payment program/physician burdens Medicare program: National Coverage determination/validated home blood pressure monitors Medicare program: Health IT/physician burden Medicare program: Drug pricing Medicare program: Most favored nation drug pricing Medicare program: Provider compliance/regulatory relief Medicare program: Provider Enrollment, Chain and Ownership (PECOS) enrollment/revalidation Medicare and Medicaid programs: 21st Century Cures Act/health data and privacy Medicaid program: CMS proposed regulation Medicaid Program Medicaid program: FMAP increases Medicaid program: Interoperability
Client expense: $4,170,000 · Firm income: Not reported
Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA), White House Office
2020 · fourth_quarter · Medicare/Medicaid
Issues related to Part B and Part D pricing; S. 3353 Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020
Client expense: Not reported · Firm income: $80,000
Government targets: SENATE
2020 · fourth_quarter · Health Issues
H.R. 8254 / S. 4574, Bringing Enhanced Treatments and Therapies to ESRD Recipients (BETTER) Kidney Care Act, all provisions CMS regulations pertaining to reimbursement rates for ESRD-related services CMS regulations pertaining to the Medicare Advantage program Protection of third party premium assistance for coverage under the Patient Protection and Affordable Care Act Issues related to Chronic Kidney Disease and prevention Issues related to home dialysis Issues related to access to kidney transplantation for ESRD patients H.R. 3912 / S.1676, Chronic Kidney Disease Improvement in Research and Treatment Act of 2019, all provisions ESRD Treatment Choices (ETC) Mandatory Demonstration Worked with HHS and CMS on emergency response related to COVID-19 H.R. 5534/S. 3353 Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 H.R. 133 Consolidated Appropriations Act, 2021, dialysis and kidney care issues
Client expense: $1,080,000 · 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)
2020 · fourth_quarter · Medicare/Medicaid
H.R. 8254 / S. 4574, Bringing Enhanced Treatments and Therapies to ESRD Recipients (BETTER) Kidney Care Act, all provisions CMS regulations pertaining to reimbursement rates for ESRD-related services CMS regulations pertaining to the Medicare Advantage program Protection of third party premium assistance for coverage under the Patient Protection and Affordable Care Act Issues related to Chronic Kidney Disease and prevention Issues related to home dialysis Issues related to access to kidney transplantation for ESRD patients H.R. 3912 / S.1676, Chronic Kidney Disease Improvement in Research and Treatment Act of 2019, all provisions ESRD Treatment Choices (ETC) Mandatory Demonstration Worked with HHS and CMS on emergency response related to COVID-19 H.R. 5534/S. 3353 Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 H.R. 133 Consolidated Appropriations Act, 2021, dialysis and kidney care issues
Client expense: $1,080,000 · 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)
2020 · fourth_quarter · Medicare/Medicaid
Early detection and management of Chronic Kidney Disease, including Alternative Payment Model. Increased utilization of home dialysis and other home health benefits. Extension of Medicare Part B coverage of immunosuppressive drugs for kidney transplant recipients (H.R. 5534; S. 3353). Activities in response to COVID-19,including expanding access to telehealth, access to home kidney dialysis, access to kidney transplantation, waiver of patient copayments, and waiver of certain regulatory requirements. Increased use of Kidney Discards for transplantation.
Client expense: $120,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Natl Institutes of Health (NIH), SENATE
2020 · fourth_quarter · Medicare/Medicaid
H.R.1224 and S.511, The Living Donor Protection Act S.1676 and H.R.3912 -- The Chronic Kidney Disease Improvement in Research and Treatment Act of 2019 S. 3548 -- CARES Act S. 3353 and HR 5534 -- The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · fourth_quarter · Medicare/Medicaid
Assist the Administration during Covid-19 epidemic on how to help and protect dialysis patients; Advise the Administration on implementation of Medicare Advantage coverage for dialysis patients starting in 2021, which has since resulted in litigation over a final regulation that is reducing patient access in violation of anti-discrimination laws and was enacted in violation of the Administrative Procedures Act; Urge Congress to provide access to Medigap for all ESRD patients under 65 years of age - (H.R. 8181) - The Jack Reynolds Memorial Medigap Expansion Bill; Protect dialysis patient access to charitable premium assistance; Ensure ESRD patients retain access to private insurance; Support ESRD care coordination - (H.R. 8254/S. 4574) - The BETTER Kidney Care Bill; Encourage support for improved kidney research and treatment; Support increased oversight of Organ Procurement Organizations; Assist the Administration about Prioritizing Prevention, Home Dialysis, and Transplant; and Support for extending access to immunosuppressive drugs for transplant patients - (H.R. 5534/S. 3353) - The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act.
