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Medicare Patient Empowerment Act of 2021
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Medicare Patient Empowerment Act of 2021 This bill allows any Medicare beneficiary to enter into a contract with an eligible professional, regardless of whether the professional is a participating or non-participating physician or practitioner, for any item or service covered by Medicare. Such beneficiaries may submit a claim for Medicare payment in the amount that would otherwise apply, except that, where the professional is considered to be non-participating, payment shall be paid as if the professional were participating. An eligible professional is a physician, physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, registered dietitian or nutrition professional, physical or occupational therapist, qualified speech-language pathologist, or qualified audiologist. A Medicare beneficiary must agree in writing in such a contract to (1) pay the eligible professional for a Medicare-covered item or service; and (2) submit, in lieu of the eligible professional, a claim for Medicare payment. However, a beneficiary may negotiate, as a term of the contract, for the eligible professional to file such claims on the beneficiary's behalf. The bill preempts state laws from limiting the amount of charges for physician and practitioner services for which Medicare payment is made.
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Filing registrants (8)
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
Payment of EMG services under Medicare Medicare sequestration moratorium Medicaid coverage and reimbursement Medicare wound care coverage National Correct Coding Initiative Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth under Medicare, Medicare Advantage, and Medicaid H.R. 2168/S. 3193 Expanded Telehealth Access Act APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act Improving Medicare Post-Acute Care Transformation Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting H.R. 3322/S. 826 Medicare Patient Empowerment Act Skilled Nursing Facility 3-Day rule H.R. 5536 Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Pelvic Health/Pelvic Health Awareness Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking durable medical equipment prosthetics orthotics and supplies competitive bidding H.R. 3630/S. 1315 Lymphedema Treatment Act Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Reducing Health Care costs REAADI & DRMA Acts Home Health Payment Innovation Act H.R. 3173/S. 3018 Improving Seniors Timely Access to Care Act H.R. 3650/S. 2048 Improving Access to Medicare Coverage Act Critical Access Hospital Relief Act Medicare Fee Schedule Unified post-acute care prospective payment system Inpatient rehabilitation facilities / long term care hospital payment HIPAA proposed rule HR 6020 - Support Medicare Providers Act S. 3799 PREVENT Pandemics Act H.R. 5365 Primary Health Services Enhancement Act H.R. 8181 Optimizing Postpartum Outcomes Act
Client expense: $195,457 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office
2022 · third_quarter · Medicare/Medicaid
HR 8344: Electrodiagnostic Medicine Patient Protection and Fraud Elimination Act of 2022 Medicare sequestration moratorium Medicaid coverage and reimbursement Medicare wound care coverage National Correct Coding Initiative Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth under Medicare, Medicare Advantage, and Medicaid H.R. 2168/S. 3193 Expanded Telehealth Access Act APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act Improving Medicare Post-Acute Care Transformation Act Chronic Care Management Orthotics and Prosthetics H.R. 1990/S. 2556: Medicare Orthotics and Prosthetics Patient-Centered Care Act Medicare Private Contracting H.R. 3322/S. 826 Medicare Patient Empowerment Act Skilled Nursing Facility 3-Day rule H.R. 5536 Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking durable medical equipment prosthetics orthotics and supplies competitive bidding H.R. 3630/S. 1315 Lymphedema Treatment Act Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Reducing Health Care costs REAADI & DRMA Acts Home Health Payment Innovation Act H.R. 3173/S. 3018 Improving Seniors Timely Access to Care Act H.R. 3650/S. 2048 Improving Access to Medicare Coverage Act Critical Access Hospital Relief Act Medicare Fee Schedule Unified post-acute care prospective payment system Inpatient rehabilitation facilities / long term care hospital payment HIPAA proposed rule HR 6020 - Support Medicare Providers Act S. 3799 PREVENT Pandemics Act H.R. 5365 Primary Health Services Enhancement Act H.R. 8181 Optimizing Postpartum Outcomes Act H.R 8800 Supporting Medicare Providers Act of 2022
Client expense: $194,970 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office
2022 · second_quarter · Medicare/Medicaid
Payment of EMG services under Medicare Medicare sequestration moratorium Medicaid coverage and reimbursement Medicare wound care coverage National Correct Coding Initiative Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth under Medicare, Medicare Advantage, and Medicaid H.R. 2168/S. 3193 Expanded Telehealth Access Act APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act Improving Medicare Post-Acute Care Transformation Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting H.R. 3322/S. 826 Medicare Patient Empowerment Act Skilled Nursing Facility 3-Day rule H.R. 5536 Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Pelvic Health/Pelvic Health Awareness Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking durable medical equipment prosthetics orthotics and supplies competitive bidding H.R. 3630/S. 1315 Lymphedema Treatment Act Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Reducing Health Care costs REAADI & DRMA Acts Home Health Payment Innovation Act H.R. 3173/S. 3018 Improving Seniors Timely Access to Care Act H.R. 3650/S. 2048 Improving Access to Medicare Coverage Act Critical Access Hospital Relief Act Medicare Fee Schedule Unified post-acute care prospective payment system Inpatient rehabilitation facilities / long term care hospital payment HIPAA proposed rule HR 6020 - Support Medicare Providers Act S. 3799 PREVENT Pandemics Act H.R. 5365 Primary Health Services Enhancement Act H.R. 8181 Optimizing Postpartum Outcomes Act
Client expense: $195,457 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office
2022 · second_quarter · Medicare/Medicaid
H.R. 2256/S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: To expand the physician workforce by funding new Medicare-supported graduate medical education (GME) positions. H.R. 1868, Preventing Across-the-Board Direct Spending Cuts Issue: Support extending the moratorium on the Medicare sequester and act to prevent mandatory PAYGO cuts, including 4% Medicare spending sequestration, stemming from the American Rescue Plan Act of 2021. H.R. 315/S.748, Medicare Sequester Moratorium Act of 2021 Issue: Support eliminating Medicare sequester cuts through the duration of the public health emergency. H.R. 3322/S. 826, Medicare Patient Empowerment Act of 2021 Support: Support authorizing Medicare payment option for patients and eligible professionals to freely contract Medicare fee-for-service items and services. Medicare Physician Fee Schedule (MPFS) Issue: Support measures to mitigate expected reductions to the Medicare conversion factor set to take effect in 2022. Medicare Access and CHIP Reauthorization Act (MACRA) Issue: Support request for an oversight hearing on the implementation of MACRA and physician-focused value-based care initiatives.
