mr GARY FITZGERALD

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP/SHIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine EHR Meaningful Use Medicare Shared Savings Program HOPD site neutral law changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP/SHIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine EHR Meaningful Use Medicare Shared Savings Program HOPD site neutral law changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP/SHIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine EHR Meaningful Use Medicare Shared Savings Program HOPD site neutral law changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP/SHIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine EHR Meaningful Use Medicare Shared Savings Program HOPD site neutral law changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP/SHIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine EHR Meaningful Use Medicare Shared Savings Program HOPD site neutral law changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: Treatment of opioid abuse; Issues facing rural hospitals; Site neutral reimbursement of outpatient services

H.R. 4771 Help Efficient, Accessible, Low-cost, Timely Healthcare Act H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 H.R. 2124/S.1148 Resident Physician Shortage Reduction Act H.R. 4774 Training Tomorrows Doctors Today Act General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP/SHIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine EHR Meaningful Use Medicare Shared Savings Program HOPD site neutral law changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

S.568/H.R.1088 Trade Adjustment Assistance Act of 2015 S.1268/ H.R.1892 Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 2124 Resident Physician Shortage Reduction Act H.R. 2496 Construction Authorization and Choice Improvements Act H.R. 2156 Medicare Audit Improvement Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine King vs. Burwell (SCOTUS)

S.568/H.R.1088 Trade Adjustment Assistance Act of 2015 S.1268/ H.R.1892 Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 2124 Resident Physician Shortage Reduction Act H.R. 2496 Construction Authorization and Choice Improvements Act H.R. 2156 Medicare Audit Improvement Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine King vs. Burwell (SCOTUS)

H.R. 2 Medicare Access and CHIP Reauthorization Act Sustainable Growth Rate (SGR); rural hospitals, CAHs and SCHs, Medicaid DSH, Two-Midnight Rule, MDH/LV, ICD-10, 340B, the Medicare Recovery Audit Contractor (RAC), Graduate Medical Education (GME), and ebola funding

H.R. 2029 omnibus spending package for federal fiscal year (FFY) 2016 (regarding HOPD site-neutral law) H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP/SHIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine Changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

S.568/H.R.1088 Trade Adjustment Assistance Act of 2015 S.1268/ H.R.1892 Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 2124 Resident Physician Shortage Reduction Act H.R. 2496 Construction Authorization and Choice Improvements Act H.R. 2156 Medicare Audit Improvement Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine King vs. Burwell (SCOTUS)

S.568/H.R.1088 Trade Adjustment Assistance Act of 2015 S.1268/ H.R.1892 Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 2124 Resident Physician Shortage Reduction Act H.R. 2496 Construction Authorization and Choice Improvements Act H.R. 2156 Medicare Audit Improvement Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine King vs. Burwell (SCOTUS)

S.568/H.R.1088 Trade Adjustment Assistance Act of 2015 S.1268/ H.R.1892 Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 2124 Resident Physician Shortage Reduction Act H.R. 2496 Construction Authorization and Choice Improvements Act H.R. 2156 Medicare Audit Improvement Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine King vs. Burwell (SCOTUS)

H.R. 2029 omnibus spending package for federal fiscal year (FFY) 2016 (regarding HOPD site-neutral law) H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP/SHIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine Changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

H.R. 2029 omnibus spending package for federal fiscal year (FFY) 2016 (regarding HOPD site-neutral law) H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP/SHIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine Changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

H.R. 2029 omnibus spending package for federal fiscal year (FFY) 2016 (regarding HOPD site-neutral law) H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP/SHIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine Changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

H.R. 3292 The Medicare IME Pool Act of 2015 H.R. 3291 The Medicare Crosswalk Hospital Code Development Act of 2015 H.R. 3288 The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine changes to the Medicare and Medicaid Conditions of Participation (CoPs) for skilled nursing facilities (SNFs).