Client expense: $150,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, White House Office
2020 · fourth_quarter · Health Issues
Promoting policies that increase the number of living donors and ensuring patient access to care that improves outcomes for patients with kidney disease. The Living Donor Protection Act bill numbers are S.511/HR 1224; S.3353/ HR 5534: The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act.
Client expense: Not reported · Firm income: $40,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · third_quarter · Health Issues
Support living donors through protected time off and no insurance discrimination through the "Living Donor Protection Act" (S. 511 and H.R. 1224) Provide lifetime immunosuppressive drug coverage for kidney transplant recipients "Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019" (S. 3353 and H.R. 5534) Expand access to home dialysis through reimbursement, other payments, and clarification of anti-kickback statutes Provide education regarding ASN's support for HHS proposed rule regarding organ procurement organization reform (42 CFR 486 or CMS-3380-P) Opposed proposed rule from ICE that would limit immigration, urging that requested the final rule exclude J-1 clinicians and scientists from the proposal.
Client expense: $40,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Institutes of Health (NIH), SENATE
2020 · third_quarter · Medicare/Medicaid
Issues relating to End Stage Renal Disease (ESRD) and Chronic Kidney Disease (CKD); S. 1676 / H.R. 3912, Chronic Kidney Disease Improvement in Research and Treatment Act of 2019; End-Stage Renal Disease (ESRD) payment reform and quality metrics; Medicare kidney disease education benefit; End Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model) Proposed Rule (84 FR 34478, 7/18/19); Executive Order on Advancing American Kidney Health (July 10, 2019); COVID emergency supplemental, CKD/ESRD issues; Continued monitoring of implementation of Public Law 116-123, Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020; Continued monitoring of implementation of Public Law 116-127, Families First Coronavirus Response Act; Continued monitoring of implementation of Public Law 116-136, CARES Act - proposals related to physician and provider relief; H.R. 6800, The Heroes Act (including Medicare Accelerated Payment program, increased FMAP payments, COBRA coverage, increased funding for HHS Provider Fund, changes to the Paycheck Protection Program, medical liability reform); Monitor Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program Final Rule; H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019; S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020
Client expense: Not reported · Firm income: $50,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · third_quarter · Medicare/Medicaid
Early detection and management of Chronic Kidney Disease, including Alternative Payment Model. Increased utilization of home dialysis and other home health benefits. Extension of Medicare Part B coverage of immunosuppressive drugs for kidney transplant recipients (H.R. 5534; S. 3353). Activities in response to COVID-19,including expanding access to telehealth, access to home kidney dialysis, access to kidney transplantation, waiver of patient copayments, and waiver of certain regulatory requirements. Comments on Medicare Hospital Inpatient Prospective Payment System and Medicare and Medicaid Interoperability Programs Requirements. Comments on Medicare ESRD Prospective Payment System and Quality Incentive Program. Comments on Medicare Physician Fee Service and Quality Payment Program. Increased use of Kidney Discards for transplantation. Access of medications under Medicare Part D Protected Classes.
Client expense: $120,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), SENATE
2020 · third_quarter · Health Issues
Issues related to drug pricing; Issues relating to the 340b program; S. 3353 Comprehensive Immunosuppressive drug coverage for Kidney Transplant Patients Act of 2020
Client expense: Not reported · Firm income: $60,000
Government targets: SENATE
2020 · third_quarter · Medicare/Medicaid
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage H.R. 3925 - Reducing Barriers to Substance Use Treatment Act - Tonko - Opioids H.R. 3935 - Protecting Patients Transportation to Care Act - Carter - Medicaid coverage for transportation H.R. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud H.R. 4529 - Promoting Access to Broadband Act of 2019 - Maloney - Medicaid H.R. 4583 - Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Schneider - prescription drug affordability H.R. 4620 - More Help for Seniors Act of 2019 - Rose - expand eligibility for low-income subsidies under part D of the Medicare program H.R. 4621 - Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 - Blunt Rochester - best practices re social determinants of health H.R. 4629 - Star Rating for Biosimilars Act - Tonko - biosimilars H.R. 4632 - Better Transparency in Information for Medicare Beneficiaries Act of 2019 - Kind - provides consumers information regarding premiums under LIS benchmark plans H.R. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 4996 - Helping Medicaid Offer Maternity Services Act of 2020 - Kelly - extend Medicaid coverage post-partum H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized H.R. 5201 - Telemental Health Expansion Act of 2019 - Matsui - Medicare coverage of mental telehealth H.R. 5232 - Road to Recovery Act - Fitzpatrick - Medicaid and CHIP SUD treatment H.R. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program -Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - Increasing Hospital Capacity to Fight the Coronavirus Act of 2020 - Bishop - Medicare and Medicaid payments during COVID-19 emergency H.R. 6462 - Emergency Medicaid for Coronavirus Treatment Act - Gallego - Medicaid coverage H.R. 6511 - Ensuring Vaccination and Treatment Affordability Act - Pappas - COVID H.R. 6521 - To prohibit the Secretary of Health and Human Services from taking certain actions with respect to Medicaid supplemental payments reporting requirements, and for other purposes - Diaz Barragan - Medicaid, delays implementation of MFAR H.R. 6538 - Modernized Medicine Act - Kennedy - Medicaid, Telehealth H.R. 6539 - Coronavirus Medicaid Response Act - Lee - FMAP H.R. 6572 - To direct the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, to carry out a national campaign to increase awareness and knowledge of COVID-19. -Bilirakis - COVID H.R. 6583 - To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes. - Houlahan - COVID H.R. 6616 - Stronger Medicaid Response to the COVID-19 Pandemic Act -Cardenas - COVID H.R. 6640 - Medicare Advantage COVID Treatment Act - Mucarsel-Powell - COVID H.R. 6658 - Insular Area Medicaid Coronavirus Recovery Act - Sablan - FMAP H.R. 6727 - To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program - Schrier - COVID H.R. 6744 - Computer and Internet Equity Act - Davis - internet access for Lifeline program H.R. 6753 - Save Rural Hospitals Act of 2020 - Finkenauer - Medicare hospital payments H.R. 6792 - Improving Telehealth for Underserved Communities Act of 2020 - Smith - telehealth H.R. 6797 - CHIPPER Act - Wild - CHIP, COVID H.R. 6837 - Medicare Accelerated and Advance Payments Improvement Act of 2020 -Schneider - COVID H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act -Boyle - outpatient therapy services H.R. 7187 - HEALTH Act of 2020 -Thompson -Smith - telehealth H.R. 7292 - To amend title XVIII of the Social Security Act to provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. - Kaptur - advance payments H.R. 7338 - To amend title XVIII of the Social Security Act to permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program, and for other purposes. - Cheney - Telehealth H.R. 7391 - To amend title XVIII of the Social Security Act to remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program - Sherrill- Telehealth H.R. 7606 - MFAR Transparency Act - Williams - report on impact of MFAR to Congress H.R. 7627 - MORE Savings Act - Dean - Medicare access to opioid treatment and MAT H.R. 7663 - Protecting Access to Post-COVID-19 Telehealth Act of 2020 - Thompson - waive or modify application of Medicare requirements with respect to telehealth during PHE H.R. 7791 - Value in Health Care Act of 2020 - Welch - Medicare shared savings program and alternative payment arrangements H.R. 7877 - Lowering Drug Costs for Seniors Act of 2020 - Katko - Medicare Part D costs H.R. 7892 - Medicaid Expansion During Crisis Act - Coleman - extend eligibility period for Medicaid enrollment application H.R. 8177 - Renal Anemia Innovation Support and Expansion Act - OHalleran - Medicare prescription drug coverage for chronic kidney disease H.R. 8218 - Rural Ambulance Reimbursement Fairness Act - Gianforte - Medicare payment for rural ambulance services H.R. 8254 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Blumenauer - integrated care for Medicare beneficiaries with ESRD H.R. 8427 - To provide for certain reports on enrollment in the Lifeline program, and for other purposes - Luria - Lifeline program S. 2846 - Protecting Patients Transportation to Care Act - Isakson - Medicaid coverage of transportation S. 2911 - Seniors Prescription Drug Relief Act of 2019 - Cassidy - Part D smoothing S. 3013 - Encouraging Innovative Benefit Design to Lower Costs for Seniors Act - Crapo - offer additional prescription drugs under Part D S. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program S. 3615 - Rural Community Hospital Demonstration Extension Act of 2020 - Murkowski - rural community hospital demonstration program S. 3665 - Save Rural Hospitals Act of 2020 - Alexander - Medicare hospital payments S. 3750 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Shaheen - COVID S. 3881 - CHIPPER Act - Casey - CHIP, COVID S. 3998 - HEALTH Act of 2020 - Hyde-Smith - telehealth S. 3999 - Mental and Behavioral Health Connectivity Act - King - Mental Health S. 4108 - A bill to amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns - Casey - FMAP S. 4151 - SOS: Sustaining Outpatient Services Act - Hoeven - Medicare OPPS coverage S. 4230 - Telehealth Expansion Act of 2020 - Wyden - Telehealth mental health services in Medicare S. 4274 - Legalizing Drug Discounts for Seniors Act of 2020 - Paul - exclude discounts for covered part D drugs from the anti-kickback prohibition S. 4295 - Public Health Emergency Pass-Through Payment Fairness Act of 2020 - Paul - access to drugs and devices under Medicare S. 4358 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Bennet - Medicaid coverage for vaccines and treatment for COVID-19 for uninsured without cost-sharing S. 4375 - Telehealth Modernization Act - Alexander - make permanent Medicare