Client expense: $150,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office
2022 · fourth_quarter · Medicare/Medicaid
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R.340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021- Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - Treatment in Place Act - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - Jack Reynolds Memory Medigap Expansion Act - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - KEEP Telehealth Options Act of 2021 - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - Stabilize Medicaid and CHIP Coverage Act - Rep. Dingell, Debbie - Medicaid and CHIP continuous enrollment H.R. 1784 - Medicaid REACH Act - Rep. Doggett, Lloyd - requirements for non-expansion H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - Immediate Coverage for Former Foster Youth Act - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - Foster Youth Dental Act of 2021 - Rep. Bass, Karen - Medicaid dental coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - Territories Medicare Prescription Drug Assistance Equality Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare Part D premium and cost-sharing subsidies H.R. 1826 - Fairness in Medicare Part B Enrollment Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - RUSH Protection Act of 2021 - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - Rural Hospital Support Act - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - Health Insurance Consumer Protection Act - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - CAHOOTS Act - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - Improving Access to Mental Health Act of 2021 - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - SAVE Act - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri - Medicare Advantage payments for audio-only diagnoses H.R. 2168 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 2170 - HAPI Act - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - Affordable Insulin for the COVID-19 Emergency Act - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicaid FMAP for Territories H.R. 2228 - Rural Behavioral Health Access Act of 2021 - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. - Medicare Advantage supplemental benefits H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd - Medigap policies H.R. 6833 - Affordable Insulin Now Act - Rep. Craig, Angie - Insulin prices and cost sharing S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - HAPI Act -Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - KEEP Telehealth Options Act of 2021 - Sen. Fischer, Deb - telehealth expansion S. 644 - Rural Hospital Closure Relief Act of 2021 - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - Stabilize Medicaid and CHIP Coverage Act of 2021 - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - COMP Act - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - Dosha Joi Immediate Coverage for Former Foster Youth Act - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne - Medicare payment sequestration S. 764 - CAHOOTS Act - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - Medicare Patient Empowerment Act of 2021 - Sen. Paul, Rand - Medicaid payment options S. 870 - Improving Access to Mental Health Act of 2021 - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - Save Rural Hospitals Act of 2021 - Sen. Warner, Mark - Medicare hospital 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); issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2024 Rate Notice; issues related to the expiration of Medicaid continuous eligibility and transitions in coverage; issues related to coverage of EUA drugs under Medicare Part D; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; issues related to specialty infant formula; issues related to the Inflation Reduction Act passage and implementation; contraceptive coverage and reproductive health; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; issues related to Managed Long Term Services and Supports (MLTSS); issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; 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 or legislation, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; 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 value based payment 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; 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; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); issues relating to potential Medicare mental health parity requirements; 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 Affordable Care Act (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; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; 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: $2,470,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
2022 · fourth_quarter · Medicare/Medicaid
Medicare physician reimbursement issues Merit-Based Incentive Payment System (MIPS) Advanced Alternative Payment (APM) models Quality Payment Program (QPP) Misvalued global surgical codes Ambulatory Surgical Center (ASC) reimbursement issues Telehealth programs and reimbursement Health Information Technology (HIT) Medicare Advantage utilization management, including prior authorization and step therapy Pass-Through payments for ophthalmic products Office-based ophthalmic surgery H.R.3173-Improving Seniors' Timely Access to Care Act of 2021 H.R.3322-Medicare Patient Empowerment Act of 2021 H.R.7995-GOLD CARD Act of 2022 H.R.8800-Supporting Medicare Providers Act of 2022 S.826-Medicare Patient Empowerment Act of 2021 S.3018-Improving Seniors' Timely Access to Care Act of 2021
Client expense: $170,854 · 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
2022 · fourth_quarter · Medicare/Medicaid
HR 8344: Electrodiagnostic Medicine Patient Protection and Fraud Elimination Act of 2022 Medicare sequestration moratorium Medicaid coverage and reimbursement Medicare wound care coverage National Correct Coding Initiative Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth under Medicare, Medicare Advantage, and Medicaid H.R. 2168/S. 3193 Expanded Telehealth Access Act APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act Improving Medicare Post-Acute Care Transformation Act Chronic Care Management Orthotics and Prosthetics H.R. 1990/S. 2556: Medicare Orthotics and Prosthetics Patient-Centered Care Act Medicare Private Contracting H.R. 3322/S. 826 Medicare Patient Empowerment Act Skilled Nursing Facility 3-Day rule H.R. 5536 Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking durable medical equipment prosthetics orthotics and supplies competitive bidding H.R. 3630/S. 1315 Lymphedema Treatment Act Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Reducing Health Care costs REAADI & DRMA Acts Home Health Payment Innovation Act H.R. 3173/S. 3018 Improving Seniors Timely Access to Care Act H.R. 3650/S. 2048 Improving Access to Medicare Coverage Act Critical Access Hospital Relief Act Medicare Fee Schedule Unified post-acute care prospective payment system Inpatient rehabilitation facilities / long term care hospital payment HIPAA proposed rule HR 6020 - Support Medicare Providers Act S. 3799 PREVENT Pandemics Act H.R. 5365 Primary Health Services Enhancement Act H.R. 8181 Optimizing Postpartum Outcomes Act H.R 8800 Supporting Medicare Providers Act of 2022 S. 5 PTA/OTA Supervision
2022 · fourth_quarter · Medicare/Medicaid
H.R. 2256/S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: To expand the physician workforce by funding new Medicare-supported graduate medical education (GME) positions. H.R. 1868, Preventing Across-the-Board Direct Spending Cuts Issue: Support extending the moratorium on the Medicare sequester and act to prevent mandatory PAYGO cuts, including 4% Medicare spending sequestration, stemming from the American Rescue Plan Act of 2021. H.R. 315/S.748, Medicare Sequester Moratorium Act of 2021 Issue: Support eliminating Medicare sequester cuts through the duration of the public health emergency. H.R. 3322/S. 826, Medicare Patient Empowerment Act of 2021 Support: Support authorizing Medicare payment option for patients and eligible professionals to freely contract Medicare fee-for-service items and services. Medicare Physician Fee Schedule (MPFS) Issue: Support measures to mitigate expected reductions to the Medicare conversion factor set to take effect in 2022. Medicare Access and CHIP Reauthorization Act (MACRA) Issue: Support request for an oversight hearing on the implementation of MACRA and physician-focused value-based care initiatives.
Client expense: $240,000 · Firm income: Not reported
2022 · fourth_quarter · Medicare/Medicaid
S.2999 A bill to prohibit the Secretary of Health and Human Services, any officer or employee of the Department of Health and Human Services, and States from requiring COVID-19 vaccination as a condition of eligibility for benefits or assistance under the Medicare, Medicaid, or CHIP program; S.J.Res.32 A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination; H.R.1677 - KEEP Telehealth Options Act of 2021 To direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency; S.620 KEEP Telehealth Options Act of 2021; S104 HR379 Improving Social Determinants of Health Act of 2021; H.R.1227, S386 Medicare-X Choice Act of 2021; HR 3322-S826 Medicare Patient Empowerment Act of 2021; HR2410 Medicare & You Handbook Improvement Act of 2021; S1180 Choose Medicare Act' S748 Medicare Sequester Relief Act; HR 315 Medicare Sequester COVID Moratorium Act; HR599 Protecting Medicare Beneficiaries with Pre-Existing Conditions Act; S.2146 Improving Medicare Beneficiary Access to Innovative Diabetes Technologies Act of 2021; S.4067 A bill to amend title XI of the Social Security Act to improve access to care for all Medicare and Medicaid beneficiaries through models tested under the Center for Medicare and Medicaid Innovation, and for other purposes; H.R.3755 Women's Health Protection Act of 2022; . S.J.Res.32 - A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination"; H.J.Res.79 - Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Department of the Treasury and the Centers for Medicare & Medicaid Services relating to "Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond".
2022 · fourth_quarter · Health Issues
1. The Prevent Interruptions in Physical Therapy Act (H.R.1611/S.2612)to allow ALL private practice physical therapists-regardless of where their clinic is located-to use a locum tenens to provide their Medicare patients continued care when they need to be out of the clinic. 2. The Expanded Telehealth Access Act (H.R.2168/S.3193) to permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the list of providers that Medicare pays for telehealth. 3. The Medicare Patient Empowerment Act (S.826/H.R.3322)to allow a Medicare beneficiary to enter into a direct contract with an eligible professional (regardless of whether that person was a participating or non-participating physician or practitioner) for any item or service covered by Medicare. 4. The SMART Act (H.R.5536) to delay implementation of the PTA/OTA differential by one year, exempt therapy assistants in rural and medically underserved areas from the differential, and to change the supervision requirement for PTAs in private practice settings to that which state law requires. 5. S.5, a bill to change the supervision requirement for PTAs in private practice settings to that which state law requires. 6. The Improving Seniors Timely Access to Care Act (H.R.3173/S.3108) to reduce administrative burden by requiring a streamed and standardized way Medicare Advantage (MA) plans use prior authorization as well as increasing oversight and transparency around prior authorization.
Client expense: Not reported · Firm income: $30,000
2022 · third_quarter · Health Issues
1. The Prevent Interruptions in Physical Therapy Act (H.R.1611/S.2612)to allow ALL private practice physical therapists-regardless of where their clinic is located-to use a locum tenens to provide their Medicare patients continued care when they need to be out of the clinic. 2. The Expanded Telehealth Access Act (H.R.2168/S.3193) to permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the list of providers that Medicare pays for telehealth. 3. The Medicare Patient Empowerment Act (S.826/H.R.3322)to allow a Medicare beneficiary to enter into a direct contract with an eligible professional (regardless of whether that person was a participating or non-participating physician or practitioner) for any item or service covered by Medicare. 4. The SMART Act (H.R.5536) to delay implementation of the PTA/OTA differential by one year, exempt therapy assistants in rural and medically underserved areas from the differential, and to change the supervision requirement for PTAs in private practice settings to that which state law requires. 5. S.5, a bill to change the supervision requirement for PTAs in private practice settings to that which state law requires. 6. The Improving Seniors Timely Access to Care Act (H.R.3173/S.3108) to reduce administrative burden by requiring a streamed and standardized way Medicare Advantage (MA) plans use prior authorization as well as increasing oversight and transparency around prior authorization.
