A concurrent resolution supporting the observance of "Spirit of '45 Day".

HConRes 312 - House Budget Resolution SConRes 70 - Senate Budget Resolution Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, FY '11

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions in the Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Care Act (H.R.3590, P.L. 111-148)); and Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872), P.L. 111-152); Medicare Commission legislation (S.1110, S. 1380, H.R.2718), provisions that would empower a Commission to implement Medicare policy changes; geographic variation legislation (H.R. 2844, H.R. 2919, H.R. 2921, H.R. 2201, S.Amdt. 887) affecting hospitals and/or physician payment policy; value-based purchasing legislation (H.R. 1776); other workforce legislation (H.R. 1946, S.1569)); Puerto Rico Medicare Parity (H.R. 2680, H.R. 1501, H.R.1502); Medicare physician payment adjustment (HR. 3961, S.1776, H.R.3326, H.R. 3590, H.R. 4851, S. 3153, H.R. 4213); Section 508 wage index extension and gainsharing extension (H.R. 4213); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); Medicare 72-hour payment window limitation (H.R.4213); and HIT incentive payments and meaningful use requirements in proposed rule CMS-0033-P. Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) and ARRA FMAP Extension (H.R. 4263, H.R. 2847, H.R.4213) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679), Affordable Helahtcare for America Act (H.R. 3962), Patient Protection and Affordable Care Act (H.R. 3590, P.L. 111-148), and the Health and Education Affordability Reconciliation Act of 2010 (H.R. 4872, P.L. 111-152)), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); and HIT incentive payments and meaningful use requirements in proposed rule CMS-0033-P.

Client expense: $420,000 · Firm income: Not reported

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

Provisions of the FY 2009 Budget and Budget Resolution (S Con Res 70 and HR 1105) and related Labor/HHS appropriations legislation regarding funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ). Labor HHS Appropriations, Appropriations for Community Health Centers, and Increased Funding for Tele-health Activities. Funding for Dental programs in underserved areas. Future funding for Hospital Emergency Department infrastructure in Flambeau, Wisconsin. Provisions of the American Recovery and Reinvestment Act (HR 1) including appropriations for: USDA $1.2 B for essential rural clinics, vehicles equipment, etc; Rural business enterprise grants $150 M; $2.5 B Telemedicine, and distance Learning and Broadband deployment. Labor Workforce programs $3.95 B; $750 M for Training grants for high growth sectors, Priority given to health care sector; Job Corps $250 M. HRSA - $500 M for community health centers; $500M for health professions training; and $200 M for primary care and dentistry programs. NIH research $10 billion expansion $1 B for extramural research facilities; $330 M for instrumentation; $8.2 B/2 yrs for the Office of Director for transfer to Institutes for peer reviewed and competitively ranked research. Comparative effectiveness research at NIH $400 M, AHRQ $300M, and HHS $400M. The funding in the conference agreement shall be used to conduct or support research to evaluate and compare the clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition. HHS ONCHIT $2 B, $300 M of which is for regional efforts for health information exchange; remaining funds can be used for: development of certified electronic health records software if HHS sees that the private market does not meet certain providers needs; training on best practices to integrate health I.T. systems; infrastructure and tools to provide telemedicine; promotion of technologies and best practices that enhance the protection of health information; promotion of the interoperability of clinical data repositories or registries; and improvement and expansion of the use of health I.T. by public health departments. Much of the funds could be distributed to states as planning and implementation grants. HHS/CDC $1 B of which $300 M is for immunization; and $650 M for evidence based clinical and community based prevention and wellness strategies. Transportation Surface transportation $1.5 B; Highway infrastructure $27.5B. HHS HIT Grants to facilitate the purchase, train personnel in use, and secure electronic exchange of health information; Medicare HIT incentive payments up to $44,000 for physicians who are meaningful users of certified EHR technology to improve quality, and who submit quality information (under PQRI - Rules for 2010 forthcoming in July) - with 10% additional in Health professional shortage areas; $11 million for hospitals; Penalties for those physician and providers who have not implemented EMRs begin in 2015. Medicaid incentive payments for non-hospital based physicians, nurse practitioners, nurse midwives, and physician assistants who are meaningful users, but not claiming Medicare incentives equal to 85% of net allowable technology costs not exceeding $63,750. Rural Health Clinics and FQHCs with at least 30% patient volume attributable to Medicaid will be eligible for payments not exceeding $63,750 for the cost of adoption and use of certified HER Provisions of the FY 2010 Budget and Budget Resolution (S Con Res 13 and H C Res 85) regarding health care reform, funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, value based purchasing and geographic fairness in Medicare reimbursement, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ).

Client expense: $150,000 · 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

HConRes 312 - House Budget Resolution SConRes 70 - Senate Budget Resolution Transportation, Housing and Urban Development, and Related Agencies Appropriations Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

FY 2010 Budget Resolutions (H Con Res 312, S Con Res 70) provisions related to Medicare, Medicaid, health reform reserve fund

Client expense: $310,000 · Firm income: Not reported

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

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions in the Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Care Act (H.R.3590)); and Health Care and Education Reconciliation Act of 2010 (H.R. 4872)); Medicare Commission legislation (S.1110, S. 1380, H.R.2718), provisions that would empower a Commission to implement Medicare policy changes; geographic variation legislation (H.R. 2844, H.R. 2919, H.R. 2921, H.R. 2201, S.Amdt. 887) affecting hospitals and/or physician payment policy; value-based purchasing legislation (H.R. 1776); other workforce legislation (H.R. 1946, S.1569)); Puerto Rico Medicare Parity (H.R. 2680, H.R. 1501, H.R.1502); Medicare physician payment adjustment (HR. 3961, S.1776, H.R.3326, H.R. 3590, H.R. 4851, S. 3153, H.R. 4213); Section 508 wage index extension and gainsharing extension (H.R. 4213); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213). Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) and ARRA FMAP Extension (H.R. 4263, H.R. 2847) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679), Affordable Helahtcare for America Act (H.R. 3962), Patient Protection and Affordable Care Act (H.R. 3590), and the Health and Education Reconciliation Act of 2010 (H.R. 4872)), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213).