telehealth flexibilities S. 4423 - COVID-19 Hospice Respite Care Relief Act of 2020 - Brown - Medicare hospice care S. 4448 - Fair Drug Prices for Kids Act - Warner - extend Medicaid drug rebate program to CHIP S. 4574 - Bringing Enhanced Treatments and Therapies to ESRD Recipients Kidney Care Act - Young - integrated care for Medicare beneficiaries with ESRD S. 4690 - A bill to increase vaccination rates among pregnant women enrolled in Medicaid or CHIP, and for other purposes - Hassan - Medicaid and maternal health S. 4705 - A bill to amend title XIX requiring coverage under Medicaid of vaccines for pregnant women - Cassidy - Medicaid coverage S. 4717 - A bill to amend title XIX of the Social Security Act to streamline enrollment of certain Medicaid providers across State lines, and for other purposes - Grassley - Medicaid enrollment S. 4742 - A bill to amend title XIX of the Social Security Act to promote access to life-saving therapies for Medicaid enrollees by ensuring coverage of routine patient costs for items and services furnished in connection with participation in qualifying clinical trials, and for other purposes - Burr - Medicaid coverage 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 risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; 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); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2022 Rate Notice; Executive Orders relating to international pricing, Part D rebates, insulin costs, and importation; issues related to MLTSS; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to COVID-19, including testing; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; 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); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; 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) and the Bipartisan Budget Act of 2018 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's substantial revisions to the managed care regulations, 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; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Client expense: $2,230,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Trade Commission (FTC), 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), SENATE, Treasury, Dept of, White House Office
2020 · third_quarter · Medicare/Medicaid
H.R.1224 and S.511, The Living Donor Protection Act S.1676 and H.R.3912 -- The Chronic Kidney Disease Improvement in Research and Treatment Act of 2019 S. 3548 -- CARES Act S. 3353 and HR 5534 -- The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Medicare Part A, B and D AMP Cap H.R 3 S.2543 - Prescription Drug Pricing Reduction Act of 2019 H.R. 1046/S.377 - Medicare Negotiation and Competitive Licensing Act of 2019 Innovative pharmaceuticals (including cell, gene and radioligand therapies), Biosimilars and Generics Drug Pricing Outcomes Based Contracts/value based arrangements Medicaid H.R.275 - Medicare Prescription Drug Price Negotiation Act of 2019 H.R.448 - Medicare Drug Price Negotiation Act H.R.19 - Lower Costs, More Cures Act of 2019 H.R.107 - To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs H.R.4455 - BIOSIM Act H.R.4619 - Pharmaceutical Rebates for Excessive Pricing Above Inflation Act HR. 3772 - The Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019 HR. 4597 - Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars Act of 2019 S.3466 - ACCESS for Biosimilars Act of 2020 HR. 6179 - Increasing Access to Biosimilars Act of 2020 HR. 4629 - Star Rating for Biosimilars Act S. 3129 - Lower Costs, More Cures Act of 2019 S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 S. 3457 - Preserving Patient Access to Home Infusion Act H.R.5741 - Strengthening Innovation in Medicare and Medicaid Act Department of Health and Human Services (HHS) drug policy issues and regulatory policy issues Transparency policy issues Center for Medicare and Medicaid Innovation (CMMI) policy issues ANPRM; Medicare Program; International Pricing Index Model for Medicare Part B Drugs (CMS-5528-ANPRM) Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection (RIN 0936-AA08) Proposed Rule; Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2021; Notice Requirement for Non-Federal Governmental Plans (CMS-9916-P) Reimbursement for cell therapy products S. 3353/H.R. 5534 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act Patient Cost-Sharing and Smoothing S. 4134 - Increasing Access to Biosimilars Act of 2020 S. 102 - Prescription Drug Price Relief Act of 2019 CMS Proposed Rule: Medicaid Program; Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based Purchasing (VBP) or Drugs Covered in Medicaid, Revising Medicaid Rebate and Third Party Liability (TPL) Requirements (CMS-2482-P)
Client expense: $1,190,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), White House Office
2020 · third_quarter · Medicare/Medicaid
Centers for Medicare and Medicaid Innovation (CMMI) models including, Comprehensive ESRD care, ESRD Treatment Choices, and voluntary Kidney Care models, Improving policies on chronic kidney disease and transplantation, Improving end of life, hospice, and palliative care options for individuals with ESRD, Policies impacting Organ Procurement Organizations, COVID-19 policies and relief, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 5534/S.3353), Policies related to the implementation of ESRD coverage in Medicare Advantage.