Client expense: Not reported · Firm income: $30,000
2022 · third_quarter · Medicare/Medicaid
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021- Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - Treatment in Place Act - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - Jack Reynolds Memory Medigap Expansion Act - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - KEEP Telehealth Options Act of 2021 - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - Stabilize Medicaid and CHIP Coverage Act - Rep. Dingell, Debbie - Medicaid and CHIP continuous enrollment H.R. 1784 - Medicaid REACH Act - Rep. Doggett, Lloyd - requirements for non-expansion H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - Immediate Coverage for Former Foster Youth Act - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - Foster Youth Dental Act of 2021 - Rep. Bass, Karen - Medicaid dental coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - Territories Medicare Prescription Drug Assistance Equality Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare Part D premium and cost-sharing subsidies H.R. 1826 - Fairness in Medicare Part B Enrollment Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - RUSH Protection Act of 2021 - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - Rural Hospital Support Act - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - Health Insurance Consumer Protection Act - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - CAHOOTS Act - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - Improving Access to Mental Health Act of 2021 - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - SAVE Act - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri - Medicare Advantage payments for audio-only diagnoses H.R. 2168 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 2170 - HAPI Act - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - Affordable Insulin for the COVID-19 Emergency Act - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicaid FMAP for Territories H.R. 2228 - Rural Behavioral Health Access Act of 2021 - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. - Medicare Advantage supplemental benefits H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd - Medigap policies H.R. 6833 - Affordable Insulin Now Act - Rep. Craig, Angie - Insulin prices and cost sharing S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - HAPI Act -Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - KEEP Telehealth Options Act of 2021 - Sen. Fischer, Deb - telehealth expansion S. 644 - Rural Hospital Closure Relief Act of 2021 - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - Stabilize Medicaid and CHIP Coverage Act of 2021 - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - COMP Act - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - Dosha Joi Immediate Coverage for Former Foster Youth Act - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne - Medicare payment sequestration S. 764 - CAHOOTS Act - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - Medicare Patient Empowerment Act of 2021 - Sen. Paul, Rand - Medicaid payment options S. 870 - Improving Access to Mental Health Act of 2021 - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - Save Rural Hospitals Act of 2021 - Sen. Warner, Mark - Medicare hospital 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 2023 policy and technical regulation for MA and Part D; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2023 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; issues related to specialty infant formula; issues related to the Inflation Reduction Act passage and implementation; contraceptive coverage and reproductive health; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; issues related to Managed Long Term Services and Supports (MLTSS); issues related to removal of safe harbor protection for rebates; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; 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 or legislation, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; 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 value based payment 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; 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; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); issues relating to potential Medicare mental health parity requirements; 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 Affordable Care Act (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; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; 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. *Add MACPAC to Agency List.
2022 · third_quarter · Medicare/Medicaid
S.2999 A bill to prohibit the Secretary of Health and Human Services, any officer or employee of the Department of Health and Human Services, and States from requiring COVID-19 vaccination as a condition of eligibility for benefits or assistance under the Medicare, Medicaid, or CHIP program; S.J.Res.32 A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination; H.R.1677 - KEEP Telehealth Options Act of 2021 To direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency; S.620 KEEP Telehealth Options Act of 2021; S104 HR379 Improving Social Determinants of Health Act of 2021; H.R.1227, S386 Medicare-X Choice Act of 2021; HR 3322-S826 Medicare Patient Empowerment Act of 2021; HR2410 Medicare & You Handbook Improvement Act of 2021; S1180 Choose Medicare Act' S748 Medicare Sequester Relief Act; HR 315 Medicare Sequester COVID Moratorium Act; HR599 Protecting Medicare Beneficiaries with Pre-Existing Conditions Act; S.2146 Improving Medicare Beneficiary Access to Innovative Diabetes Technologies Act of 2021; S.4067 A bill to amend title XI of the Social Security Act to improve access to care for all Medicare and Medicaid beneficiaries through models tested under the Center for Medicare and Medicaid Innovation, and for other purposes; H.R.3755 Women's Health Protection Act of 2022; . S.J.Res.32 - A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination"; H.J.Res.79 - Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Department of the Treasury and the Centers for Medicare & Medicaid Services relating to "Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond".
2022 · third_quarter · Medicare/Medicaid
H.R. 2256/S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: To expand the physician workforce by funding new Medicare-supported graduate medical education (GME) positions. H.R. 1868, Preventing Across-the-Board Direct Spending Cuts Issue: Support extending the moratorium on the Medicare sequester and act to prevent mandatory PAYGO cuts, including 4% Medicare spending sequestration, stemming from the American Rescue Plan Act of 2021. H.R. 315/S.748, Medicare Sequester Moratorium Act of 2021 Issue: Support eliminating Medicare sequester cuts through the duration of the public health emergency. H.R. 3322/S. 826, Medicare Patient Empowerment Act of 2021 Support: Support authorizing Medicare payment option for patients and eligible professionals to freely contract Medicare fee-for-service items and services. Medicare Physician Fee Schedule (MPFS) Issue: Support measures to mitigate expected reductions to the Medicare conversion factor set to take effect in 2022. Medicare Access and CHIP Reauthorization Act (MACRA) Issue: Support request for an oversight hearing on the implementation of MACRA and physician-focused value-based care initiatives.
Client expense: $200,000 · Firm income: Not reported
2022 · third_quarter · Medicare/Medicaid
HR 8344: Electrodiagnostic Medicine Patient Protection and Fraud Elimination Act of 2022 Medicare sequestration moratorium Medicaid coverage and reimbursement Medicare wound care coverage National Correct Coding Initiative Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth under Medicare, Medicare Advantage, and Medicaid H.R. 2168/S. 3193 Expanded Telehealth Access Act APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act Improving Medicare Post-Acute Care Transformation Act Chronic Care Management Orthotics and Prosthetics H.R. 1990/S. 2556: Medicare Orthotics and Prosthetics Patient-Centered Care Act Medicare Private Contracting H.R. 3322/S. 826 Medicare Patient Empowerment Act Skilled Nursing Facility 3-Day rule H.R. 5536 Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking durable medical equipment prosthetics orthotics and supplies competitive bidding H.R. 3630/S. 1315 Lymphedema Treatment Act Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Reducing Health Care costs REAADI & DRMA Acts Home Health Payment Innovation Act H.R. 3173/S. 3018 Improving Seniors Timely Access to Care Act H.R. 3650/S. 2048 Improving Access to Medicare Coverage Act Critical Access Hospital Relief Act Medicare Fee Schedule Unified post-acute care prospective payment system Inpatient rehabilitation facilities / long term care hospital payment HIPAA proposed rule HR 6020 - Support Medicare Providers Act S. 3799 PREVENT Pandemics Act H.R. 5365 Primary Health Services Enhancement Act H.R. 8181 Optimizing Postpartum Outcomes Act H.R 8800 Supporting Medicare Providers Act of 2022
2022 · third_quarter · Medicare/Medicaid
Medicare physician reimbursement issues Merit-Based Incentive Payment System (MIPS) Advanced Alternative Payment (APM) models Quality Payment Program (QPP) Misvalued global surgical codes Ambulatory Surgical Center (ASC) reimbursement issues Telehealth programs and reimbursement Health Information Technology (HIT) Medicare Advantage utilization management, including prior authorization and step therapy Pass-Through payments for ophthalmic products Office-based ophthalmic surgery H.R.3173-Improving Seniors' Timely Access to Care Act of 2021 H.R.3322-Medicare Patient Empowerment Act of 2021 H.R.7995-GOLD CARD Act of 2022 H.R.8800-Supporting Medicare Providers Act of 2022 S.826-Medicare Patient Empowerment Act of 2021 S.3018-Improving Seniors' Timely Access to Care Act of 2021
Client expense: $194,452 · 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
2022 · second_quarter · Medicare/Medicaid
Medicare physician reimbursement issues Merit-Based Incentive Payment System (MIPS) Advanced Alternative Payment (APM) models Quality Payment Program (QPP) Misvalued global surgical codes Ambulatory Surgical Center (ASC) reimbursement issues Telehealth programs and reimbursement Health Information Technology (HIT) Medicare Advantage utilization management, including prior authorization and step therapy Pass-Through payments for ophthalmic products H.R.3173-Improving Seniors' Timely Access to Care Act of 2021 H.R.3322-Medicare Patient Empowerment Act of 2021 H.R.7995-GOLD CARD Act of 2022 S.826-Medicare Patient Empowerment Act of 2021 S.3018-Improving Seniors' Timely Access to Care Act of 2021
Client expense: $154,186 · 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
2022 · second_quarter · Medicare/Medicaid
H.R. 2256/S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: To expand the physician workforce by funding new Medicare-supported graduate medical education (GME) positions. H.R. 1868, Preventing Across-the-Board Direct Spending Cuts Issue: Support extending the moratorium on the Medicare sequester and act to prevent mandatory PAYGO cuts, including 4% Medicare spending sequestration, stemming from the American Rescue Plan Act of 2021. H.R. 315/S.748, Medicare Sequester Moratorium Act of 2021 Issue: Support eliminating Medicare sequester cuts through the duration of the public health emergency. H.R. 3322/S. 826, Medicare Patient Empowerment Act of 2021 Support: Support authorizing Medicare payment option for patients and eligible professionals to freely contract Medicare fee-for-service items and services. Medicare Physician Fee Schedule (MPFS) Issue: Support measures to mitigate expected reductions to the Medicare conversion factor set to take effect in 2022. Medicare Access and CHIP Reauthorization Act (MACRA) Issue: Support request for an oversight hearing on the implementation of MACRA and physician-focused value-based care initiatives.