S.568/H.R.1088 Trade Adjustment Assistance Act of 2015 S.1268/ H.R.1892 Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 2124 Resident Physician Shortage Reduction Act H.R. 2496 Construction Authorization and Choice Improvements Act H.R. 2156 Medicare Audit Improvement Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine King vs. Burwell (SCOTUS)

S.568/H.R.1088 Trade Adjustment Assistance Act of 2015 S.1268/ H.R.1892 Trade Adjustment Assistance Reauthorization Act of 2015 H.R. 2124 Resident Physician Shortage Reduction Act H.R. 2496 Construction Authorization and Choice Improvements Act H.R. 2156 Medicare Audit Improvement Act of 2015 General Issues: 340B program NYS Medicaid 1115 Waiver/DSRIP Vital Access Provider funds (UPL) Physician shortage Medicare sequestration cuts Telemedicine King vs. Burwell (SCOTUS)

SEE ATTACHED PAGEIROQUOIS HEALHCARE ALLIANCE 1Q2014 NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGENYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGENYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIROQUOIS HEALHCARE ALLIANCE 1Q2014 NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGENYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIROQUOIS HEALHCARE ALLIANCE 1Q2014 NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGENYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIROQUOIS HEALHCARE ALLIANCE 1Q2014 NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIROQUOIS HEALHCARE ALLIANCE 1Q2014 NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGENYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIROQUOIS HEALHCARE ALLIANCE 1Q2014 NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGENYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

see attached pageIroquois Healthcare Alliance H.R. 8 /American Taxpayer Relief Act of 2012 Sequestration Continuing Resolution (CR) Development of federal fiscal year (FFY) 2014 Rural Hospital Access Act (H.R. 1787 / S.842) Medicare Audit Improvement Act of 2013 (H.R. 1250) NYS 1115 Medicaid Waiver proposal Key issues: Extension of key Medicare provisions No additional funding cuts to Medicaid or Medicare No Medicare outpatient reductions to evaluation and management (E&M) services Support of the Transitional Outpatient Payments (TOPs) program Medicare Dependent Hospital (MDH) status The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected. The Medicare Dependent Hospital Program (MDH) and the current criteria for the Medicare Low Volume Payment Adjustment should be extended as both are due to expire on September 30. .

SEE ATTACHED PAGEIROQUOIS HEALTHCARE ALLIANCE NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIroquois Healthcare Alliance Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated. NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds

SEE ATTACHED PAGEIROQUOIS HEALTHCARE ALLIANCE NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIroquois Healthcare Alliance Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated. NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds

see attached pageIroquois Healthcare Alliance H.R. 8 /American Taxpayer Relief Act of 2012 Sequestration Continuing Resolution (CR) Development of federal fiscal year (FFY) 2014 Rural Hospital Access Act (H.R. 1787 / S.842) Medicare Audit Improvement Act of 2013 (H.R. 1250) NYS 1115 Medicaid Waiver proposal Key issues: Extension of key Medicare provisions No additional funding cuts to Medicaid or Medicare No Medicare outpatient reductions to evaluation and management (E&M) services Support of the Transitional Outpatient Payments (TOPs) program Medicare Dependent Hospital (MDH) status The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected. The Medicare Dependent Hospital Program (MDH) and the current criteria for the Medicare Low Volume Payment Adjustment should be extended as both are due to expire on September 30. .

SEE ATTACHED PAGEIroquois Healthcare Alliance Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated. NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds

SEE ATTACHED PAGEIROQUOIS HEALTHCARE ALLIANCE NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIROQUOIS HEALTHCARE ALLIANCE NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIROQUOIS HEALTHCARE ALLIANCE NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIroquois Healthcare Alliance Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated. NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds

SEE ATTACHED PAGEIROQUOIS HEALTHCARE ALLIANCE NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds Two-Midnight Rule Delay Act of 2013 (H.R. 3698) To delay the enforcement of the Medicare two-midnight rule for short inpatient hospital stays until the implementation of a new Medicare payment methodology for short inpatient hospital stays, and for other purposes. Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated.