Client expense: $310,000 · Firm income: Not reported

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

S con Res 70, setting forth the congressional budget for the United States Government for fiscal year 2009 and including the appropiate budgetary levels for fiscal yeary 2009, and 2001 throught 2014 (sections 201, 202, 301 and 314) S Con Res 13, an orgianl concurrent resolutions setting forth the congressional budget for the US Government for fiscal year 2010, revising the appropiate budgetary levels for fiscal year 2009, amd setting forth the appropiated budgetary levels for FY 2011 through 2014 (sections 104, 201)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Education funding, incl. applicable provisions in H.R. 1 & S. 1, and their enactment as Public Law No: 111-5 Family planning (Title X and Title V) and sex education (incl. comprehensive and abstinence-only programs, as well as medical accuracy language) funding, incl. the Presidents FY10 budget District of Columbias voucher program, incl. report by the government, reauthorization proposals, applicable provisions in and amendment to the omnibus appropriations package (H.R. 1105) enacted as Public Law No: 111-8, and FY10 appropriations, as well as amendment to S. 160 Faith-based initiatives and other government-related religion proposals, incl. funding and grant-making practices Funding for maintenance of public facilities, incl. applicable provisions in and amendment to H.R. 1 (Public Law No: 111-5) Presidents FY10 budget and the FY10 budget resolution (H.Con.Res. 312 & S.Con.Res. 70) Funding and implementation of the Help America Vote Act (Public Law No: 107-252), incl. budget resolution (H.Con.Res. 312 & S.Con.Res. 70)

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Office of Faith-Based & Community Initiatives, Office of the Vice President of the United States, President of the U.S., SENATE, Vice President of the U.S., White House Office

Hate crimes prevention/enforcement Decennial Census to be conducted in 2010 Funding and implementation of the Help America Vote Act (Public Law No: 107-252), incl. budget resolution (H.Con.Res. 312 & S.Con.Res. 70) Federal voting representation for the District of Columbia, incl. H.R. 157 & S. 160 Pay equity and Congressional response to the Ledbetter v. Goodyear decision, incl. H.R. 11, S. 181, and their enactment as Public Law No: 111-2, as well as the Paycheck Fairness Act, incl. H.R. 12 & S. 182 Mandatory electronic employment verification proposals, incl. applicable provisions in H.R. 1 & S. 1, and their enactment as Public Law No: 111-5 Equal opportunity protections, incl. applicable provisions in H.R. 1 & S. 1, and their enactment as Public Law No: 111-5 Voter fraud issues and Congressional response to the Crawford v. Marion County Election Board and Democratic Party v. Rokita decisions, incl. report by the government, oversight of the Voting Rights Section of the Civil Rights Division at the Department of Justice, and amendment to H.R. 1388 Deceptive practices in voting, incl. H.R. 97 and oversight of the Voting Rights Section of the Civil Rights Division at the Department of Justice, as well as caging (H.R. 103 & S. 528) legislation and vote challenging practices Voter identification and Congressional response to the Crawford v. Marion County Election Board and Democratic Party v. Rokita decisions, incl. amendment to S. 160 Voter registration, incl. implementation of the National Voter Registration Act (Public Law No: 103-31) Early voting Oversight of the Department of Justices Civil Rights Division, incl. its Voting Rights Section Investigation into the United States Attorneys program, incl. voter fraud issues, and pursuit of contempt citations (incl. 110th: H.Res. 979, H.Res. 980 & H.Res. 982) Implementation of the Dont Ask, Dont Tell provisions in Public Law No: 103-160, Title V, Subtitle G, incl. H.R. 1283 Marriage equality, incl. amendment to S. 160 Legal and policy issues related to national security detainees, incl. establishment of a truth commission to investigate detainee treatment and other actions taken by the previous Administration Election preparedness and contingency plans, incl. lessons learned from the 2004 and 2008 election cycles Development of a 2009 Civil Rights Act that would close loopholes created by recent Supreme Court decisions

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Office of Faith-Based & Community Initiatives, Office of the Vice President of the United States, President of the U.S., SENATE, Vice President of the U.S., White House Office

Action on the 2011 Department of the Interior, Environment, and Related Agencies Appropriations Act, including specific provisions relating to US Geological Survey funding for water management and climate research, the USDA Forest Service Forest Health Protection program, invasive species research and development, Land and Water Conservation Fund projects, Forest Legacy projects, Forest Service wildland fire management funding, the Cooperative Endangered Species Fund, funding for river restoration projects, US Fish and Wildlife Service international programs, US Forest Service international programs, Corps of Engineers appropriations including the Williamette Floodplain Restoration Study, Bureau of Reclamation appropriations, the Multi-Species Conservation Fund, Peru/US Free Trade Agreement logging annex, and Hells Canyon, Oregon, and Savannah River Comprehensive Water Resources Study; H.R. 2647/S.1390, National Defense Authorization Act for Fiscal Year 2010, including specific provisions relating to Sikes Act agreements, the Department of Defense Legacy grant proposal, Department of Defense readiness and environmental protection initiative, authority of combatant commanders to fund conservation activities overseas, military base expansion, training and testing area requirements, authority to participate in conservation banking programs, and provisions related to the impact of climate change on national security; H.R. 2892/S. 1298, Department of Homeland Security Appropriations Act, 2010, including specific provisions relating to border security initiatives; HR 3326, Department of Defense Appropriations Act, 2010, including specific provisions relating to funding for the Department of Defense Legacy grant program, the Readiness and Environmental Protection Initiative, overseas conservation activities, and other military activities impacting biodiversity; H.R. 2997, Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2010, including specific provisions relating to funding for Animal and Plant Health Inspection Service Plant Protection, primarily the Emerging Plant Pests line; The 2011 Commerce, Justice, Science, and Related Agencies Appropriations Act, including specific provisions relating to NOAA funding, the Coastal and Estuarine Land Conservation Program, funding for Pacific Coastal Salmon Recovery, Fisheries Habitat Restoration programs, and coral reef conservation programs; H.R. 3288, Consolidated Appropriations Act, 2010, including specific provisions relating to foreign operations, international conservation funding initiative, and coral triangle funding, NOAA funding, the Coastal and Estuarine Land Conservation Program, Fisheries Habitat Restoration programs, and coral reef conservation programs; S. 1436/H.R. 3183, Energy and Water Development and Related Agencies Appropriations Act, 2010, including specific provisions relating to Army Corps of Engineers projects, and Bureau of Reclamation projects; H.R. 2200, Transportation Security Administration Authorization Act, including specific provisions relating to Land and Water Conservation Fund funding; funding for the Forest Landscape Restoration Act authorized in P.L. 111-11; funding for the Wild and Scenic Rivers System; S. Con. Res. 70, Budget resolution for the US Government for FY2010 through 2013; FY11 appropriations research on natural resources adaptation and land and water conservation fund funding sources and funding opportunities for Treasured Landscapes; H.R. 3288, Transportation, Housing, and Urban Development and Related Agencies Appropriations Act, 2010; FY11 Presidents budget request for the Department of the Interior and the U.S. Forest Service, including specific provisions relating to Land and Water Conservation Fund projects, Forest Legacy projects, wildland fire funding, and the Cooperative Endangered Species Fund; and support of S. 2747, Land and Water Conservation Authorization and Funding Act of 2009. Covered Officials Contacted: Director for Environmental Readiness and Safety, Office of the Deputy Under Secretary of Defense, Department of Defense; Assistant Deputy Under Secretary of Defense for Environmental, Safety, and Occupational Health, Department of Defense; Deputy Under Secretary of Defense for Environmental, Safety, and Occupational Health, Department of Defense; Deputy Assistant Secretary of the Navy, Environment, United States Navy; Deputy Assistant Secretary of the Army for Environment, Safety, and Occupational Healthy, United States Army; Deputy Director, Joint Guam Program Office, United States Navy; Director, Civil Works Programs Integration Directorate, US Army Corps of Engineers; Deputy Assistant Secretary of the Army, Management and Budget, United States Army; Deputy Assistant Secretary of the Army, Civil Works, United States Army; Assistant Secretary of the Army, Civil Works, United States Army; Budget Director, National Oceanic and Atmospheric Administration, Department of Commerce; Associate Director Land and Water Ecosystems, Council on Environmental Quality; Associate Director for Policy Outreach, Council on Environmental Quality; Assistant Secretary for Policy, Management and Management, Department of the Interior; Animal and Plant Health Inspection Service Administrator, US Department of Agriculture; Deputy Undersecretary for Natural Resources & Environment, US Department of Agriculture; Assistant Secretary, Fish, Wildlife and Parks, Department of the Interior; Deputy Directors of External Affairs, Department of the Interior; Counselor to the Secretary, United States Department of Agriculture; Policy Associate Director, Natural Resource Programs, Office of Management and Budget; Policy Associate Director, General Government Programs, Office of Management and Budget; Deputy Associate Director, Natural Resource Division, Office of Management and Budget; Commerce Branch Chief, Office of Management and Budget; Program Examiner, Commerce Branch, OMB; Program Examiner, Homeland Security Branch, Office of Management and Budget; Program Examiner, Interior Branch, Office of Management and Budget; Chief Scientist, National Marine Fisheries Service, National Oceanic and Atmospheric Administration; Undersecretary, Natural Resources and Environment, US Department of Agriculture; Secretary, US Department of Agriculture; Deputy Assistant Secretary, Energy and Environment, Department of Treasury; and the Special Assistant to the President for Energy and Environment.