Client expense: $150,000 · Firm income: Not reported
2022 · second_quarter · Health Issues
1. The Prevent Interruptions in Physical Therapy Act (H.R.1611/S.2612)and potential Senate companion bill, to allow ALL private practice physical therapists-regardless of where their clinic is located-to use a locum tenens to provide their Medicare patients continued care when they need to be out of the clinic. 2. The Expanded Telehealth Access Act (H.R.2168/S.3193) and potential Senate companion bill, to permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the list of providers that Medicare pays for telehealth. 3. The Medicare Patient Empowerment Act (S.826/H.R.3322)to allow a Medicare beneficiary to enter into a direct contract with an eligible professional (regardless of whether that person was a participating or non-participating physician or practitioner) for any item or service covered by Medicare. 4. The SMART Act (H.R.5536) to delay implementation of the PTA/OTA differential by one year, exempt therapy assistants in rural and medically underserved areas from the differential, and to change the supervision requirement for PTAs in private practice settings to that which state law requires. 5. The Improving Seniors Timely Access to Care Act (H.R.3173/S.3108) to reduce administrative burden by requiring a streamed and standardized way Medicare Advantage (MA) plans use prior authorization as well as increasing oversight and transparency around prior authorization. 6. The bipartisan Primary Health Services Enhancement Act (H.R.5365) would allow CHCs to offer physical therapy services which will be provided by a physical therapist.
Client expense: Not reported · Firm income: $50,000
2022 · first_quarter · Health Issues
1. The Prevent Interruptions in Physical Therapy Act (H.R.1611/S.2612)and potential Senate companion bill, to allow ALL private practice physical therapists-regardless of where their clinic is located-to use a locum tenens to provide their Medicare patients continued care when they need to be out of the clinic. 2. The Expanded Telehealth Access Act (H.R.2168/S.3193) and potential Senate companion bill, to permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the list of providers that Medicare pays for telehealth. 3. The Medicare Patient Empowerment Act (S.826/H.R.3322)to allow a Medicare beneficiary to enter into a direct contract with an eligible professional (regardless of whether that person was a participating or non-participating physician or practitioner) for any item or service covered by Medicare. 4. The SMART Act (H.R.5536) to delay implementation of the PTA/OTA differential by one year, exempt therapy assistants in rural and medically underserved areas from the differential, and to change the supervision requirement for PTAs in private practice settings to that which state law requires. 5. The Improving Seniors Timely Access to Care Act (H.R.3173/S.3108) to reduce administrative burden by requiring a streamed and standardized way Medicare Advantage (MA) plans use prior authorization as well as increasing oversight and transparency around prior authorization.
Client expense: Not reported · Firm income: $50,000
2022 · second_quarter · Medicare/Medicaid
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021- Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - Treatment in Place Act - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - Jack Reynolds Memory Medigap Expansion Act - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - KEEP Telehealth Options Act of 2021 - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - Stabilize Medicaid and CHIP Coverage Act - Rep. Dingell, Debbie - Medicaid and CHIP continuous enrollment H.R. 1784 - Medicaid REACH Act - Rep. Doggett, Lloyd - requirements for non-expansion H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - Immediate Coverage for Former Foster Youth Act - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - Foster Youth Dental Act of 2021 - Rep. Bass, Karen - Medicaid dental coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - Territories Medicare Prescription Drug Assistance Equality Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare Part D premium and cost-sharing subsidies H.R. 1826 - Fairness in Medicare Part B Enrollment Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - RUSH Protection Act of 2021 - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - Rural Hospital Support Act - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - Health Insurance Consumer Protection Act - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - CAHOOTS Act - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - Improving Access to Mental Health Act of 2021 - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - SAVE Act - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri - Medicare Advantage payments for audio-only diagnoses H.R. 2168 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 2170 - HAPI Act - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - Affordable Insulin for the COVID-19 Emergency Act - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicaid FMAP for Territories H.R. 2228 - Rural Behavioral Health Access Act of 2021 - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. - Medicare Advantage supplemental benefits H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd - Medigap policies H.R. 6833 - Affordable Insulin Now Act - Rep. Craig, Angie - Insulin prices and cost sharing S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - HAPI Act -Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - KEEP Telehealth Options Act of 2021 - Sen. Fischer, Deb - telehealth expansion S. 644 - Rural Hospital Closure Relief Act of 2021 - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - Stabilize Medicaid and CHIP Coverage Act of 2021 - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - COMP Act - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - Dosha Joi Immediate Coverage for Former Foster Youth Act - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne - Medicare payment sequestration S. 764 - CAHOOTS Act - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - Medicare Patient Empowerment Act of 2021 - Sen. Paul, Rand - Medicaid payment options S. 870 - Improving Access to Mental Health Act of 2021 - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - Save Rural Hospitals Act of 2021 - Sen. Warner, Mark - Medicare hospital 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 2023 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2023 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; contraceptive coverage and reproductive health; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; 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, vaccines and therapeutics; issues related to the end of the public health emergency; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; 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 or legislation, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; 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 value based payment 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; 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; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); issues relating to potential Medicare mental health parity requirements; 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 Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; 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.
2022 · second_quarter · Medicare/Medicaid
Payment of EMG services under Medicare Medicare sequestration moratorium Medicaid coverage and reimbursement Medicare wound care coverage National Correct Coding Initiative Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth under Medicare, Medicare Advantage, and Medicaid H.R. 2168/S. 3193 Expanded Telehealth Access Act APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act Improving Medicare Post-Acute Care Transformation Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting H.R. 3322/S. 826 Medicare Patient Empowerment Act Skilled Nursing Facility 3-Day rule H.R. 5536 Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Pelvic Health/Pelvic Health Awareness Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking durable medical equipment prosthetics orthotics and supplies competitive bidding H.R. 3630/S. 1315 Lymphedema Treatment Act Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Reducing Health Care costs REAADI & DRMA Acts Home Health Payment Innovation Act H.R. 3173/S. 3018 Improving Seniors Timely Access to Care Act H.R. 3650/S. 2048 Improving Access to Medicare Coverage Act Critical Access Hospital Relief Act Medicare Fee Schedule Unified post-acute care prospective payment system Inpatient rehabilitation facilities / long term care hospital payment HIPAA proposed rule HR 6020 - Support Medicare Providers Act S. 3799 PREVENT Pandemics Act H.R. 5365 Primary Health Services Enhancement Act H.R. 8181 Optimizing Postpartum Outcomes Act
2022 · second_quarter · Medicare/Medicaid
S.2999 A bill to prohibit the Secretary of Health and Human Services, any officer or employee of the Department of Health and Human Services, and States from requiring COVID-19 vaccination as a condition of eligibility for benefits or assistance under the Medicare, Medicaid, or CHIP program; S.J.Res.32 A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination; H.R.1677 - KEEP Telehealth Options Act of 2021 To direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency; S.620 KEEP Telehealth Options Act of 2021; S104 HR379 Improving Social Determinants of Health Act of 2021; H.R.1227, S386 Medicare-X Choice Act of 2021; HR 3322-S826 Medicare Patient Empowerment Act of 2021; HR2410 Medicare & You Handbook Improvement Act of 2021; S1180 Choose Medicare Act' S748 Medicare Sequester Relief Act; HR 315 Medicare Sequester COVID Moratorium Act; HR599 Protecting Medicare Beneficiaries with Pre-Existing Conditions Act; S.2146 Improving Medicare Beneficiary Access to Innovative Diabetes Technologies Act of 2021; S.4067 A bill to amend title XI of the Social Security Act to improve access to care for all Medicare and Medicaid beneficiaries through models tested under the Center for Medicare and Medicaid Innovation, and for other purposes; H.R.3755 Women's Health Protection Act of 2022; . S.J.Res.32 - A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination"; H.J.Res.79 - Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Department of the Treasury and the Centers for Medicare & Medicaid Services relating to "Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond".