SEE ATTACHED PAGEIroquois Healthcare Alliance Rural Hospital Access Act (H.R. 1787/S. 842) Related to Medicare Dependent Hospital (MDH) and Medicare Low Volume (LV) Hospital, legislation to reauthorize for one year the MDH program and extend the current, expiring criteria for the LV adjustment. Rural Hospital Fairness Act of 2013 (H.R. 2578) Legislation that would reinstitute the TOPS (Transitional Outpatient Payments)program. Medicare Audit Improvement Act of 2013 (H.R. 1250/S. 1012) Legislation that would institute improvements in the Recovery Audit Contractor (RAC) program and other Medicare audit programs. The bill makes important changes to the RAC program that would streamline processes, establish more reasonable standards, and create greater fairness in RAC operations. 340B Drug Discount Program Allows hospitals that care for a disproportionate share of poor patients to purchase outpatient drugs at discounted rates. These hospitals experience chronic underpayments from public payers, like Medicaid. Maintaining the Special Medicare Status of Certain Rural Hospitals Special Medicare designations for certain rural hospitals preserve patient access to emergency, acute care, and other services largely in rural communities across Upstate New York; The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected as currently delineated. NYS Medicaid 1115 Waiver NYS Vital Access Provider (VAP) funds

see attached pageIroquois Healthcare Alliance H.R. 8 /American Taxpayer Relief Act of 2012 Sequestration Continuing Resolution (CR) Development of federal fiscal year (FFY) 2014 Rural Hospital Access Act (H.R. 1787 / S.842) Medicare Audit Improvement Act of 2013 (H.R. 1250) NYS 1115 Medicaid Waiver proposal Key issues: Extension of key Medicare provisions No additional funding cuts to Medicaid or Medicare No Medicare outpatient reductions to evaluation and management (E&M) services Support of the Transitional Outpatient Payments (TOPs) program Medicare Dependent Hospital (MDH) status The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected. The Medicare Dependent Hospital Program (MDH) and the current criteria for the Medicare Low Volume Payment Adjustment should be extended as both are due to expire on September 30. .

See attached pageIROQUOI S HEALTHCARE ALLIANCE H.R. 8 /American Taxpayer Relief Act of 2012 Sequestration Continuing Resolution (CR) Development of federal fiscal year (FFY) 2014 NYS 1115 Medicaid Waiver proposal Key issues: Extension of key Medicare provisions No additional funding cuts to Medicaid or Medicare No Medicare outpatient reductions to evaluation and management (E&M) services Support of the Transitional Outpatient Payments (TOPs) program Medicare Dependent Hospital (MDH) status

see attached pageIroquois Healthcare Alliance H.R. 8 /American Taxpayer Relief Act of 2012 Sequestration Continuing Resolution (CR) Development of federal fiscal year (FFY) 2014 Rural Hospital Access Act (H.R. 1787 / S.842) Medicare Audit Improvement Act of 2013 (H.R. 1250) NYS 1115 Medicaid Waiver proposal Key issues: Extension of key Medicare provisions No additional funding cuts to Medicaid or Medicare No Medicare outpatient reductions to evaluation and management (E&M) services Support of the Transitional Outpatient Payments (TOPs) program Medicare Dependent Hospital (MDH) status The Sole Community Hospital (SCH) and Critical Access Hospital (CAH) permanent programs should be fully protected. The Medicare Dependent Hospital Program (MDH) and the current criteria for the Medicare Low Volume Payment Adjustment should be extended as both are due to expire on September 30. .

See attached sheet Iroquois Healthcare Alliance Extension of key Medicare provisions No additional funding cuts to Medicaid Also, we have been publicly supportive of NYS 1115 Medicaid Waiver proposal H.R.6446 /S .3473 Sequestration Prevention Act of 2012 creates incentive for innovative diagnostics by improving the process for determining Medicare payment rates for new tests. S.2620/H.R. 5943 Rural Hospital Access Act provides an extension of the enhanced low-volume Medicare adjustment for PPS hospitals through Sept 30, 2013

See attached sheet Iroquois Healthcare Alliance Extension of key Medicare provisions No additional funding cuts to Medicaid Also, we have been publicly supportive of NYS 1115 Medicaid Waiver proposal H.R.6446 /S .3473 Sequestration Prevention Act of 2012 creates incentive for innovative diagnostics by improving the process for determining Medicare payment rates for new tests. S.2620/H.R. 5943 Rural Hospital Access Act provides an extension of the enhanced low-volume Medicare adjustment for PPS hospitals through Sept 30, 2013