Client expense: $470,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Bureau of Land Management (BLM), Bureau of Reclamation, Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Natl Oceanic & Atmospheric Administration (NOAA), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, U.S. Fish & Wildlife Service (USFWS), U.S. Forest Service, White House Office

HConRes 312 - House Budget Resolution SConRes 70 - Senate Budget Resolution H.R. 3288 - Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2010

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1: Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for fiscal year ending September 30, 2009, and for other purposes. H. 1105: FY 2009 Omnibus H. Con. Res. 312: FY 2010 Budget Resolutions. S. Con. Res. 70: FY 2010 Budget Resolutions. .

Client expense: $440,000 · Firm income: Not reported

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

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679)); Senate Finance Committee delivery system, coverage, and financing options papers and bill (America's Healthy Futures Act of 2009); House tri-committee discussion draft bill and legislation (H.R. 3200), including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions; Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Care Act (H.R.3590)); Medicare Commission legislation (S.1110, S. 1380, H.R.2718), provisions that would empower a Commission to implement Medicare policy changes; geographic variation legislation (H.R. 2844, H.R. 2919, H.R. 2921, H.R. 2201, S.Amdt. 887) affecting hospitals and/or physician payment policy; value-based purchasing legislation (H.R. 1776); other workforce legislation (H.R. 1946, S.1569)); Puerto Rico Medicare Parity (H.R. 2680, H.R. 1501, H.R.1502); Medicare physician payment adjustment (HR. 3961, S.1776, H.R.3326). Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) and ARRA FMAP Extension (H.R. 4263, H.R. 2847) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679)); Senate Finance Committee delivery system, coverage, and financing options papers and legislation (America's Healthy Futures Act of 2009); House tri-committee discussion draft bill and legislation (H.R. 3200), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)).

Client expense: $380,000 · Firm income: Not reported

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

FY 2010 Budget Resolutions (H Con Res 312, S Con Res 70) provisions related to Medicare, Medicaid, health reform reserve fund

Client expense: $380,000 · Firm income: Not reported

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

Provisions of the FY 2009 Budget and Budget Resolution (S Con Res 70 and HR 1105) and related Labor/HHS appropriations legislation regarding funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ). Labor HHS Appropriations, Appropriations for Community Health Centers, and Increased Funding for Tele-health Activities. Funding for Dental programs in underserved areas. Future funding for Hospital Emergency Department infrastructure in Flambeau, Wisconsin. Provisions of the American Recovery and Reinvestment Act (HR 1) including appropriations for: USDA $1.2 B for essential rural clinics, vehicles equipment, etc; Rural business enterprise grants $150 M; $2.5 B Telemedicine, and distance Learning and Broadband deployment. Labor Workforce programs $3.95 B; $750 M for Training grants for high growth sectors, Priority given to health care sector; Job Corps $250 M. HRSA - $500 M for community health centers; $500M for health professions training; and $200 M for primary care and dentistry programs. NIH research $10 billion expansion $1 B for extramural research facilities; $330 M for instrumentation; $8.2 B/2 yrs for the Office of Director for transfer to Institutes for peer reviewed and competitively ranked research. Comparative effectiveness research at NIH $400 M, AHRQ $300M, and HHS $400M. The funding in the conference agreement shall be used to conduct or support research to evaluate and compare the clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition. HHS ONCHIT $2 B, $300 M of which is for regional efforts for health information exchange; remaining funds can be used for: development of certified electronic health records software if HHS sees that the private market does not meet certain providers needs; training on best practices to integrate health I.T. systems; infrastructure and tools to provide telemedicine; promotion of technologies and best practices that enhance the protection of health information; promotion of the interoperability of clinical data repositories or registries; and improvement and expansion of the use of health I.T. by public health departments. Much of the funds could be distributed to states as planning and implementation grants. HHS/CDC $1 B of which $300 M is for immunization; and $650 M for evidence based clinical and community based prevention and wellness strategies. Transportation Surface transportation $1.5 B; Highway infrastructure $27.5B. HHS HIT Grants to facilitate the purchase, train personnel in use, and secure electronic exchange of health information; Medicare HIT incentive payments up to $44,000 for physicians who are meaningful users of certified EHR technology to improve quality, and who submit quality information (under PQRI - Rules for 2010 forthcoming in July) - with 10% additional in Health professional shortage areas; $11 million for hospitals; Penalties for those physician and providers who have not implemented EMRs begin in 2015. Medicaid incentive payments for non-hospital based physicians, nurse practitioners, nurse midwives, and physician assistants who are meaningful users, but not claiming Medicare incentives equal to 85% of net allowable technology costs not exceeding $63,750. Rural Health Clinics and FQHCs with at least 30% patient volume attributable to Medicaid will be eligible for payments not exceeding $63,750 for the cost of adoption and use of certified HER Provisions of the FY 2010 Budget and Budget Resolution (S Con Res 13 and H C Res 85) regarding health care reform, funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, value based purchasing and geographic fairness in Medicare reimbursement, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ).