2022 · first_quarter · Medicare/Medicaid
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021- Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - Treatment in Place Act - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - Jack Reynolds Memory Medigap Expansion Act - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - KEEP Telehealth Options Act of 2021 - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - Protecting Married Seniors from Impoverishment Act of 2021 - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2021 - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - Stabilize Medicaid and CHIP Coverage Act - Rep. Dingell, Debbie - Medicaid and CHIP continuous enrollment H.R. 1784 - Medicaid REACH Act - Rep. Doggett, Lloyd - requirements for non-expansion H.R. 1791 - CHIPP Act - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - Ensuring Kids Have Access to Medically Necessary Dental Care Act - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - Immediate Coverage for Former Foster Youth Act - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - Foster Youth Dental Act of 2021 - Rep. Bass, Karen - Medicaid dental coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - Territories Medicare Prescription Drug Assistance Equality Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare Part D premium and cost-sharing subsidies H.R. 1826 - Fairness in Medicare Part B Enrollment Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - RUSH Protection Act of 2021 - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - Rural Hospital Support Act - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - Health Insurance Consumer Protection Act - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - CAHOOTS Act - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - Improving Access to Mental Health Act of 2021 - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - SAVE Act - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021 - Rep. Sewell, Terri - Medicare Advantage payments for audio-only diagnoses H.R. 2168 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 2170 - HAPI Act - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - Affordable Insulin for the COVID-19 Emergency Act - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - Territory Federal Matching Requirement Equity Act of 2021 - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicaid FMAP for Territories H.R. 2228 - Rural Behavioral Health Access Act of 2021 - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services H.R. 4074 - Addressing Social Determinants in Medicare Advantage Act of 2021 - Rep. Bilirakis, Gus M. - Medicare Advantage supplemental benefits H.R. 4640 - Close the Medigap Act of 2021 - Rep. Doggett, Lloyd -- Medigap policies H.R. 6833 - Affordable Insulin Now Act - Rep. Craig, Angie - Insulin prices and cost sharing S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - HAPI Act -Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - KEEP Telehealth Options Act of 2021 - Sen. Fischer, Deb - telehealth expansion S. 644 - Rural Hospital Closure Relief Act of 2021 - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - Stabilize Medicaid and CHIP Coverage Act of 2021 - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - COMP Act - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - Dosha Joi Immediate Coverage for Former Foster Youth Act - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - Medicare Sequester Relief Act - Sen. Shaheen, Jeanne - Medicare payment sequestration S. 764 - CAHOOTS Act - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - Medicare Patient Empowerment Act of 2021 - Sen. Paul, Rand - Medicaid payment options S. 870 - Improving Access to Mental Health Act of 2021 - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - Save Rural Hospitals Act of 2021 - Sen. Warner, Mark - Medicare hospital 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 2023 policy and technical regulation for MA and Part D; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2023 Rate Notice; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to Medicaid coverage gap; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; 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, vaccines and therapeutics; issues related to the end of the public health emergency; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; issues related to health equity; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; 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; 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 value based payment 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; 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; issues relating to MACRA, including implications for MA and Part D plans; 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 Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; 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.
2022 · first_quarter · Medicare/Medicaid
Payment of EMG services under Medicare Medicare sequestration moratorium Medicaid coverage and reimbursement Medicare wound care coverage National Correct Coding Initiative Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth under Medicare, Medicare Advantage, and Medicaid H.R. 2168/S. 3193 Expanded Telehealth Access Act APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act Improving Medicare Post-Acute Care Transformation Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting H.R. 3322/S. 826 Medicare Patient Empowerment Act Skilled Nursing Facility 3-Day rule H.R. 5536 Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking durable medical equipment prosthetics orthotics and supplies competitive bidding H.R. 3630/S. 1315 Lymphedema Treatment Act Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Reducing Health Care costs REAADI & DRMA Acts Home Health Payment Innovation Act H.R. 3173/S. 3018 Improving Seniors Timely Access to Care Act H.R. 3650/S. 2048 Improving Access to Medicare Coverage Act Critical Access Hospital Relief Act Medicare Fee Schedule Unified post-acute care prospective payment system Inpatient rehabilitation facilities / long term care hospital payment HIPAA proposed rule HR 6020 - Support Medicare Providers Act S. 3799 PREVENT Pandemics Act H.R. 5365 Primary Health Services Enhancement Act
2022 · first_quarter · Medicare/Medicaid
S.2999 A bill to prohibit the Secretary of Health and Human Services, any officer or employee of the Department of Health and Human Services, and States from requiring COVID-19 vaccination as a condition of eligibility for benefits or assistance under the Medicare, Medicaid, or CHIP program; S.J.Res.32 A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination";H.R.1677 To direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency; . S.620 KEEP Telehealth Options Act of 2021; S104 HR379 Improving Social Determinants of Health Act of 2021; H.R.2517, S1125 To recommend that the Center for Medicare and Medicaid Innovation test the effect of a dementia care management model, and for other purposes; H.R.1227, S386 Medicare-X Choice Act of 2021; HR 3322-S826 Medicare Patient Empowerment Act of 2021; HR2410 Medicare & You Handbook Improvement Act of 2021; S1180 Choose Medicare Act' S748 Medicare Sequester Relief Act; HR 315 Medicare Sequester COVID Moratorium Act; HR599 Protecting Medicare Beneficiaries with Pre-Existing Conditions Act; S.2146 Improving Medicare Beneficiary Access to Innovative Diabetes Technologies Act of 2021; S.4067 A bill to amend title XI of the Social Security Act to improve access to care for all Medicare and Medicaid beneficiaries through models tested under the Center for Medicare and Medicaid Innovation, and for other purposes.
2022 · first_quarter · Medicare/Medicaid
H.R. 2256/S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: To expand the physician workforce by funding new Medicare-supported graduate medical education (GME) positions. H.R. 1868, Preventing Across-the-Board Direct Spending Cuts Issue: Support extending the moratorium on the Medicare sequester and act to prevent mandatory PAYGO cuts, including 4% Medicare spending sequestration, stemming from the American Rescue Plan Act of 2021. H.R. 315/S.748, Medicare Sequester Moratorium Act of 2021 Issue: Support eliminating Medicare sequester cuts through the duration of the public health emergency. H.R. 3322/S. 826, Medicare Patient Empowerment Act of 2021 Support: Support authorizing Medicare payment option for patients and eligible professionals to freely contract Medicare fee-for-service items and services. Medicare Physician Fee Schedule (MPFS) Issue: Support measures to mitigate expected reductions to the Medicare conversion factor set to take effect in 2022. Medicare Access and CHIP Reauthorization Act (MACRA) Issue: Support request for an oversight hearing on the implementation of MACRA and physician-focused value-based care initiatives.
Client expense: $90,000 · Firm income: Not reported
2021 · fourth_quarter · Health Issues
1. The Prevent Interruptions in Physical Therapy Act (H.R.1611/S.2612)and potential Senate companion bill, to allow ALL private practice physical therapists-regardless of where their clinic is located-to use a locum tenens to provide their Medicare patients continued care when they need to be out of the clinic. 2. The Expanded Telehealth Access Act (H.R.2168/S.3193) and potential Senate companion bill, to permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the list of providers that Medicare pays for telehealth. 3. The Medicare Patient Empowerment Act (S.826/H.R.3322)to allow a Medicare beneficiary to enter into a direct contract with an eligible professional (regardless of whether that person was a participating or non-participating physician or practitioner) for any item or service covered by Medicare. 4. The SMART Act (H.R.5536) to delay implementation of the PTA/OTA differential by one year, exempt therapy assistants in rural and medically underserved areas from the differential, and to change the supervision requirement for PTAs in private practice settings to that which state law requires. 5. Gain supporters for extending the 3.75% Medicare payment adjustment for another year, including gaining cosigners for Bera-Bucshon letter requesting that action before end of 2021. 6. The bipartisan Eliminating Provider Relief Fund Tax Penalties Act (H.R.2079) is seeking to override the 2020 IRS guidance which stated provider relief fund grants are to be treated as gross income and therefore taxable. 7. The Improving Seniors Timely Access to Care Act (H.R.3173/S.3108) to reduce administrative burden by requiring a streamed and standardized way Medicare Advantage (MA) plans use prior authorization as well as increasing oversight and transparency around prior authorization.
2021 · fourth_quarter · Medicare/Medicaid
Payment of EMG services under Medicare Medicare sequestration moratorium Medicaid coverage and reimbursement Medicare wound care coverage National Correct Coding Initiative Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth under Medicare, Medicare Advantage, and Medicaid H.R. 2168/S. 3193 Expanded Telehealth Access Act APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act Improving Medicare Post-Acute Care Transformation Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting H.R. 3322/S. 826 Medicare Patient Empowerment Act Skilled Nursing Facility 3-Day rule H.R. 5536 Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking durable medical equipment prosthetics orthotics and supplies competitive bidding H.R. 3630/S. 1315 Lymphedema Treatment Act Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Reducing Health Care costs REAADI & DRMA Acts Home Health Payment Innovation Act H.R. 3173/S. 3018 Improving Seniors Timely Access to Care Act H.R. 3650/S. 2048 Improving Access to Medicare Coverage Act Critical Access Hospital Relief Act Medicare Fee Schedule Unified post-acute care prospective payment system Inpatient rehabilitation facilities / long term care hospital payment HIPAA proposed rule HR 6020 - Support Medicare Providers Act
2021 · fourth_quarter · Medicare/Medicaid
S.2999 A bill to prohibit the Secretary of Health and Human Services, any officer or employee of the Department of Health and Human Services, and States from requiring COVID-19 vaccination as a condition of eligibility for benefits or assistance under the Medicare, Medicaid, or CHIP program; S.J.Res.32 A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination";H.R.1677 To direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency; . S.620 KEEP Telehealth Options Act of 2021; S104 HR379 Improving Social Determinants of Health Act of 2021; H.R.2517, S1125 To recommend that the Center for Medicare and Medicaid Innovation test the effect of a dementia care management model, and for other purposes; H.R.1227, S386 Medicare-X Choice Act of 2021; HR 3322-S826 Medicare Patient Empowerment Act of 2021; HR2410 Medicare & You Handbook Improvement Act of 2021; S1180 Choose Medicare Act' S748 Medicare Sequester Relief Act; HR 315 Medicare Sequester COVID Moratorium Act; HR599 Protecting Medicare Beneficiaries with Pre-Existing Conditions Act; S.2146 Improving Medicare Beneficiary Access to Innovative Diabetes Technologies Act of 2021.