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
2020 · third_quarter · Medicare/Medicaid
Assist the Administration during Covid-19 epidemic on how to help and protect dialysis patients; Advise the Administration on implementation of Medicare Advantage coverage for dialysis patients starting in 2021, which has since resulted in litigation over a final regulation that is reducing patient access in violation of anti-discrimination laws and was enacted in violation of the Administrative Procedures Act; Urge Congress to provide access to Medigap for all ESRD patients under 65 years of age - (H.R. 8181) - The Jack Reynolds Memorial Medigap Expansion Bill; Protect dialysis patient access to charitable premium assistance; Ensure ESRD patients retain access to private insurance; Support ESRD care coordination - (H.R. 8254/S. 4574) - The BETTER Kidney Care Bill; Encourage support for improved kidney research and treatment; Support increased oversight of Organ Procurement Organizations; Assist the Administration about Prioritizing Prevention, Home Dialysis, and Transplant; and Support for extending access to immunosuppressive drugs for transplant patients - (H.R. 5534/S. 3353) - The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act.
Client expense: $250,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), SENATE, White House Office
2020 · third_quarter · Health Issues
Promoting policies that increase the number of living donors and ensuring patient access to care that improves outcomes for patients with kidney disease. The Living Donor Protection Act bill numbers are S.511/HR 1224; S.3353/ HR 5534: The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act.
Client expense: Not reported · Firm income: $40,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Health Issues
Support living donors through protected time off and no insurance discrimination through the "Living Donor Protection Act" (S. 511 and H.R. 1224) Provide lifetime immunosuppressive drug coverage for kidney transplant recipients "Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019" (S. 3353 and H.R. 5534) Expand access to home dialysis through reimbursement, other payments, and clarification of antikickback statutes
Client expense: $40,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE
2020 · second_quarter · Medicare/Medicaid
H.R.1224 and S.511, The Living Donor Protection Act S.1676 and H.R.3912 -- The Chronic Kidney Disease Improvement in Research and Treatment Act of 2019 S. 3548 -- CARES Act S. 3353 and HR 5534 -- The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Medicare/Medicaid
Issues relating to End Stage Renal Disease (ESRD) and Chronic Kidney Disease (CKD); S. 1676 / H.R. 3912, Chronic Kidney Disease Improvement in Research and Treatment Act of 2019; End-Stage Renal Disease (ESRD) payment reform and quality metrics; Medicare kidney disease education benefit; End Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model) Proposed Rule (84 FR 34478, 7/18/19); Executive Order on Advancing American Kidney Health (July 10, 2019); COVID emergency supplemental, CKD/ESRD issues; Continued monitoring of implementation of Public Law 116-123, Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020; Continued monitoring of implementation of Public Law 116-127, Families First Coronavirus Response Act; Continued monitoring of implementation of Public Law 116-136, CARES Act - proposals related to physician and provider relief; H.R, 6800, HEROES Act (including Medicare Accelerated Payment program, increased FMAP payments, COBRA coverage, increased funding for HHS Provider Fund, changes to the Paycheck Protection Program, medical liability reform); Monitor Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program Final Rule; H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019; S. 3353, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020
Client expense: Not reported · Firm income: $50,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2020 · second_quarter · Medicare/Medicaid
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage H.R. 3925 - Reducing Barriers to Substance Use Treatment Act - Tonko - Opioids H.R. 3935 - Protecting Patients Transportation to Care Act - Carter - Medicaid coverage for transportation H.R. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud H.R. 4529 - Promoting Access to Broadband Act of 2019 - Maloney - Medicaid H.R. 4583 - Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Schneider - prescription drug affordability H.R. 4620 - More Help for Seniors Act of 2019 - Rose - expand eligibility for low-income subsidies under part D of the Medicare program H.R. 4621 - Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 - Blunt Rochester - best practices re social determinants of health H.R. 4629 - Star Rating for Biosimilars Act - Tonko - biosimilars H.R. 4632 - Better Transparency in Information for Medicare Beneficiaries Act of 2019 - Kind - provides consumers information regarding premiums under LIS benchmark plans H.R. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized H.R. 5201 - Telemental Health Expansion Act of 2019 - Matsui - Medicare coverage of mental telehealth H.R. 5232 - Road to Recovery Act - Fitzpatrick - Medicaid and CHIP SUD treatment H.R. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Jodey Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program - Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Abby Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - Increasing Hospital Capacity to Fight the Coronavirus Act of 2020 - Bishop - Medicare and Medicaid payments during COVID-19 emergency H.R. 6462 - Emergency Medicaid for Coronavirus Treatment Act - Gallego - Medicaid coverage H.R. 6511 - Ensuring Vaccination and Treatment Affordability Act - Pappas - COVID H.R. 6521 - To prohibit the Secretary of Health and Human Services from taking certain actions with respect to Medicaid supplemental payments reporting requirements, and for other purposes - Diaz Barragan H.R. 6538 - Modernized Medicine Act - Kennedy - Medicaid, Telehealth H.R. 6539 - Coronavirus Medicaid Response Act - Lee - FMAP H.R. 6572 - To direct the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, to carry out a national campaign to increase awareness and knowledge of COVID-19. - Bilirakis - COVID H.R. 6583 - To amend title XVIII of the Social Security Act to establish a risk corridor program for Medicare Advantage plans during the COVID-19 emergency, and for other purposes. - Houlahan - COVID H.R. 6616 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Cardenas - COVID H.R. 6640 - Medicare Advantage COVID Treatment Act - Mucarsel-Powell - COVID H.R. 6658 - Insular Area Medicaid Coronavirus Recovery Act - Sablan - FMAP H.R. 6727 - To hold Medicare beneficiaries harmless for specified COVID-19 treatment services furnished under part A or part B of the Medicare program - Schrier - COVID H.R. 6744 - Computer and Internet Equity Act - Davis - internet access for Lifeline program H.R. 6753 - Save Rural Hospitals Act of 2020 - Finkenauer - Medicare hospital payments H.R. 6792 - Improving Telehealth for Underserved Communities Act of 2020 - Smith - telehealth H.R. 6797 - CHIPPER Act - Wild - CHIP, COVID H.R. 6837 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Schneider - COVID H.R. 7154 - Outpatient Therapy Modernization and Stabilization Act - Boyle - outpatient therapy services H.R. 7187 - HEALTH Act of 2020 -Thompson -Smith - telehealth H.R. 7297 - To amend title XVIII of the Social Security Act to provide for forgiveness of certain accelerated and advance payments under parts A and B of the Medicare program. - Kaptur H.R. 7338 - To amend title XVIII of the Social Security Act to permit the Secretary of Health and Human Services to waive requirements relating to the furnishing of telehealth services under the Medicare program, and for other purposes. - Cheney - Telehealth H.R. 7391 - To amend title XVIII of the Social Security Act to remove certain geographic and originating site restrictions on the furnishing of telehealth services under the Medicare program - Sherrill - Telehealth S. 2846 - Protecting Patients Transportation to Care Act - Isakson - Medicaid coverage of transportation S. 2911 - Seniors Prescription Drug Relief Act of 2019 - Cassidy - Part D smoothing S. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program S. 3615 - Rural Community Hospital Demonstration Extension Act of 2020 - Murkowski - rural community hospital demonstration program S. 3665 - Save Rural Hospitals Act of 2020 - Alexander - Medicare hospital payments S. 3750 - Medicare Accelerated and Advance Payments Improvement Act of 2020 - Shaheen - COVID S. 3881 - CHIPPER Act - Casey - CHIP, COVID S. 3998 - HEALTH Act of 2020 - Hyde-Smith - telehealth S. 3999 - Mental and Behavioral Health Connectivity Act - King - Mental Health S. 4108 - A bill to amend title XIX of the Social Security Act to increase Federal support to State Medicaid programs during economic downturns - Casey - FMAP 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 risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; 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); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2021 Rate Notice and Call Letter; issues related to MLTSS; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to COVID-19; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; 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); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; 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) and the Bipartisan Budget Act of 2018 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's substantial revisions to the managed care regulations, 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; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Client expense: $2,250,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
Medicare Part A, B and D AMP Cap H.R 3 S.2543 - Prescription Drug Pricing Reduction Act of 2019 H.R. 1046/S.377: Medicare Negotiation and Competitive Licensing Act of 2019 Innovative pharmaceuticals (including cell, gene and radioligand therapies), Biosimilars and Generics Drug Pricing Outcomes Based Contracts/value based arrangements Medicaid H.R.275 - Medicare Prescription Drug Price Negotiation Act of 2019 H.R.448 - Medicare Drug Price Negotiation Act H.R.19 - Lower Costs, More Cures Act of 2019 H.R.107 - To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs H.R.4455 - BIOSIM Act H.R.4619 - Pharmaceutical Rebates for Excessive Pricing Above Inflation Act HR. 3772, the Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019 HR. 4597 - Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars Act of 2019 S.3466 - ACCESS for Biosimilars Act of 2020 HR. 6179 - Increasing