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE

Action on H.R. 2996, Department of the Interior, Environment, and Related Agencies Appropriations Act, 2010, including specific provisions relating to US Geological Survey funding for water management and climate research, the USDA Forest Service Forest Health Protection program, invasive species research and development, Land and Water Conservation Fund projects, Forest Legacy projects, Forest Service wildland fire management funding, the Cooperative Endangered Species Fund, funding for river restoration projects, US Fish and Wildlife Service international programs, US Forest Service international programs, the Multi-Species Conservation Fund, Peru/US Free Trade Agreement logging annex, and Savannah River Comprehensive Water Resources Study; H.R. 2647/S.1390, National Defense Authorization Act for Fiscal Year 2010, including specific provisions relating to Sikes Act agreements, the Department of Defense Legacy grant proposal, Department of Defense readiness and environmental protection initiative, authority of combatant commanders to fund conservation activities overseas, military base expansion, training and testing area requirements, authority to participate in conservation banking programs, and provisions related to the impact of climate change on national security; H.R. 2892/S. 1298, Department of Homeland Security Appropriations Act, 2010, including specific provisions relating to border security initiatives; H.R. 3326, Department of Defense Appropriations Act, 2010, including specific provisions relating to funding for the Department of Defense Legacy grant program, the Readiness and Environmental Protection Initiative, overseas conservation activities, and other military activities impacting biodiversity; H.R. 2997, Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2010, including specific provisions relating to funding for Animal and Plant Health Inspection Service Plant Protection, primarily the Emerging Plant Pests line, and funding for invasive species, pests, and pathogens; H.R. 2847, Commerce, Justice, Science, and Related Agencies Appropriations Act, 2010, including specific provisions relating to NOAA funding, the Coastal and Estuarine Land Conservation Program, Fisheries Habitat Restoration programs, and coral reef conservation programs; H.R. 2764, Consolidated Appropriations Act, 2008, including specific provisions relating to foreign operations, international conservation funding initiative, and coral triangle funding; S. 1436/H.R. 3183, Energy and Water Development and Related Agencies Appropriations Act, 2010, including specific provisions relating to Army Corps of Engineers projects, and Bureau of Reclamation projects; H.R. 2200, Transportation Security Administration Authorization Act, including specific provisions relating to Land and Water Conservation Fund funding; funding for the Forest Landscape Restoration Act authorized in P.L. 111-11; funding for the Wild and Scenic Rivers System; S. Con. Res. 70, Budget resolution for the US Government for FY2010 through 2013; FY11 appropriations research on natural resources adaptation and Land and Water Conservation Fund funding sources and funding opportunities for Treasured Landscapes; increase funding for National Wildlife Refuge System; and H.R. 3288, Transportation, Housing, and Urban Development and Related Agencies Appropriations Act, 2010. Covered officials contacted: Director for Environmental Readiness and Safety, Office of the Deputy Under Secretary of Defense, Department of Defense; Assistant Deputy Under Secretary of Defense for Environmental, Safety, and Occupational Health, Department of Defense; Deputy Assistant Secretary of the Navy, Environment, United States Navy; Deputy Assistant Secretary of the Army for Environment, Safety, and Occupational Healthy, United States Army; Deputy Director, Joint Guam Program Office, United States Navy; Director, Civil Works Programs Integration Directorate, US Army Corps of Engineers; Deputy Assistant Secretary of the Army, Management and Budget, United States Army; Deputy Assistant Secretary of the Army, Civil Works, United States Army; Budget Director, National Oceanic and Atmospheric Administration, Department of Commerce; Associate Director Land and Water Ecosystems, Council on Environmental Quality; Associate Director for Policy Outreach, Council on Environmental Quality; Deputy Assistant Secretary for Policy, Management and Budget, Department of the Interior; Assistant Secretary for Policy, Management and Management, Department of the Interior; Associate Director, Natural Resources, Energy, and Science, Office of Management and Budget; Animal and Plant Health Inspection Service Administrator, US Department of Agriculture; and Deputy Undersecretary for Natural Resources & Environment, US Department of Agriculture; Program Examiner, Forest Service, Office of Management and Budget; Secretary of the Interior; Assistant Secretary, Fish, Wildlife and Parks, Department of the Interior; Deputy Assistant Secretary, Fish, Wildlife and Parks, Department of the Interior, Counselor to the Secretary of the Interior; Deputy Directors of External Affairs, Department of the Interior; Counselor to the Secretary, United States Department of Agriculture; Policy Associate Director, Natural Resource Programs, Office of Management and Budget; Policy Associate Director, General Government Programs, Office of Management and Budget; Deputy Associate Director, Natural Resource Division, Office of Management and Budget; Commerce Branch Chief, Office of Management and Budget; Program Examiner, Commerce Branch, Office of Management and Budget; Program Examiner, Homeland Security Branch, Office of Management and Budget; Program Examiner, Interior Branch, Office of Management and Budget; Chief Scientist, National Marine Fisheries Service, National Oceanic and Atmospheric Administration; Assistant Deputy Under Secretary of Defense for Readiness; Deputy Under Secretary of Defense for Installations and Environment; and Assistant Deputy Under Secretary of Defense for Installations and Environment.

Client expense: $350,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Bureau of Land Management (BLM), Bureau of Reclamation, Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Energy, Dept of, Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Natl Oceanic & Atmospheric Administration (NOAA), Office of Management & Budget (OMB), SENATE, U.S. Fish & Wildlife Service (USFWS), U.S. Forest Service

H.R. 1: Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for fiscal year ending September 30, 2009, and for other purposes. H. 1105: FY 2009 Omnibus H. Con. Res. 312: FY 2010 Budget Resolutions. S. Con. Res. 70: FY 2010 Budget Resolutions.