See attached list Iroquois Healthcare Alliance H.R. 8 /American Taxpayer Relief Act of 2012 Key issues: Extension of key Medicare provisions No additional funding cuts to Medicaid or Medicare No Medicare outpatient reductions to evaluation and management (E&M) services Support of the TOPS program

See attached sheet H.R. 5 Protecting Access to Healthcare Act S.2516 Food and Drug Administration Safety and Innovation Act (drug shortage legislation) Patient Protection and Affordable Care Act and the Healthcare and Education Reconciliation Act - P.L 111-148 Extension of key Medicare provisions No additional funding cuts to Medicaid

see attached sheet Iroquois Healthcare Alliance Patient Protection and Affordable Care Act HR 3590 and the Reconciliation Act HR 4872 - which is all now P.L. 111-148. Center for Medicare and Medicaid Innovation as it relates to chronic care management and readmissions H.R. 1 -- Full-Year Continuing Appropriations Act, 2011

see attached sheet Iroquois Healthcare Alliance Patient Protection and Affordable Care Act (HR 3590) and the Healthcare and Education Reconciliation Act (HR 4872). Specific issues included CMMI, physician shortage, readmissions, value-based purchasing, HACs, ACOs, Medicare payment issues, Medicaid, HIT, and geographic variation.

HR 3765 - TEMPORARY [AYROLL TAX CUT CONTINUATION ACT OF 2011

see attached sheet Iroquois Healthcare Alliance Patient Protection and Affordable Care Act HR 3590 and the Reconciliation Act HR 4872 - which is all now P.L. 111-148. Center for Medicare and Medicaid Innovation as it relates to chronic care management and readmissions H.R. 1 -- Full-Year Continuing Appropriations Act, 2011

see attached sheet Iroquois Healthcare Alliance Patient Protection and Affordable Care Act (HR 3590) and the Healthcare and Education Reconciliation Act (HR 4872). Specific issues included CMMI, physician shortage, readmissions, value-based purchasing, HACs, ACOs, Medicare payment issues, Medicaid, HIT, and geographic variation.

See attached sheet IROQUOIS HEALTHCARE ALLIANCE FMAP: HR 1586 Electronic Health Records: HR 1586, HR 6072/S 3078, HR 6005 related specifically to meaningful use

See attached sheet IROQUOIS HEALTHCARE ALLIANCE FMAP: HR 1586 Electronic Health Records: HR 1586, HR 6072/S 3078, HR 6005 related specifically to meaningful use

See attached sheet IROQUOIS HEALTHCARE ALLIANCE FMAP: HR 1586 Electronic Health Records: HR 1586, HR 6072/S 3078, HR 6005 related specifically to meaningful use

See attached sheet IROQUOIS HEALTHCARE ALLIANCE FMAP: HR 1586 Electronic Health Records: HR 1586, HR 6072/S 3078, HR 6005 related specifically to meaningful use

Patient Protection and Affordable Care Act (HR 3590) Healthcare and Education Reconciliation Act (HR 4872) Specific issues included CMMI and physician shortage.

Patient Protection and Affordable Care Act HR 3590 and the Reconciliation Act HR 4872 - which is all now P.L. 111-148

Patient Protection and Affordable Care Act HR 3590 and the Reconciliation Act HR 4872 - which is all now P.L. 111-148

Patient Protection and Affordable Care Act (HR 3590) Healthcare and Education Reconciliation Act (HR 4872) Specific issues included CMMI and physician shortage.

See attached sheet Iroquois Healthcare Alliance: HR 3200 House of Representatives Tri-Committee Americas Healthy Future Act of 2009 Senate Finance Committee Americas Healthy Future Act of 2009 S.1679 - Senate HELP Committees Affordable Health Choices Act HR 1409 / S560 Employee Free Choice Act

See attached sheet Iroquois Healthcare Alliance U.S. House of Representatives Tri-Committee Health Care Reform Discussion Draft Legislation H.R. 1 American Recovery and Reinvstment Act of 2009 H.R. 1409 / S. 560 Employee Free Choice Act H.R. 2273 / S.1031 Nurse-to-Patient Staffing Ratio