Access to Biosimilars Act of 2020 HR. 4629 - Star Rating for Biosimilars Act S. 3129: Lower Costs, More Cures Act of 2019 S. 3384: Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 S. 3457: Preserving Patient Access to Home Infusion Act - Provisions related to Medicare and prescription drug access H.R.5741 - Strengthening Innovation in Medicare and Medicaid Act Department of Health and Human Services (HHS) drug policy issues and regulatory policy issues Transparency policy issues Center for Medicare and Medicaid Innovation (CMMI) policy issues ANPRM; Medicare Program; International Pricing Index Model for Medicare Part B Drugs (CMS-5528-ANPRM) Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection (RIN 0936-AA08) Proposed Rule; Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2021; Notice Requirement for Non-Federal Governmental Plans (CMS-9916-P) Reimbursement for cell therapy products S. 3353/H.R. 5534, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act Patient Cost-Sharing and Smoothing S. 4134, Increasing Access to Biosimilars Act of 2020 S. 102, Prescription Drug Price Relief Act of 2019
Client expense: $780,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), U.S. Trade Representative (USTR), White House Office
2020 · second_quarter · Medicare/Medicaid
Early detection and management of Chronic Kidney Disease, including Alternative Payment Model Increased utilization of home dialysis and other home health benefits Extension of Medicare coverage of immunosuppressive drugs for kidney transplant recipients (H.R. 5534; S. 3353) Activities in response to COVID-19,including expanding access to telehealth, access to home kidney dialysis, access to kidney transplantation, waiver of patient copayments, and waiver of certain regulatory requirements. Comments on Proposed Rule for changes to Medicare Advantage (including enrollment of ESRD patients), Medicare prescription drug program, and Medicare Cost Plan Program Comments on Origin and Destination Requirements under the Ambulance Fee Schedule Increased use of Kidney Discards for transplantation Access of medications under Medicare Part D Protected Classes Support for H.R. 6971, Medical Nutrition Therapy Act
Client expense: $120,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), SENATE
2020 · second_quarter · Medicare/Medicaid
Centers for Medicare and Medicaid Innovation (CMMI) models including, Comprehensive ESRD care, ESRD Treatment Choices, and voluntary Kidney Care models, Improving policies on chronic kidney disease and transplantation, Improving end of life, hospice, and palliative care options for individuals with ESRD, Policies impacting Organ Procurement Organizations, COVID-19 policies and relief, Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 5534/S.3353), Policies related to the implementation of ESRD coverage in Medicare Advantage.
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
2020 · first_quarter · Health Issues
Support living donors through protected time off and no insurance discrimination through the "Living Donor Protection Act" (S. 511 and H.R. 1224) Provide lifetime immunosuppressive drug coverage for kidney transplant recipients "Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019" (S. 3353 and H.R. 5534)
Client expense: $40,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE
2020 · first_quarter · Medicare/Medicaid
H.R. 3107 - Improving Seniors' Timely Access to Care Act of 2019 - DelBene - prior authorization in Medicare Advantage H.R. 3925 - Reducing Barriers to Substance Use Treatment Act - Tonko - Opioids H.R. 3935 - Protecting Patients Transportation to Care Act - Carter - Medicaid coverage for transportation H.R. 4453 - Protecting Seniors from Health Care Fraud Act of 2019 - Ruiz -Distributing information to Medicare beneficiaries to prevent fraud H.R. 4529 - Promoting Access to Broadband Act of 2019 - Maloney - Medicaid H.R. 4583 - Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Schneider - prescription drug affordability H.R. 4620 - More Help for Seniors Act of 2019 - Rose - expand eligibility for low-income subsidies under part D of the Medicare program H.R. 4621 - Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2019 - Blunt Rochester - best practices re social determinants of health H.R. 4629 - Star Rating for Biosimilars Act - Tonko - biosimilars H.R. 4632 - Better Transparency in Information for Medicare Beneficiaries Act of 2019 - Kind - provides consumers information regarding premiums under LIS benchmark plans H.R. 4671 - Helping Seniors Afford Health Care Act - Kim - Medicare affordability and low income beneficiaries H.R. 5006 - Expanding Access to Inpatient Mental Health Act - Emmer - Medicaid coverage for SUD/mental health for institutionalized H.R. 5201 - Telemental Health Expansion Act of 2019 - Matsui - Medicare coverage of mental telehealth H.R. 5232 - Road to Recovery Act - Fitzpatrick - Medicaid and CHIP SUD treatment H.R. 5693 - Primary Health Services Enhancement Act - Kind - Medicare rural health H.R. 5808 - Save Rural Communities Act of 2020 - Jodey Arrington - rural emergency medical access services under Medicare H.R. 5833 - To amend title XVIII of the Social Security Act to permit the use of certain psychological evaluation via telehealth for Medicare coverage of neurostimulation services for the treatment of chronic pain - Latta - Medicare coverage in telehealth