Client expense: $420,000 · Firm income: Not reported

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

HConRes 312 - House Budget Resolution SConRes 70 - Senate Budget Resolution Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2010

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Provisions of the FY 2009 Budget and Budget Resolution (S Con Res 70 and HR 1105) and related Labor/HHS appropriations legislation regarding funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ). Labor HHS Appropriations, Appropriations for Community Health Centers, and Increased Funding for Tele-health Activities. Funding for Dental programs in underserved areas. Future funding for Hospital Emergency Department infrastructure in Flambeau, Wisconsin. Provisions of the American Recovery and Reinvestment Act (HR 1) including appropriations for: USDA $1.2 B for essential rural clinics, vehicles equipment, etc; Rural business enterprise grants $150 M; $2.5 B Telemedicine, and distance Learning and Broadband deployment. Labor Workforce programs $3.95 B; $750 M for Training grants for high growth sectors, Priority given to health care sector; Job Corps $250 M. HRSA - $500 M for community health centers; $500M for health professions training; and $200 M for primary care and dentistry programs. NIH research $10 billion expansion $1 B for extramural research facilities; $330 M for instrumentation; $8.2 B/2 yrs for the Office of Director for transfer to Institutes for peer reviewed and competitively ranked research. Comparative effectiveness research at NIH $400 M, AHRQ $300M, and HHS $400M. The funding in the conference agreement shall be used to conduct or support research to evaluate and compare the clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition. HHS ONCHIT $2 B, $300 M of which is for regional efforts for health information exchange; remaining funds can be used for: development of certified electronic health records software if HHS sees that the private market does not meet certain providers needs; training on best practices to integrate health I.T. systems; infrastructure and tools to provide telemedicine; promotion of technologies and best practices that enhance the protection of health information; promotion of the interoperability of clinical data repositories or registries; and improvement and expansion of the use of health I.T. by public health departments. Much of the funds could be distributed to states as planning and implementation grants. HHS/CDC $1 B of which $300 M is for immunization; and $650 M for evidence based clinical and community based prevention and wellness strategies. Transportation Surface transportation $1.5 B; Highway infrastructure $27.5B. HHS HIT Grants to facilitate the purchase, train personnel in use, and secure electronic exchange of health information; Medicare HIT incentive payments up to $44,000 for physicians who are meaningful users of certified EHR technology to improve quality, and who submit quality information (under PQRI - Rules for 2010 forthcoming in July) - with 10% additional in Health professional shortage areas; $11 million for hospitals; Penalties for those physician and providers who have not implemented EMRs begin in 2015. Medicaid incentive payments for non-hospital based physicians, nurse practitioners, nurse midwives, and physician assistants who are meaningful users, but not claiming Medicare incentives equal to 85% of net allowable technology costs not exceeding $63,750. Rural Health Clinics and FQHCs with at least 30% patient volume attributable to Medicaid will be eligible for payments not exceeding $63,750 for the cost of adoption and use of certified HER Provisions of the FY 2010 Budget and Budget Resolution (S Con Res 13 and H C Res 85) regarding health care reform, funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, value based purchasing and geographic fairness in Medicare reimbursement, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ).

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Economic Council (NEC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, White House Office

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679)); Senate Finance Committee delivery system, coverage, and financing options papers and bill (America's Healthy Futures Act of 2009); House tri-committee discussion draft bill and legislation (H.R. 3200), including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions); Medicare Commission legislation (S.1110, H.R.2718), provisions that would empower a Commission to implement Medicare policy changes; geographic variation legislation (H.R. 2844, H.R. 2919, H.R. 2921) affecting hospitals and/or physician payment policy; value-based purchasing legislation (H.R. 1776); other workforce legislation (H.R. 1946, S.1569)). Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679)); Senate Finance Committee delivery system, coverage, and financing options papers and legislation (America's Healthy Futures Act of 2009); House tri-committee discussion draft bill and legislation (H.R. 3200), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)).

Client expense: $370,000 · Firm income: Not reported

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

FY 2010 Budget Resolutions (H Con Res 312, S Con Res 70) provisions related to Medicare, Medicaid, health reform reserve fund

Client expense: $370,000 · Firm income: Not reported

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

Hate crimes prevention/enforcement Decennial Census to be conducted in 2010 Funding and implementation of the Help America Vote Act (Public Law No: 107-252), incl. budget resolution (H.Con.Res. 312 & S.Con.Res. 70) Federal voting representation for the District of Columbia, incl. H.R. 157 & S. 160 Pay equity and Congressional response to the Ledbetter v. Goodyear decision, incl. H.R. 11, S. 181, and their enactment as Public Law No: 111-2, as well as the Paycheck Fairness Act, incl. H.R. 12 & S. 182 Mandatory electronic employment verification proposals, incl. applicable provisions in H.R. 1 & S. 1, and their enactment as Public Law No: 111-5 Equal opportunity protections, incl. applicable provisions in H.R. 1 & S. 1, and their enactment as Public Law No: 111-5 Voter fraud issues and Congressional response to the Crawford v. Marion County Election Board and Democratic Party v. Rokita decisions, incl. report by the government, oversight of the Voting Rights Section of the Civil Rights Division at the Department of Justice, and amendment to H.R. 1388 Deceptive practices in voting, incl. H.R. 97 and oversight of the Voting Rights Section of the Civil Rights Division at the Department of Justice, as well as caging (H.R. 103 & S. 528) legislation and vote challenging practices Voter identification and Congressional response to the Crawford v. Marion County Election Board and Democratic Party v. Rokita decisions, incl. amendment to S. 160 Voter registration, incl. implementation of the National Voter Registration Act (Public Law No: 103-31) Early voting Oversight of the Department of Justices Civil Rights Division, incl. its Voting Rights Section Investigation into the United States Attorneys program, incl. voter fraud issues, and pursuit of contempt citations (incl. 110th: H.Res. 979, H.Res. 980 & H.Res. 982) Implementation of the Dont Ask, Dont Tell provisions in Public Law No: 103-160, Title V, Subtitle G, incl. H.R. 1283 Marriage equality, incl. amendment to S. 160 Legal and policy issues related to national security detainees, incl. establishment of a truth commission to investigate detainee treatment and other actions taken by the previous Administration Election preparedness and contingency plans, incl. lessons learned from the 2004 and 2008 election cycles Development of a 2009 Civil Rights Act that would close loopholes created by recent Supreme Court decisions

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Office of Faith-Based & Community Initiatives, Office of the Vice President of the United States, President of the U.S., SENATE, Vice President of the U.S., White House Office

Education funding, incl. applicable provisions in H.R. 1 & S. 1, and their enactment as Public Law No: 111-5 Family planning (Title X and Title V) and sex education (incl. comprehensive and abstinence-only programs, as well as medical accuracy language) funding, incl. the Presidents FY10 budget District of Columbias voucher program, incl. report by the government, reauthorization proposals, applicable provisions in and amendment to the omnibus appropriations package (H.R. 1105) enacted as Public Law No: 111-8, and FY10 appropriations, as well as amendment to S. 160 Faith-based initiatives and other government-related religion proposals, incl. funding and grant-making practices Funding for maintenance of public facilities, incl. applicable provisions in and amendment to H.R. 1 (Public Law No: 111-5) Presidents FY10 budget and the FY10 budget resolution (H.Con.Res. 312 & S.Con.Res. 70) Funding and implementation of the Help America Vote Act (Public Law No: 107-252), incl. budget resolution (H.Con.Res. 312 & S.Con.Res. 70)