See attached sheet Iroquois Healthcare Alliance U.S. House of Representatives Tri-Committee Health Care Reform Discussion Draft Legislation H.R. 1 American Recovery and Reinvstment Act of 2009 H.R. 1409 / S. 560 Employee Free Choice Act H.R. 2273 / S.1031 Nurse-to-Patient Staffing Ratio

See attached sheet Iroquois Healthcare Alliance U.S. House of Representatives Tri-Committee Health Care Reform Discussion Draft Legislation H.R. 1 American Recovery and Reinvstment Act of 2009 H.R. 1409 / S. 560 Employee Free Choice Act H.R. 2273 / S.1031 Nurse-to-Patient Staffing Ratio

See attached sheet Iroquois Healthcare Alliance U.S. House of Representatives Tri-Committee Health Care Reform Discussion Draft Legislation H.R. 1 American Recovery and Reinvstment Act of 2009 H.R. 1409 / S. 560 Employee Free Choice Act H.R. 2273 / S.1031 Nurse-to-Patient Staffing Ratio

See attached sheet Iroquois Healthcare Alliance: HR 3200 House of Representatives Tri-Committee Americas Healthy Future Act of 2009 Senate Finance Committee Americas Healthy Future Act of 2009 S.1679 - Senate HELP Committees Affordable Health Choices Act HR 1409 / S560 Employee Free Choice Act

See attached sheet Iroquois Healthcare Alliance U.S. House of Representatives Tri-Committee Health Care Reform Discussion Draft Legislation H.R. 1 American Recovery and Reinvstment Act of 2009 H.R. 1409 / S. 560 Employee Free Choice Act H.R. 2273 / S.1031 Nurse-to-Patient Staffing Ratio

See attached sheet Iroquois Healthcare Alliance U.S. House of Representatives Tri-Committee Health Care Reform Discussion Draft Legislation H.R. 1 American Recovery and Reinvstment Act of 2009 H.R. 1409 / S. 560 Employee Free Choice Act H.R. 2273 / S.1031 Nurse-to-Patient Staffing Ratio

See attached sheet Iroquois Healthcare Alliance: HR 3200 House of Representatives Tri-Committee Americas Healthy Future Act of 2009 Senate Finance Committee Americas Healthy Future Act of 2009 S.1679 - Senate HELP Committees Affordable Health Choices Act HR 1409 / S560 Employee Free Choice Act

See attached sheet Iroquois Healthcare Alliance Federal legislation for January 1 through March 31, 2009 HR1: The American Recovery and Reinvestment Act (stimulus bill) S.3230 the Labor/HHS/Education appropriations bill

S.3590 H.R. 3962

See attached sheet Iroquois Healthcare Alliance U.S. House of Representatives Tri-Committee Health Care Reform Discussion Draft Legislation H.R. 1 American Recovery and Reinvstment Act of 2009 H.R. 1409 / S. 560 Employee Free Choice Act H.R. 2273 / S.1031 Nurse-to-Patient Staffing Ratio

See attached sheet Iroquois Healthcare Alliance U.S. House of Representatives Tri-Committee Health Care Reform Discussion Draft Legislation H.R. 1 American Recovery and Reinvstment Act of 2009 H.R. 1409 / S. 560 Employee Free Choice Act H.R. 2273 / S.1031 Nurse-to-Patient Staffing Ratio

See attached sheet Iroquois Healthcare Alliance: HR 3200 House of Representatives Tri-Committee Americas Healthy Future Act of 2009 Senate Finance Committee Americas Healthy Future Act of 2009 S.1679 - Senate HELP Committees Affordable Health Choices Act HR 1409 / S560 Employee Free Choice Act