H.R. 5882 - GENE Therapy Payment Act - Schrader - value based care H.R. 6098 - To amend title XXI of the Social Security Act to allow States to expand income eligibility standards under the Children's Health Insurance Program -Barragan - CHIP eligibility H.R. 6151 - CARING for Kids Act - Abby Fineknauer - CHIP H.R. 6179 - Increasing Access to Biosimilars Act of 2020 - Cardenas - payments to providers of biosimilars under Medicare H.R. 6209 - Reducing Unnecessary Senior Hospitalizations Act of 2020 or the RUSH Act of 2020 -Kuster - Medicare coverage for certain services in hospital emergency departments H.R. 6244 - To amend titles XVIII and XIX to provide for coverage at no cost sharing of COVID-19 testing under the Medicaid program and Children's Health Insurance Program - Kelly - Medicaid coverage of COVID-19 related visits and testing H.R. 6263 - To amend title XVIII of the Social Security Act to waive cost sharing under the Medicare program for certain visits relating to testing for COVID-19 -Sarbanes - Medicare coverage of COVID-19 related visits and testing H.R. 6273 - Protecting Vulnerable Americans in Times of Crisis Act of 2020 - Butterfield - FMAP H.R. 6311 - Care for COVID-19 Act - Ruiz - COVID-19 cost sharing H.R. 6336 - To amend title XI of the Social Security Act to provide for a waiver of payment reductions under the Medicare and Medicaid programs for certain nonapproved capital expenditures undertaken by health care facilities during the COVID-19 emergency - Bishop - Medicare and Medicaid payments during COVID-19 emergency S. 2846 - Protecting Patients Transportation to Care Act - Isakson - Medicaid coverage of transportation S. 2911 - Seniors Prescription Drug Relief Act of 2019 - Cassidy - Part D smoothing S. 3220 - Ensuring Access to Direct Support Professionals Act - Portman - Medicaid coverage in acute care hospitals S. 3238 - Preventive Home Visit Act - King - preventative home visits S. 3277 - HCBS Infrastructure Improvement Act - Casey - access to community based services S. 3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 - Cassidy - Medicare coverage of kidney transplant services S. 3384 - Lowering Prescription Drug Prices for America's Seniors and Families Act of 2020 - McSally - Medicare Part D drug pricing negotiation S. 3399 - FCHIP Extension Act - Tester - rural health S. 3442 - Care for COVID-19 Act - Booker - COVID-19 cost sharing S. 3443 - Improving Coverage and Care for Mothers Act - Casey - Medicaid coverage for all pregnant and postpartum women S. 3447 - RUSH Act of 2020 - Thune - Medicare coverage for certain services in hospital emergency departments S. 3466 - ACCESS for Biosimilars Act of 2020 - McSally - eliminates cost sharing for biosimilar biological products furnished under part B of the Medicare program 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 risk adjustment data validation (RADV) audit issues including proposed RADV regulation for MA; 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); calendar year 2021 policy and technical regulation for MA and Part D; MA and Part D proposed rule on drug pricing changes for 2020; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; CMSs price transparency proposal for direct-to-consumer advertisements; issues relating to 2021 Rate Notice and Call Letter; issues related to MLTSS; issues related to proposed changes to removal of safe harbor protection for rebates (proposed rule); issues relating to COVID-19; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; 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); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; 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) and the Bipartisan Budget Act of 2018 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's substantial revisions to the managed care regulations, 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; issues relating to prescription drug price blueprint; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; and other issues relating to health care reform implementation.
Client expense: $3,630,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of the Vice President of the United States, SENATE, Treasury, Dept of, White House Office
2020 · first_quarter · Medicare/Medicaid
Early detection and management of Chronic Kidney Disease, including Alternative Payment Model Increased utilization of home dialysis Extension of Medicare coverage of immunosuppressive drugs for kidney transplant recipients (H.R. 5534; S. 3353 Comments on the Advanced Notice for Medicare Advantage Capitation and Part C and Part D payments Activities in response to COVID-19,including expanding access to telehealth, access to home kidney dialysis, access to kidney transplantation, waiver of patient copayments, and waiver of certain regulatory requirements. Increased use of Kidney Discards for transplantation Access of medications under Medicare Part D Protected Classes
Client expense: $120,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), SENATE
2020 · first_quarter · Health Issues
Executive order on the Advancing American Kidney health initiative; S.1399/H.R.728 - Title VIII Nursing Workforce Reauthorization Act of 2019; H.R. 748 CARES Act; S.3353 - Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Paients Act of 2020.
Client expense: Not reported · Firm income: $20,000
Government targets: HOUSE OF REPRESENTATIVES