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Office of Faith-Based & Community Initiatives, Office of the Vice President of the United States, President of the U.S., SENATE, Vice President of the U.S., White House Office

Health Care Reform Equity for our Nation's Self-Employed Act, H.R. 1470 -- support America's Affordable Health Choices Act, H.R. 3200 --oppose In general -- advocated for tax credits, pooling arrangements, health savings accounts expansion and improvement (cont.) Health Care Reform (cont): Nationwide marketplace for health insurance, and tax parity for the self-employed to help bring small businesses more affordable access to health coverage. Opposed employer mandates, "play-or-pay", increased taxes (surtaxes, for example), a public option for health coverage, and excessive bureaucracy and spending in health care reform. Opposed President Obama's $637 billion "down payment" for health care reform in his budget proposal. The "Private Property Rights Protection Act of 2009", H.R. 1885 -- support The "Withholding Tax Relief Act of 2009", S 292, H.R. 275 -- support The "Telecommuter Tax Fairness Act of 2009" -- support "Travel Promotion Act of 2009" -- supported Senator Dick Durbin's small business amendment. "Investing in Tomorrow's Technology Act of 2009" -- supported Small Business Innovation Research and Small Business Technology Program Modernization, H.R. 2965 -- supported The Budget: Opposed the Budget Resolution. Opposed the Budget Resolution Conference Report, (S. Con Res 70) Opposed adding comprehensive health care reform, climate change legislation and increased taxes in budget reconciliation. The "American Clean Energy and Security Act of 2009" (Waxman-Markey) -- opposed -- particularly the higher taxes and establishment of a cap-and-trade program. Renewable Portfolio Standards mandate in Waxman-Markey, opposed "Employee Free Choice Act" -- opposed "The Credit Card Holders Bill of Rights," H.627 -- opposed Broadband Filed comments with Federal Communications Commission for their NOI on a "National Broadband Plan" -- encouraged a focus on unserved and underserved areas, education and policies that continue to promote investment and competition. Filed comments with NTIA, RUS and Department of Agriculture on the broadband initiatives within "The American Recovery and Reinvestment Act of 2009" -- encouraged a focus on unserved and underserved areas, transparency and coordination with respect to spending, and a light regulatory approach regarding requirements for participation. General advocacy efforts continue in these areas: Advancing pending Free Trade agreements Patent Reform Regulatory reform and relief Tax system reform, and making permanent current tax relief measures such as Section 179 expensing, capital gains, dividend, and personal income tax rates. Research and Development Tax Credit extension and permanency. Access to capital issues such as tax reform and relief, increased tax incentives and zero capital gains for small business investment. Repealing "cell phone" tax reporting requirements for employees.

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

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Environmental Protection Agency (EPA), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Natl Telecommunications & Information Administration (NTIA), SENATE

Action on H.R. 2996, Department of the Interior, Environment, and Related Agencies Appropriations Act, 2010, including specific provisions relating to US Geological Survey funding for water management and climate research, the USDA Forest Service Forest Health Protection program, invasive species research and development, Land and Water Conservation Fund projects, Forest Legacy projects, Forest Service wildland fire management funding, the Cooperative Endangered Species Fund, the Albemarle/Pamlico National Estuary Program, funding for river restoration projects, the National Landscape Conservation System budget, the Healthy Lands Initiative budget, US Fish and Wildlife Service international programs, US Forest Service international programs, the Multi-Species Conservation Fund, Peru/US Free Trade Agreement logging annex, and Hells Canyon, Oregon, and Savannah River Comprehensive Water Resources Study; H.R. 2647/S.1390, National Defense Authorization Act for Fiscal Year 2010, including specific provisions relating to Sikes Act agreements, the Department of Defense Legacy grant proposal, Department of Defense readiness and environmental protection initiative, authority of combatant commanders to fund conservation activities overseas, military base expansion, training and testing area requirements, authority to participate in conservation banking programs, and provisions related to the impact of climate change on national security; H.R. 2892/S. 1298, Department of Homeland Security Appropriations Act, 2010, including specific provisions relating to border security initiatives; the 2010 Department of Defense Appropriations Act, including specific provisions relating to funding for the Department of Defense Legacy grant program, the Readiness and Environmental Protection Initiative, overseas conservation activities, and other military activities impacting biodiversity; H.R. 2997, Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2010, including specific provisions relating to funding for Animal and Plant Health Inspection Service Plant Protection, primarily the Emerging Plant Pests line, and funding for invasive species, pests, and pathogens; H.R. 2847, Commerce, Justice, Science, and Related Agencies Appropriations Act, 2010, including specific provisions relating to NOAA funding, the Coastal and Estuarine Land Conservation Program, Fisheries Habitat Restoration programs, the Pacific Coastal Salmon Recovery Fund, and coral reef conservation programs; H.R. 2764, Consolidated Appropriations Act, 2008, including specific provisions relating to foreign operations, international conservation funding initiative, and coral triangle funding; S. 1436/H.R. 3183, Energy and Water Development and Related Agencies Appropriations Act, 2010, including specific provisions relating to Army Corps of Engineers ecosystem restoration projects, Bureau of Reclamation projects, and certain New Mexico projects; H.R. 1, The American Recovery and Reinvestment Act of 2009, including specific provisions relating to funding for AmeriCorps, NOAA Restoration projects, border security, and funding for the US Army Corps of Engineers; H.R. 2200, Transportation Security Administration Authorization Act; FY2010 Presidents Budget, including the budget to support the Land and Water Conservation Fund, Forest Legacy, and wildland fire funding; funding for the Forest Landscape Restoration Act authorized in P.L. 111-11; funding for the Wild and Scenic Rivers System; S. Con. Res. 70, Budget resolution for the US Government for FY2010 through 2013; and proposed legislation to establish permanent appropriations for ocean research, conservation, and restoration. Covered Officials Contacted: Director for Environmental Readiness and Safety, Office of the Deputy Under Secretary of Defense, Department of Defense; Assistant Deputy Under Secretary of Defense for Environmental, Safety, and Occupational Health, Department of Defense; Deputy Assistant Secretary of the Navy, Environment, United States Navy; Deputy Assistant Secretary of the Army for Environment, Safety, and Occupational Healthy, United States Army; Deputy Director, Joint Guam Program Office, United States Navy; Director, Civil Works Programs Integration Directorate, US Army Corps of Engineers; Deputy Assistant Secretary of the Army, Management and Budget, United States Army; Deputy Assistant Secretary of the Army, Civil Works, United States Army; Director, Bureau of Land Management; Budget Director, National Oceanic and Atmospheric Administration, Department of Commerce; Associate Director Land and Water Ecosystems, Council on Environmental Quality; Associate Director for Policy Outreach, Council on Environmental Quality; Deputy Assistant Secretary for Policy, Management and Budget, Department of the Interior; Assistant Secretary for Policy, Management and Management, Department of the Interior; Program Examiners, Office of Management and Budget; Associate Director, Natural Resources, Energy, and Science, Office of Management and Budget; Animal and Plant Health Inspection Service Administrator, US Department of Agriculture; and Deputy Undersecretary for Natural Resources & Environment, US Department of Agriculture.