Client expense: Not reported · Firm income: $11,000
2021 · fourth_quarter · Medicare/Medicaid
H.R. 2256/S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: To expand the physician workforce by funding new Medicare-supported graduate medical education (GME) positions. H.R. 1868, Preventing Across-the-Board Direct Spending Cuts Issue: Support extending the moratorium on the Medicare sequester and act to prevent mandatory PAYGO cuts, including 4% Medicare spending sequestration, stemming from the American Rescue Plan Act of 2021. H.R. 315/S.748, Medicare Sequester Moratorium Act of 2021 Issue: Support eliminating Medicare sequester cuts through the duration of the public health emergency. H.R. 3322/S. 826, Medicare Patient Empowerment Act of 2021 Support: Support authorizing Medicare payment option for patients and eligible professionals to freely contract Medicare fee-for-service items and services. Medicare Physician Fee Schedule (MPFS) Issue: Support measures to mitigate expected reductions to the Medicare conversion factor set to take effect in 2022. Medicare Access and CHIP Reauthorization Act (MACRA) Issue: Support request for an oversight hearing on the implementation of MACRA and physician-focused value-based care initiatives.
Client expense: $140,000 · Firm income: Not reported
2021 · third_quarter · Health Issues
1. The Prevent Interruptions in Physical Therapy Act (H.R.1611/S.2612)and potential Senate companion bill, to allow ALL private practice physical therapists-regardless of where their clinic is located-to use a locum tenens to provide their Medicare patients continued care when they need to be out of the clinic. 2. The Expanded Telehealth Access Act (H.R.2168/S.3193) and potential Senate companion bill, to permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the list of providers that Medicare pays for telehealth. 3. The Medicare Patient Empowerment Act (S.826/H.R.3322)to allow a Medicare beneficiary to enter into a direct contract with an eligible professional (regardless of whether that person was a participating or non-participating physician or practitioner) for any item or service covered by Medicare. 4. The SMART Act (H.R.5536) to delay implementation of the PTA/OTA differential by one year, exempt therapy assistants in rural and medically underserved areas from the differential, and to change the supervision requirement for PTAs in private practice settings to that which state law requires. 5. Gain supporters for extending the 3.75% Medicare payment adjustment for another year, including gaining cosigners for Bera-Bucshon letter requesting that action before end of 2021. 6. The bipartisan Eliminating Provider Relief Fund Tax Penalties Act (H.R.2079) is seeking to override the 2020 IRS guidance which stated provider relief fund grants are to be treated as gross income and therefore taxable. 7. The Improving Seniors Timely Access to Care Act (H.R.3173/S.3108) to reduce administrative burden by requiring a streamed and standardized way Medicare Advantage (MA) plans use prior authorization as well as increasing oversight and transparency around prior authorization.
2021 · third_quarter · Medicare/Medicaid
Payment of EMG services under Medicare Medicare sequestration moratorium Medicaid coverage and reimbursement Medicare wound care coverage National Correct Coding Initiative Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth under Medicare, Medicare Advantage, and Medicaid H.R. 2168 Expanded Telehealth Access Act APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act Improving Medicare Post-Acute Care Transformation Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting H.R. 3322/S. 826 Medicare Patient Empowerment Act Skilled Nursing Facility 3-Day rule H.R. 5536 Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking durable medical equipment prosthetics orthotics and supplies competitive bidding H.R. 3630/S. 1315 Lymphedema Treatment Act Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Reducing Health Care costs REAADI & DRMA Acts Home Health Payment Innovation Act H.R. 3173 Improving Seniors Timely Access to Care Act H.R. 3650/S. 2048 Improving Access to Medicare Coverage Act Critical Access Hospital Relief Act Medicare Fee Schedule Unified post-acute care prospective payment system Inpatient rehabilitation facilities / long term care hospital payment HIPAA proposed rule
2021 · third_quarter · Medicare/Medicaid
H.R.1677 To direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency; . S.620 KEEP Telehealth Options Act of 2021; S104 HR379 Improving Social Determinants of Health Act of 2021; H.R.2517, S1125 To recommend that the Center for Medicare and Medicaid Innovation test the effect of a dementia care management model, and for other purposes; H.R.1227, S386 Medicare-X Choice Act of 2021; HR 3322-S826 Medicare Patient Empowerment Act of 2021; HR2410 Medicare & You Handbook Improvement Act of 2021; S1180 Choose Medicare Act' S748 Medicare Sequester Relief Act; HR 315 Medicare Sequester COVID Moratorium Act; HR599 Protecting Medicare Beneficiaries with Pre-Existing Conditions Act; S.2146 Improving Medicare Beneficiary Access to Innovative Diabetes Technologies Act of 2021.
Client expense: Not reported · Firm income: $11,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2021 · third_quarter · Medicare/Medicaid
H.R. 2256/S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: To expand the physician workforce by funding new Medicare-supported graduate medical education (GME) positions. H.R. 1868, Preventing Across-the-Board Direct Spending Cuts Issue: Support extending the moratorium on the Medicare sequester and act to prevent mandatory PAYGO cuts, including 4% Medicare spending sequestration, stemming from the American Rescue Plan Act of 2021. H.R. 315/S.748, Medicare Sequester Moratorium Act of 2021 Issue: Support eliminating Medicare sequester cuts through the duration of the public health emergency. H.R. 3322/S. 826, Medicare Patient Empowerment Act of 2021 Support: Support authorizing Medicare payment option for patients and eligible professionals to freely contract Medicare fee-for-service items and services. Medicare Physician Fee Schedule (MPFS) Issue: Support measures to mitigate expected reductions to the Medicare conversion factor set to take effect in 2022. Medicare Access and CHIP Reauthorization Act (MACRA) Issue: Support request for an oversight hearing on the implementation of MACRA and physician-focused value-based care initiatives.
Client expense: $90,000 · Firm income: Not reported
2021 · second_quarter · Medicare/Medicaid
H.R.1677 To direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency; . S.620 KEEP Telehealth Options Act of 2021; S104 HR379 Improving Social Determinants of Health Act of 2021; H.R.2517, S1125 To recommend that the Center for Medicare and Medicaid Innovation test the effect of a dementia care management model, and for other purposes; H.R.1227, S386 Medicare-X Choice Act of 2021; HR 3322-S826 Medicare Patient Empowerment Act of 2021; HR2410 Medicare & You Handbook Improvement Act of 2021; S1180 Choose Medicare Act' S748 Medicare Sequester Relief Act; HR 315 Medicare Sequester COVID Moratorium Act; HR599 Protecting Medicare Beneficiaries with Pre-Existing Conditions Act.
Client expense: Not reported · Firm income: $11,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2021 · second_quarter · Medicare/Medicaid
H.R. 2256/S. 834, Resident Physician Shortage Reduction Act of 2021 Issue: To expand the physician workforce by funding new Medicare-supported graduate medical education (GME) positions. H.R. 1868, Preventing Across-the-Board Direct Spending Cuts Issue: Support extending the moratorium on the Medicare sequester and act to prevent mandatory PAYGO cuts, including 4% Medicare spending sequestration, stemming from the American Rescue Plan Act of 2021. H.R. 315/S.748, Medicare Sequester Moratorium Act of 2021 Issue: Support eliminating Medicare sequester cuts through the duration of the public health emergency. H.R. 3322/S. 826, Medicare Patient Empowerment Act of 2021 Support: Support authorizing Medicare payment option for patients and eligible professionals to freely contract Medicare fee-for-service items and services. Medicare Physician Fee Schedule (MPFS) Issue: Support measures to mitigate expected reductions to the Medicare conversion factor set to take effect in 2022. Medicare Access and CHIP Reauthorization Act (MACRA) Issue: Support request for an oversight hearing on the implementation of MACRA and physician-focused value-based care initiatives.