S.3590 H.R. 3962

See attached Iroquois Healthcare Alliance Federal legislation for July 1 through September 30, 2008 Preserving Access to Healthcare (PATH) Act, S.3656/ H.R. 7241 blocks for six months implementation of both the Medicare capital IME cut and the Medicaid outpatient regulation Rural Hospital Assistance Act of 2008 S.3300 IS / H.R.6912.IH To amend title XVIII of the Social Security Act to provide for temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals and to provide for the use of the non-wage adjusted PPS rate under the Medicare-dependent hospital (MDH) program, and for other purposes. Physician Availability Act of 2008 H.R.5739.IH Physician Workforce and Graduate Medical Education Enhancement Act of 2007 HR 2583 IH To amend title VII of the Public Health Service Act to establish a loan program for eligible hospitals to establish residency training programs. Physician Workforce Enhancement Act of 2008 HR 2583 EH Nursing and Allied Health Education Preservation Act of 2008 S.3468 IS /H.R.5174.IH To amend title XVIII of the Social Security Act to continue the ability of hospitals to supply a needed workforce of nurses and allied health professionals by preserving funding for hospital operated nursing and allied health education programs. 340B Program Improvement and Integrity Act of 2007 S.1376 Resident Physician Shortage Reduction Act of 2007 S.588.IS/ H.R.1093.IH Medicare Rural Health Access Improvement Act of 2008 S.2786.IS Physician Availability Act of 2008 HR 5739 IH To assure that the services of a nonemergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds.

See attached Iroquois Healthcare Alliance Federal legislation for January 1 - March 31, 2008 Federal Budget FFY 2009 (specifically related to health and human services issues and physician and hospital issues) S. 1710.PCS/ H.R. 3043.RH Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2008 H.R. 4105 Medicare Recovery Audit Contractor Program Moratorium Act of 2007 (impose a moratorium on the use of recovery audit contractors under the Medicare Integrity Program) H.R. 3533 The Public and Teaching Hospital Preservation Act (extends moratorium on Medicaid regulations -- To extend by one year the moratorium on implementation of a rule relating to the Federal-State financial partnership under Medicaid and the State Children's Health Insurance Program and on finalization of a Medicaid rule regarding graduate medical education ) S. 2499. ES/ S.2499.CPS Medicare, Medicaid, and SCHIP Extension Act of 2007 S.1605A Craig Thomas Rural Hospital and Provider Equity Act of 2007 (amends SSA to protect and preserve access of Medicare beneficiaries in rural areas) S.2729 Ensuring the Future Physician Workforce Act of 2008 (amends title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce, and for other purposes) S.2729.IS / H.R. 5545.IH Ensuring the Future Physician Workforce Act of 2008 H.R. 410. IH United States Physician Shortage Elimination Act of 2007 (to amend the Public Health Service Act to increase the number of primary care physicians serving health professional shortage areas) S. 290.IS Rural Physicians Relief Act of 2007 (to amend the Internal Revenue Code of 1986 to provide a tax credit to rural primary health providers ) H.R.1358.IH Nursing Relief Act of 2007 ( To create a new nonimmigrant visa category for registered nurses, and for other purposes)

See attached Iroquois Healthcare Alliance Federal legislation for April 1 through June 30, 2008 Federal Budget FFY 2009 (specifically related to health and human services issues and physician and hospital issues) S. 1710.PCS/ H.R. 3043.RH Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2008 H.R. 4105 Medicare Recovery Audit Contractor Program Moratorium Act of 2007 (impose a moratorium on the use of recovery audit contractors under the Medicare Integrity Program) H.R. 3533 The Public and Teaching Hospital Preservation Act (extends moratorium on Medicaid regulations -- To extend by one year the moratorium on implementation of a rule relating to the Federal-State financial partnership under Medicaid and the State Children's Health Insurance Program and on finalization of a Medicaid rule regarding graduate medical education ) S. 2499. ES/ S.2499.CPS Medicare, Medicaid, and SCHIP Extension Act of 2007 S.1605A Craig Thomas Rural Hospital and Provider Equity Act of 2007 (amends SSA to protect and preserve access of Medicare beneficiaries in rural areas) S.2729 Ensuring the Future Physician Workforce Act of 2008 (amends title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce, and for other purposes) S.2729.IS / H.R. 5545.IH Ensuring the Future Physician Workforce Act of 2008 H.R. 410. IH United States Physician Shortage Elimination Act of 2007 (to amend the Public Health Service Act to increase the number of primary care physicians serving health professional shortage areas) S. 290.IS Rural Physicians Relief Act of 2007 (to amend the Internal Revenue Code of 1986 to provide a tax credit to rural primary health providers ) H.R.1358.IH Nursing Relief Act of 2007 ( To create a new nonimmigrant visa category for registered nurses, and for other purposes)