Client expense: $650,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Bureau of Land Management (BLM), Bureau of Reclamation, Commerce, Dept of (DOC), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Energy, Dept of, HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Natl Oceanic & Atmospheric Administration (NOAA), Office of Management & Budget (OMB), SENATE, U.S. Fish & Wildlife Service (USFWS), U.S. Forest Service

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee proposal); Senate Finance Committee delivery system, coverage, and financing options papers; House tri-committee discussion draft bill), including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, and other provisions). Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee proposal); Senate Finance Committee delivery system, coverage, and financing options papers; House tri-committee discussion draft bill, later H.R. 3200), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)).

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

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

FY 2010 Budget Resolutions (H Con Res 312, S Con Res 70) provisions related to Medicare, Medicaid, health reform reserve fund

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

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

FY 10 Labor HHS Education Appropriations; H Con Res 312/S Con Res 70, Budget Resolutions for FY10; Division of Nursing - Title VIII

Client expense: $273,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

H.R. 1: Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for fiscal year ending September 30, 2009, and for other purposes. H. 1105: FY 2009 Omnibus H. Con. Res. 312: FY 2010 Budget Resolutions. S. Con. Res. 70: FY 2010 Budget Resolutions.

Client expense: $440,000 · Firm income: Not reported

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

Provisions of the FY 2009 Budget and Budget Resolution (S Con Res 70 and HR 1105) and related Labor/HHS appropriations legislation regarding funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ). Labor HHS Appropriations, Appropriations for Community Health Centers, and Increased Funding for Tele-health Activities. Funding for Dental programs in underserved areas. Future funding for Hospital Emergency Department infrastructure in Flambeau, Wisconsin. Provisions of the American Recovery and Reinvestment Act (HR 1) including appropriations for: USDA $1.2 B for essential rural clinics, vehicles equipment, etc; Rural business enterprise grants $150 M; $2.5 B Telemedicine, and distance Learning and Broadband deployment. Labor Workforce programs $3.95 B; $750 M for Training grants for high growth sectors, Priority given to health care sector; Job Corps $250 M. HRSA - $500 M for community health centers; $500M for health professions training; and $200 M for primary care and dentistry programs. NIH research $10 billion expansion $1 B for extramural research facilities; $330 M for instrumentation; $8.2 B/2 yrs for the Office of Director for transfer to Institutes for peer reviewed and competitively ranked research. Comparative effectiveness research at NIH $400 M, AHRQ $300M, and HHS $400M. The funding in the conference agreement shall be used to conduct or support research to evaluate and compare the clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition. HHS ONCHIT $2 B, $300 M of which is for regional efforts for health information exchange; remaining funds can be used for: development of certified electronic health records software if HHS sees that the private market does not meet certain providers needs; training on best practices to integrate health I.T. systems; infrastructure and tools to provide telemedicine; promotion of technologies and best practices that enhance the protection of health information; promotion of the interoperability of clinical data repositories or registries; and improvement and expansion of the use of health I.T. by public health departments. Much of the funds could be distributed to states as planning and implementation grants. HHS/CDC $1 B of which $300 M is for immunization; and $650 M for evidence based clinical and community based prevention and wellness strategies. Transportation Surface transportation $1.5 B; Highway infrastructure $27.5B. HHS HIT Grants to facilitate the purchase, train personnel in use, and secure electronic exchange of health information; Medicare HIT incentive payments up to $44,000 for physicians who are meaningful users of certified EHR technology to improve quality, and who submit quality information (under PQRI - Rules for 2010 forthcoming in July) - with 10% additional in Health professional shortage areas; $11 million for hospitals; Penalties for those physician and providers who have not implemented EMRs begin in 2015. Medicaid incentive payments for non-hospital based physicians, nurse practitioners, nurse midwives, and physician assistants who are meaningful users, but not claiming Medicare incentives equal to 85% of net allowable technology costs not exceeding $63,750. Rural Health Clinics and FQHCs with at least 30% patient volume attributable to Medicaid will be eligible for payments not exceeding $63,750 for the cost of adoption and use of certified HER Provisions of the FY 2010 Budget and Budget Resolution (S Con Res 13 and H C Res 85) regarding health care reform, funding for the Centers for Medicare and Medicaid Services (CMS) for implementation of the Medicare program and Medicare Advantage Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, value based purchasing and geographic fairness in Medicare reimbursement, and comparative effectiveness research at the Agency for Health Research and Quality (AHRQ).

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE

HConRes 312 - House Budget Resolution SConRes 70 - Senate Budget Resolution Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2010

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

- H. Con. Res. 312 / S. Con. Res. 70, "Revising the congressional budget for the United States Government for fiscal year 2008, establishing the congressional budget for the United States Government for fiscal year 2009, and setting forth appropriate budgetary levels for fiscal years 2010 through 2013", regarding the amendment of tax provisions.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, State, Dept of (DOS)

HR 1 - American Recovery and Reinvestment Act of 2009, multiple provisions related to conservation. HR 1105 - Omnibus Appropriations Act of 2009, multiple provisions related to conservation. H Con Res, 312, S Con Res 70 - Budget Resolution FY 2010, Function 300. HR 2638 - Consolidated Security Disaster Assistance and Continuing Appropriations Act, FY 2009, multiple provisions. FY 2010 appropriations(no bills introduced yet), multiple provisions.

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

Government targets: Agriculture, Dept of (USDA), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), Justice, Dept of (DOJ), Natl Oceanic & Atmospheric Administration (NOAA), Office of Management & Budget (OMB), SENATE, Treasury, Dept of

H.R.1, H.CON.RES.312, S.CON.RES.70 Monitor stimulus bill and budget resolutions for impact on education, health infrastructure, energy, and taxes.

Client expense: $590,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1: Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for fiscal year ending September 30, 2009, and for other purposes. H. 1105: FY 2009 Omnibus H. Con. Res. 312: FY 2010 Budget Resolutions. S. Con. Res. 70: FY 2010 Budget Resolutions.