Client expense: $60,000 · Firm income: Not reported
2021 · second_quarter · Medicare/Medicaid
S. 586, Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act: To establish separate payments for certain non-opioid treatments under the Medicare prospective payment system for hospital outpatient department services and the payment system for ambulatory surgical center services S.834, Resident Physician Shortage Reduction Act: To provide additional Medicare funds to support 14,000 new GME/residency training slots S. 826, Medicare Patient Empowerment Act: To allow physicians and patients to privately contract without penalty for Medicare services S. 1512, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act: To expand access to telehealth services. H.R 2256, Resident Physician Shortage Reduction Act: To provide additional Medicare funds to support 14,000 new GME/residency training slots H.R. 2903, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act: To expand access to telehealth services. H.R. 3173, Improving Seniors Timely Access to Care Act: To streamline prior authorization in the Medicare Advantage Program H.R.3322, Medicare Patient Empowerment Act: To allow physicians and patients to privately contract without penalty for Medicare services No Bill: To prevent Medicare payment cuts and mandate that the Centers for Medicare & Medicaid Services value global codes appropriately No Bill: Urging Congressional oversight and review of Medicare's Quality Payment Program No Bill: Urging Congress to halt Medicare prior authorization requirements for hospital outpatient department services
Client expense: $35,000 · Firm income: Not reported
2021 · second_quarter · Medicare/Medicaid
S. 586, Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act: To establish separate payments for certain non-opioid treatments under the Medicare prospective payment system for hospital outpatient department services and the payment system for ambulatory surgical center services S.834, Resident Physician Shortage Reduction Act: To provide additional Medicare funds to support 14,000 new GME/residency training slots S. 826, Medicare Patient Empowerment Act: To allow physicians and patients to privately contract without penalty for Medicare services S. 1512, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act: To expand access to telehealth services. H.R 2256, Resident Physician Shortage Reduction Act: To provide additional Medicare funds to support 14,000 new GME/residency training slots H.R. 2903, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act: To expand access to telehealth services. H.R. 3173, Improving Seniors Timely Access to Care Act: To streamline prior authorization in the Medicare Advantage Program H.R.3322, Medicare Patient Empowerment Act: To allow physicians and patients to privately contract without penalty for Medicare services No Bill: To prevent Medicare payment cuts and mandate that the Centers for Medicare & Medicaid Services value global codes appropriately No Bill: Urging Congressional oversight and review of Medicare's Quality Payment Program No Bill: Urging Congress to halt Medicare prior authorization requirements for hospital outpatient department services
Client expense: $35,000 · Firm income: Not reported
2021 · second_quarter · Medicare/Medicaid
Payment of EMG services under Medicare Medicare sequestration moratorium Medicaid coverage and reimbursement Medicare wound care coverage National Correct Coding Initiative Edits Protection of programs related to physical therapy in deficit reduction Medicare Advantage Essential Health Benefits Medicare improvement standards Inclusion of physical therapists in quality programs Medicare Self-referral Coverage of telehealth under Medicare, Medicare Advantage, and Medicaid H.R. 2168 Expanded Telehealth Access Act APTA PT Outcomes Registry/Qualified Clinical Data Registries Medicare Quality Programs Accelerating Innovation in Medicine Act Improving Medicare Post-Acute Care Transformation Act Chronic Care Management Orthotics and Prosthetics Medicare Private Contracting H.R. 3322/S. 826 Medicare Patient Empowerment Act Skilled Nursing Facility 3-Day rule PTA Differential in Medicare Prior Authorization in Medicare Advantage Plans Alternative payment models Health information technology: Electronic health records, health IT incentives for physical therapists, certification of EHRs interoperability, and information blocking durable medical equipment prosthetics orthotics and supplies competitive bidding H.R. 3630/S. 1315 Lymphedema Treatment Act Medicare enrollment Skilled Nursing Facility payment Home Health payment Medical review (Medicare) Reducing Health Care costs REAADI & DRMA Acts Home Health Payment Innovation Act H.R. 3173 Improving Seniors Timely Access to Care Act H.R. 3650/S. 2048 Improving Access to Medicare Coverage Act Critical Access Hospital Relief Act Medicare Fee Schedule Unified post-acute care prospective payment system Inpatient rehabilitation facilities / long term care hospital payment HIPAA proposed rule
Client expense: $214,211 · Firm income: Not reported
2021 · second_quarter · Health Issues
1. Advocating for the passage of the bipartisan Medicare Sequester COVID Moratorium Act (H.R.315/S.748) in order to delay the reinstatement of the Medicare sequester until the public health emergency (PHE) is revoked. Supported passage of legislation to delay the return of sequestration until January 1, 2022. 2. The Prevent Interruptions in Physical Therapy Act (H.R.1611)and potential Senate companion bill, to allow ALL private practice physical therapists-regardless of where their clinic is located-to use a locum tenens to provide their Medicare patients continued care when they need to be out of the clinic. 3. The Expanded Telehealth Access Act (H.R.2168) and potential Senate companion bill, to permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the list of providers that Medicare pays for telehealth. 5. The Medicare Patient Empowerment Act (S.826/H.R.3322)to allow a Medicare beneficiary to enter into a direct contract with an eligible professional (regardless of whether that person was a participating or non-participating physician or practitioner) for any item or service covered by Medicare. 6. Requesting that the Labor Health and Human Services (Labor-H) Appropriations bill include report language that directs CMS to change the supervision requirement for PTAs in private practice settings from direct to general supervision. 7. The bipartisan Eliminating Provider Relief Fund Tax Penalties Act (H.R.2079) is seeking to override the 2020 IRS guidance which stated provider relief fund grants are to be treated as gross income and therefore taxable. 8. The Improving Seniors Timely Access to Care Act (H.R.3173) to reduce administrative burden by requiring a streamed and standardized way Medicare Advantage (MA) plans use prior authorization as well as increasing oversight and transparency around prior authorization.
2021 · first_quarter · Health Issues
1. The American Rescue Plan. enacted on March 11th. Portions most relevant to PPS: the Paycheck Protection Program (PPP), Targeted Economic Injury Disaster Loan (EIDL) Advance program, paid sick and paid family leave tax credit, Employee retention tax credit (ERTC). 2. Advocating for the passage of the bipartisan Medicare Sequester COVID Moratorium Act (H.R.315/S.748) in order to delay the reinstatement of the Medicare sequester until the public health emergency (PHE) is revoked. Supported passage delay the return of sequestration until January 1, 2022. 3. The Prevent Interruptions in Physical Therapy Act (H.R.1611) to allow ALL private practice physical therapists-regardless of where their clinic is located-to use a locum tenens to provide their Medicare patients continued care when they need to be out of the clinic. 4. The Expanded Telehealth Access Act (H.R.2168) to permanently add physical therapists, physical therapist assistants, and other rehabilitation therapists to the list of providers that Medicare pays for telehealth. 5. The Medicare Patient Empowerment Act (S.826)to allow a Medicare beneficiary to enter into a direct contract with an eligible professional (regardless of whether that person was a participating or non-participating physician or practitioner) for any item or service covered by Medicare. 6. Paycheck Protection Program (PPP) extension
Client expense: Not reported · Firm income: $40,000
2021 · first_quarter · Medicare/Medicaid
H.R. 66 - CARING for Kids Act - Rep. Buchanan, Vern - CHIP H.R. 265 - Insular Area Medicaid Parity Act - Rep. Sablan, Gregorio Kilili Camacho - Medicaid funding H.R. 315 - Medicare Sequester COVID Moratorium Act - Rep. Schneider, Bradley Scott - Medicare sequestration H.R. 340 - Incentivizing Medicaid Expansion Act of 2021 - Rep. Veasey, Marc - Medicaid expansion H.R. 432 - Mental Health Access Improvement Act of 2021 - Rep. Thompson, Mike -Medicare coverage of marriage and family therapist services and mental health counselor H.R. 502 - Medicare Dental Benefit Act of 2021 - Rep. Barragan, Nanette Diaz - Medicare coverage of dental and oral health services H.R. 525 - COVID HCBS Relief Act of 2021 - Rep. Dingell, Debbie - increased FMAP for HCBS H.R. 871 - Expand Medicaid Now Act - Rep. Fletcher, Lizzie - FMAP H.R. 918 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Rep. Cardenas, Tony - COVID-19 coverage for the uninsured via Medicaid H.R. 955 - Medicaid Reentry Act of 2021 - Rep. Tonko, Paul -Medicaid coverage for incarcerated individuals H.R. 1167 - Advancing Enrollment and Reducing Drug Costs Act of 2021 - Rep. Pappas, Chris - Medicaid eligibility for low-income subsidies H.R. 1227 - Medicare-X Choice Act of 2021 - Rep. Delgado, Antonio - Medicare public option H.R. 1332 - Telehealth Modernization Act - Rep. Carter, Earl - telehealth services under Medicare H.R. 1349 - To amend title XVIII of the Social Security Act to provide for the conversion of certain accelerated and advance payments to grants under parts A and B of the Medicare program - Rep. Kaptur, Marcy - advance payments under parts A and B of Medicare H.R. 1353 - Coronavirus Medicaid Response Act - Rep. Lee, Susie - FMAP H.R. 1390 - CHIPPER Act - Rep. Wild, Susan - CHIP funding H.R. 1397 - TIKES Act - Rep. Blunt Rochester, Lisa - telehealth under Medicaid and CHIP H.R. 1609 - To amend title XI of the Social Security Act to provide Secretarial authority to temporarily waive or modify application of certain Medicare requirements with respect to ambulance services furnished during certain emergency periods - Rep. Axne, Cynthia - Medicare coverage of ambulance services H.R. 1676 - To amend title XVIII to provide for certain Medigap coverage for Medicare beneficiaries with end-stage renal disease, and for other purposes - Rep. Axne, Cynthia - Medigap coverage for ESRD H.R. 1677 - To direct the Secretary of HHS, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children's Health Insurance programs during the COVID-19 emergency - Rep. Balderson, Troy - telehealth expansion H.R. 1717 - To amend title XIX of the Social Security Act to make permanent the protections under Medicaid for recipients of home and community-based services against spousal impoverishment - Rep. Upton, Fred - permanent protections against spousal impoverishment H.R. 1722 - To amend titles XI and XIX of the Social Security Act to stabilize the Medicaid program in Puerto Rico - Rep. Velazquez, Nydia - Medicaid in Puerto Rico H.R. 1738 - To amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment of individuals under the Medicaid program and CHIP- Rep. Dingell, Debbie - Medicaid and CHIP enrollment H.R. 1784 - To amend title XIX of the Social Security Act to enhance reporting requirements for nonexpansion States, and for other purposes - Rep. Doggett, Lloyd - nonexpansion H.R. 1791 - To amend title XXI of the Social Security Act to permanently extend the Children's Health Insurance Program, and for other purposes - Rep. Barragan, Nanette Diaz - extending CHIP H.R. 1792 - To amend title XXI of the Social Security Act to prohibit lifetime or annual limits on dental coverage under CHIP, and to require wraparound coverage of dental services for certain children under such program - Rep. Barragan, Nanette Diaz - dental coverage under CHIP H.R. 1793 - To amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1794 - To amend title XIX of the Social Security Act to strengthen coverage under the Medicaid program for certain foster youth individuals - Rep. Bass, Karen - Medicaid coverage for foster youth H.R. 1823 - To amend title XIX of the Social Security Act to remove the matching requirement for a territory to use specially allocated Federal funds for Medicare covered part D drugs for low-income individuals - Resident Commissioner Gonzalez-Colon, Jenniffer - Medicare covered part D H.R. 1825 - To amend titles XVIII and XIX of the Social Security Act to make premium and cost-sharing subsidies available to low-income Medicare part D beneficiaries who reside in Puerto Rico or another territory of the United States - Resident Commissioner Gonzalez-Colon, Jenniffer - premium and cost-sharing subsidies H.R. 1826 - To amend title XVIII of the Social Security Act to eliminate late enrollment penalties under part B of the Medicare program for individuals residing in Puerto Rico if such individuals enroll within 5 years of becoming entitled to benefits under part A of such program - Resident Commissioner Gonzalez-Colon, Jenniffer - late enrollment penalties under part B of the Medicare program H.R. 1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration - Rep. Dingell, Debbie - Money Follows the Person Rebalancing Demonstration H.R. 1885 - To amend title XVIII of the Social Security Act to adjust certain rural health clinic payments under the Medicare program - Rep. Kind, Ron - Medicare rural health clinic payments H.R. 1887 - To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes - Rep. Reed, Tom - Medicare payments for hospitals H.R. 1890 - To amend the Patient Protection and ACA to require Exchanges to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates - Rep. Schakowsky, Janice D. - network adequacy standards and premium rates H.R. 1914 - To amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Rep. DeFazio, Peter A. - Medicaid mobile crisis intervention services H.R. 1969 - To amend title XVIII of the Social Security Act to address disparity in Medicare Advantage benchmark rates for regions with low Medicare fee-for-service penetration - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 2035 - To amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Rep. Lee, Barbara - mental health services under Medicare H.R. 2080 - To amend title XVIII of the Social Security Act to provide for temporary coverage of certain transportation services for certain individuals under the Medicare program, and for other purposes - Rep. Bishop, Sanford D., Jr. - Medicare coverage of transportation services H.R. 2166 - To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans and PACE programs, and for other purposes - Rep. Sewell, Terri - audio-only diagnoses in MA H.R. 2168 - To amend title XVIII of the Social Security Act to expand the scope of practitioners eligible for payment for telehealth services under the Medicare program, and for other purposes - Rep. Sherrill, Mikie - payment for telehealth services H.R. 2170 - To amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Rep. Soto, Darren - access to vaccines and Medicaid H.R. 2179 - To amend title XVIII of the Social Security Act to eliminate cost-sharing with respect to coverage of insulin as a covered part D drug and associated medical supplies and to provide mail order access to insulin and such supplies under the Medicare program during the COVID-19 emergency period - Rep. Waters, Maxine - cost-sharing regarding insulin coverage H.R. 2217 - To amend title XIX of the Social Security Act to treat each territory as one of the 50 States for purposes of calculating the Federal medical assistance percentage under the Medicaid program - Resident Commissioner Gonzalez-Colon, Jenniffer - FMAP H.R. 2228 - To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program - Rep. Kildee, Daniel - Medicare coverage of outpatient telehealth services S. 150 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2021 - Sen. Cortez-Masto, Catherine - coverage of audio-only telehealth services in MA S. 151 - COVID HCBS Relief Act of 2021 - Sen. Casey, Robert - FMAP and HCBS S. 245 - SAME Act of 2021 - Sen. Warner, Mark - Medicaid expansion S. 274 - Stronger Medicaid Response to the COVID-19 Pandemic Act - Sen. Bennet, Michael - COVID-19 coverage for the uninsured via Medicaid S. 285 - Medicaid Reentry Act of 2021 - Sen. Baldwin, Tammy - Medicaid coverage for incarcerated individuals S. 368 - Telehealth Modernization Act - Sen. Scott, Tim - coverage of telehealth services under Medicare S. 386 - Medicare-X Choice Act of 2021 - Sen. Bennet, Michael - Medicare public option S. 439 - Coronavirus Medicaid Response Act - Sen. Casey, Robert - increases FMAP S. 440 - Continued Funding for Senior Services During COVID-19 Act - Sen. Casey, Robert - funding for services under the Older Americans Act of 1965 S. 453 - CHIPPER Act - Sen. Casey, Robert - CHIP funding S. 581 - A bill to amend title XIX of the Social Security Act to improve access to adult vaccines under Medicaid - Sen. Brown, Sherrod - vaccines under Medicaid S. 620 - A bill to direct the Secretary of Health and Human Services, the Medicare Payment Advisory Commission, and the Medicaid and CHIP Payment and Access Commission to conduct studies and report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and CHIP programs during the COVID-19 emergency - Sen. Fischer, Deb - telehealth expansion S. 644 - A bill to amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes - Sen. Durbin, Richard - Medicare coverage for critical access hospitals S. 646 - A bill to amend titles XIX and XXI of the Social Security Act to provide for 12-month continuous enrollment under Medicaid and CHIP - Sen. Brown, Sherrod - Medicaid and CHIP enrollment S. 653 - A bill to amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers' compensation settlement agreements and qualified Medicare set-aside provisions - Sen. Portman, Rob - Medicare secondary payer rules S. 712 - A bill to amend the SUPPORT for Patients and Communities Act to provide for immediate eligibility for former foster youth under Medicaid - Sen. Casey, Robert P., Jr. - Medicaid coverage for foster youth S. 748 - A bill to provide for an extension of the temporary suspension of Medicare sequestration during the COVID-19 public health emergency - Sen. Shaheen, Jeanne - Medicare sequestration S. 764 - A bill to amend title XIX of the Social Security Act to encourage State Medicaid programs to provide community-based mobile crisis intervention services, and for other purposes - Sen. Wyden, Ron - Medicaid mobile crisis intervention services S. 826 - A bill to amend title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services, while allowing Medicare beneficiaries to use their Medicare benefits - Sen. Paul, Rand - Medicaid payment options S. 870 - A bill to amend title XVIII of the Social Security Act to improve access to mental health services under the Medicare program - Sen. Stabenow, Debbie - mental health services in Medicare S. 999 - A bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments - Sen. Warner, Mark - Medicare hospital 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; Part D reform, out of pocket limits; issues related to Medicare for All, Medicare buy-in and public option; 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 and vaccines; issues related to health equity; issues related to vaccination; 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; 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 value based payment 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; 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; issues relating to MACRA, including implications for MA and Part D plans; 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 Affordable Care Act (ACA) including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; implications of the health insurer fee for Medicaid health plans; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues relating to enrollment of beneficiaries with ESRD into MA plans; 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: $202,662 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office
Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office
Client expense: Not reported · Firm income: $11,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
Client expense: $3,230,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
Client expense: Not reported · Firm income: $11,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office
Client expense: $194,970 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office
Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
Client expense: $2,890,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
Client expense: $195,457 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office
Client expense: Not reported · Firm income: $11,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Client expense: $4,680,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office
Client expense: $236,616 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office
Client expense: Not reported · Firm income: $11,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office
Client expense: Not reported · Firm income: $50,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
Client expense: $182,825 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office
Client expense: Not reported · Firm income: $40,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
Client expense: $146,158 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office
Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office
Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Government targets: HOUSE OF REPRESENTATIVES, SENATE
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Social Security Administration (SSA), Veterans Affairs, Dept of (VA), White House Office
Client expense: Not reported · Firm income: $40,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE
Client expense: $3,900,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office