Client expense: $400,000 · Firm income: Not reported

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

H.R. 2380, H.R. 4042, H.R. 4235-Estate Tax: Bills to repeal or reform the Estate Tax See attached page... H.R. 976-Tax Relief: Tax relief for small business H.R. 2049, S. 1244-OSHA Reform including legislation to streamline regulatory burdens for small business. H.Con.Res 99, S. Con Res 70-Reg Reform: Tax Gap. Immigration Reform: Legislation to reform the H-2B Guestworker Program and other immigration laws. H.R. 3396, S. 34-Streamlined Sales Tax legislation. H.R. 5546, S.3086-Credit Card Fair Fee Act. H.R. 627- The Credit Cardholder's Bill of Rights S. 414- The Credit Card Act of 2009 H.R.1470, S. 725- Equity for our Nation's Self-Employed Act of 2009 H.R. 6210, S. 2795-SHOP Act. The Small Business Health Care Options Program. S. 2818-Small business health plans. Merchant Card Reporting and Taxpayer Identification (TIN) Collection Oil and Gas Prices H.R. 1409, S. 560-Employee Free Choice Act H.R. 6248- Credit Card Interchange Fee Act of 2008 Velazquez CHOICE Act Lincoln/Kyl in FY 2010 Budget Resolution for Estate Tax Reform H.R. 5804- Taxpayer Responsibility, Accountability and Consistency Act.

Client expense: $153,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Congressional Budget Office (CBO), Environmental Protection Agency (EPA), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR)

H.R. 2764, Consolidated Appropriations Act; all provisions H. Con. Res. 85, Setting forth the congressional budget for the United States Government for fiscal year 2010 and including the appropriate budgetary levels for fiscal years 2009 and 2011 through 2014; provisions relating health care, cap and trade and corporate taxes S. Con. Res. 13, An original concurrent resolution setting forth the congressional budget for the United States Government for fiscal year 2010, revising the appropriate budgetary levels for fiscal year 2009, and setting forth the appropriate budgetary levels for fiscal years 2011 through 2014; provisions relating health care, cap and trade and corporate taxes S. Con. Res. 70, An original concurrent resolution setting forth the congressional budget for the United States Government for fiscal year 2009 and including the appropriate budgetary levels for fiscal years 2008 and 2010 through 2013; provisions relating health care, cap and trade and corporate taxes

Client expense: $1,220,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, Treasury, Dept of, U.S. Trade Representative (USTR)

Treatment of agriculture research funding in President's budget request for fiscal year 2010 and treatment of agriculture research funding in Congressional budget resolution for fiscal year 2010 (H. Con. Res. 312; S. Con. Res. 70) specifically as it relates to issues of importance to client.

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

Government targets: Agriculture, Dept of (USDA), HOUSE OF REPRESENTATIVES

Treatment of pesticide-related issues in the President's budget for fiscal year 2010 and treatment of pesticide-related issues in the Congressional budget resolution for fiscal 2010 (H. Con. Res. 312 and S. Con. Res. 70).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Hate crimes prevention/enforcement Decennial Census to be conducted in 2010 Funding and implementation of the Help America Vote Act (Public Law No: 107-252), incl. budget resolution (H.Con.Res. 312 & S.Con.Res. 70) Federal voting representation for the District of Columbia, incl. H.R. 157 & S. 160 Pay equity and Congressional response to the Ledbetter v. Goodyear decision, incl. H.R. 11, S. 181, and their enactment as Public Law No: 111-2, as well as the Paycheck Fairness Act, incl. H.R. 12 & S. 182 Mandatory electronic employment verification proposals, incl. applicable provisions in H.R. 1 & S. 1, and their enactment as Public Law No: 111-5 Equal opportunity protections, incl. applicable provisions in H.R. 1 & S. 1, and their enactment as Public Law No: 111-5 Voter fraud issues and Congressional response to the Crawford v. Marion County Election Board and Democratic Party v. Rokita decisions, incl. report by the government, oversight of the Voting Rights Section of the Civil Rights Division at the Department of Justice, and amendment to H.R. 1388 Deceptive practices in voting, incl. H.R. 97 and oversight of the Voting Rights Section of the Civil Rights Division at the Department of Justice, as well as caging (H.R. 103 & S. 528) legislation and vote challenging practices Voter identification and Congressional response to the Crawford v. Marion County Election Board and Democratic Party v. Rokita decisions, incl. amendment to S. 160 Voter registration, incl. implementation of the National Voter Registration Act (Public Law No: 103-31) Early voting Oversight of the Department of Justices Civil Rights Division, incl. its Voting Rights Section Investigation into the United States Attorneys program, incl. voter fraud issues, and pursuit of contempt citations (incl. 110th: H.Res. 979, H.Res. 980 & H.Res. 982) Implementation of the Dont Ask, Dont Tell provisions in Public Law No: 103-160, Title V, Subtitle G, incl. H.R. 1283 Marriage equality, incl. amendment to S. 160 Legal and policy issues related to national security detainees, incl. establishment of a truth commission to investigate detainee treatment and other actions taken by the previous Administration Election preparedness and contingency plans, incl. lessons learned from the 2004 and 2008 election cycles Development of a 2009 Civil Rights Act that would close loopholes created by recent Supreme Court decisions

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Office of Faith-Based & Community Initiatives, Office of the Vice President of the United States, President of the U.S., SENATE, Vice President of the U.S., White House Office

Education funding, incl. applicable provisions in H.R. 1 & S. 1, and their enactment as Public Law No: 111-5 Family planning (Title X and Title V) and sex education (incl. comprehensive and abstinence-only programs, as well as medical accuracy language) funding, incl. the Presidents FY10 budget District of Columbias voucher program, incl. report by the government, reauthorization proposals, applicable provisions in and amendment to the omnibus appropriations package (H.R. 1105) enacted as Public Law No: 111-8, and FY10 appropriations, as well as amendment to S. 160 Faith-based initiatives and other government-related religion proposals, incl. funding and grant-making practices Funding for maintenance of public facilities, incl. applicable provisions in and amendment to H.R. 1 (Public Law No: 111-5) Presidents FY10 budget and the FY10 budget resolution (H.Con.Res. 312 & S.Con.Res. 70) Funding and implementation of the Help America Vote Act (Public Law No: 107-252), incl. budget resolution (H.Con.Res. 312 & S.Con.Res. 70)

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), Office of Faith-Based & Community Initiatives, Office of the Vice President of the United States, President of the U.S., SENATE, Vice President of the U.S., White House Office

FY 10 Labor HHS Education Appropriations; HR 1105 FY 2009 Omnibus Appropriations for Fiscal Year 2009; H Con Res 312/S Con Res 70, Budget Resolutions for Fiscal Year 2010

Client expense: $260,000 · Firm income: Not reported

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

HConRes 312 - House Budget Resolution SConRes 70 - Senate Budget Resolution Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2010

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6049, Renewable Energy and Job Creation Act of 2008 S. 2886, Alternative Minimum Tax and Extenders Tax Relief Act of 2008 H. Con. Res. 312/ S. Con. Res. 70, FY 2009 Budget Resolution

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70) Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F), and HIT investments)

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

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